Dear Drs. Feck, Fang, and members,
I had a sedation patient today with some side effects I had not seen before. I think I may know the answer but would like your input and opinion on future sedations with this patient. First some background. This patient is a 27 year old female patient. She had a number of restorations needed and wanted to be sedated for the procedure. The patient was on Prozac and Tylenol (as needed for headaches.) On the pre-sedation visit I questioned the patient again on medications. I sort of scared her into telling me that she used oxycontin recreationally on weekends some times. I told he to refrain from the use over the weekend prior to the sedation--and would be a good idea to refrain on a permanent basis. I reall scared her on the interactions so I really believe she did not use the weekend prior to the sedation.
She came in on the day of the procedure. She had taken the normal .25mg triazolam 1 hour prior. She said she was a 4 on a scale of 1-10 (10 being the most sedated.) I gave her an additional .25mg of triazolam and 75mg hydroxyzine. I monitored her for one hour. At that point she said that she did not feel that sedated. I did not want to give anymore meds. I gave her N20 35%. I gave the injections. After about 30 min she was sedated. In and out of sleep. Her vitals were good. An hour into the procedure she became agitated, jittery, had chills-but was warm, not cold. She was a little nervous. Her BP went to 118 then did go back down. I did not get to finish the restorations. I did not have to reverse. She eventually was fine, and was discharged after she was alert x 3.
My personal opinion is that she may not have been totally honest on how much oxycontin she had been taking and how often. Chills, nervousness, and agitation are side effects of oxycontin. What is the half life of oxycontin and how long should the patient refrain from it before sedation---if you can trust the patient. I do not plan on sedating her again unless she can convince me she is off of it. I don't believe she took it 3-4 days at least prior to sedaton. I scared her pretty well on what could happen and the side effects. I would appreciate your input.
This should be a lesson to all. Really drill the patient on your prededation visit on meds taking. She was not going to tell me about the oxycontin until I started telling her about the side effects with different meds. Thanks to all for your input.
Tom Watson DDS, MAGD
