Question for OMFS

[UDM or bust]

I worked in an OMFS practice for four years, I have moved away for school, and I have a question about conscious sedation. The doctors I worked for administered a valium/demerol mix and a steroid before surgery as needed by the case or by the patient. I know what all of the drugs are targeting (I have pharmacology right now in a masters program) but do you think that the valium is used primarily for its anxiolytic effect or for its anterograde amnesia effect? I am assuming it is primarily for the anxiolytic effect - just curious as to what anyone thinks or knows. I appreciate it. Thanks.

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[omfsapplicant]

anxiolysis/sed is obviously the primary intended effect, amnesia is just a benefectial side effect.

I don't thimk too many people use or reccomend valium/demerol. Most commonly it is fentanyl/versed. valium has too long of a half-life, including active by-products. Demerol has some dangerous croos-rxn, and has a bad rep. Fentanyl is just a lot cleaner to use.

 

[UDM or bust]

thanks - i noticed fentanyl in my reading/studying - i assumed that it was the anxiolysis - i appreciate your help.

 

[north2southOMFS]

I don't thimk too many people use or reccomend valium/demerol. Most commonly it is fentanyl/versed. valium has too long of a half-life, including active by-products. Demerol has some dangerous croos-rxn, and has a bad rep. Fentanyl is just a lot cleaner to use.

I think he is referring to before the sedation appt as a po dose, in order to put the pt. in a more calm demeanor when they arrive, not the versed/fentanyl which is given IV during the sedation.

 

[toofache32]

At my residency we also tend to add propofol after the fentanyl/versed mix. This is because most of our patients are crack-****** and heroine-users (who are afraid of needles!?) and their bodies eat that stuff up like crazy. A dose that would knock most of us off our feet won't even touch these people.

 

[omfsapplicant]

I think he is referring to before the sedation appt as a po dose, in order to put the pt. in a more calm demeanor when they arrive, not the versed/fentanyl which is given IV during the sedation.

they said conscious sedation

 

[gryffindor]

I think he is referring to before the sedation appt as a po dose, in order to put the pt. in a more calm demeanor when they arrive, not the versed/fentanyl which is given IV during the sedation.

On a related note, how common is it to do this - give the patient a po dose of fentanyl/versed before the appt? I've got some schizo patients that just won't shut up and I wear myself out at the appointments. I asked my director about it, but he made a big deal about having to use the triplicate forms and suggested I try nitrous instead.

 

[omfsres]

On a related note, how common is it to do this - give the patient a po dose of fentanyl/versed before the appt? I've got some schizo patients that just won't shut up and I wear myself out at the appointments. I asked my director about it, but he made a big deal about having to use the triplicate forms and suggested I try nitrous instead.

The big advantage of IV is the ability to titrate to effect. You typically get a response in a few minutes. Reversability is also important. PO sedation is hard to control.

 

[USC2003]

Versed and Fentanyl do not come PO, only IM or IV. Valium is used to give pre-op.

 

[omfsapplicant]

Versed and Fentanyl do not come PO, only IM or IV. Valium is used to give pre-op.

not exactly, you can get it in a loly pop.

 

[Jediwendell]

Versed and Fentanyl do not come PO, only IM or IV. Valium is used to give pre-op.

And you can use the IV form as PO. Just mix with something tasty.

 

[USC2003]

It is true that there is a fentanyl lolly pop but as far as I know its use is restricted by the FDA and as far as mixing versed with a juice to drink it, you can't prescribe versed to a patient for them to pick it up at a pharmacy and use it at home. My point was that versed/fentanyl are not used as pre appointment meds.

 

[Jediwendell]

It is true that there is a fentanyl lolly pop but as far as I know its use is restricted by the FDA and as far as mixing versed with a juice to drink it, you can't prescribe versed to a patient for them to pick it up at a pharmacy and use it at home. My point was that versed/fentanyl are not used as pre appointment meds.

Griffin is in a GPR which means she can do conscious sedation, therefor give a PO dose of versed to a patient in office prior to appointment time. I think we were all just chiming in that there were PO options for the drugs you mentioned, not that you could send a fentanyl lolly pop or a dose of versed home with the patient.