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

north2southOMFS

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omfsapplicant said:
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.
 

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At my residency we also tend to add propofol after the fentanyl/versed mix. This is because most of our patients are crack-whores 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.
 

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north2southOMFS said:
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
 

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north2southOMFS said:
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

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griffin04 said:
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.
 

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USC2003 said:
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.
 

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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

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USC2003 said:
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.