I hope you had a happy and healthy Holiday and New Year's Day.

Even though we start another uncertain economic year it is important to remember something a mentor told me:  never treat a stranger and  don't treat everyone. Take a thorough health history and do a blood pressure before every treatment. But sometimes that just isn't enough to stay out of trouble.

I'd like to start this year with a cautionary tale from personal experience last year.  I was consulted to sedate a patient for 5 hours for implants and periodontal surgery.  I was told the patient was not nervous. I obtained the necessary consent and health history and spoke at length with the patient who denied any prescription or non-prescription medications.  As usual, I explained that the use of certain medications or "recreational" drugs could react even with local anesthesia resulting in death.  Still, a negative response.

Immediately prior to treatment I again reiterated the possible fatal result of not advising me of all prescribed and other medications.

The patient "was resistant" to sedation and not only did local anesthesia wear off inappropriately fast, 1:100,000 epi incresased her blood pressure high enough that I had to treat her intravenously with Labetolol, slowly and in small dosages.  However after 3 hours I came to the conclusion that even general anesthesia with propofol and ketamine would not allow us to finish the case and we closed up.  About that time an assistant noticed a blue pill near the patients right arm.  It was an amphetamine.  It was at that time that another assistant pointed out a bag of pills she claimed the patient brought with her.  I had assumed (incorrectly) that those were her postoperative medications from the surgeon. I found that she brought prescription bottles of amphetamine salts (120) , pain pills, tranquilizers and an ACE inhibitor for hypertension and angina!  I was especially concerned since Labetalol is  contraindicated with that ACE drug.

When the patient fully recovered, I asked her why should would lie to me about her medications.  She smiled/sneered and lifted her hands up in the "so what, we got through the case and nothing happened" manner.  Only when I advised her that we stopped the case and that only half of her work was completed did she comprehend the immediate problem for her. I found out that someone close to the case knew this patient had a history of drug abuse. 

The lesson? Patients and staff will lie to you.  Go slow.  Have no fear of stopping a case.