Expert: Ronald Levy, M.D. - 11/17/2009

Question
QUESTION: Dear Doctor Levy,
I'm the legal guardian of my 14yr old grandson who is a moderate Asthmatic 10 yrs now. He is currently taking Flovent HFA 220mcg, 2X daily. He also takes Albuterol Inhaler 2 puffs every four hours as needed or PRN. He will have four wisdom teeth extracted next week and he is terrified. He has never had surgery of any kind or even needles in his mouth. His desire is to be put to sleep, but our Dentist feels a little uneasy about it. What medicatiions do you feel, that would be safe to give him to put him at ease, something like a valium pill or versed? I'm afraid his anxiety will precipitate an Asthma attack if he is not given something to relax him a little. I'm open for suggestions and would appreciate them greatly, Thanking you,
Sincerely,
Greta

ANSWER: If your dentist is not trained to do sedation then you should not give your son anything. You might try to arrange the procedure in a hospital where an anesthesiologist can safely sedate him. Most hospitals have oral surgeons who can perform the procedure and many of them are trained to give sedation as well.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Levy,
Thank you for taking the time to answer my question.
I apologize for not mentioning in my question, that the Dentist trating Chris for his wisdom teeth removal is an Oral Surgeon. His practice is exclusive for Oral Surgery only. My concern,is his reluctance, to use any kind of anesthetic besides local injections. I am also concerned, that he may not be confidant enough to give Chris anything else. because of his Asthma. Besides a Hospital setting, are there any other suggestions, such as should I give him an Albuterol treatment a half hour before his surgery, as a precaution, or would that be detromental? Im just trying to find a way to make this procedure, as comfortable as possible under these circumstances, for a very scared 14 yr old young man.
Thank You again,
Sincerely,
Greta

Answer
I have to wonder why he is so reluctant? Certainly it wouldn't hurt to give Albuterol but that does not guarantee anything and it certainly does nothing for his fear. I am not so much concerned about an asthma attack as I am giving him a lifelong fear of doctors and needles. I might still recommend a hospital and perhaps general anesthesia for this.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston