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Case Conference Supporting Your Practice

Case Conference: Local Anesthesia for an Out-of-Control Hypertension Case

This is part 1 of a case conference presented by Dr. Joonyoung Ji.

This conversation between Drs. Ji and O’Keefe was held over the Zoom videoconferencing platform and they will be coming back to discuss next steps for the case on Friday May 27th at 1 pm (EST).

Drs. Ji and O’Keefe are welcoming 20 dentists to participate in this informal and open conversation among colleagues. The session will also be held using the Zoom videoconferencing platform and will take the form of Q&As. If you are interested in participating, please send us your name and email address to oasisdiscussions@cda-adc.ca and we will send you both the invitation link and the password to attend the session.

If you would like to contact Dr. John O’Keefe directly, please email him at jokeefe@cda-adc.ca

Please note that the session will be recorded. If you prefer not to show up on camera, you can join in without video, by disabling your computer camera.



1 Comment

  1. Marc DuVal May 17, 2016

    Thanks for sharing. Good topic, there are plenty of poorly controlled hypertensive patients out there.

    From what you describe, this is a hypertensive emergency, and cannot be simply attributed to anxiety. Patient denial is often a factor, and so we must consider that her blood pressure at home is not as low as she would have us believe.

    My view is that even if it were entirely anxiety related, the patient requires management peri operatively. Intubation will only exacerbate her hypertension, (or worse), unless properly managed. Certainly, despite the fact she has real dental needs, the proposed procedures are still considered elective.

    When presented with a case like this I send the patient to the ER via ambulance, with a prescription for antibiotics and painkillers. The ER gets her under control and will have her seen in outpatient internal medicine clinics once discharged to follow her until they get a handle on her hypertension. I then communicate with her internist to discuss management and for peri operative optimization. In case of true dental emergency requiring immediate surgical intervention (such as Ludwig angina) the anethesioligist will pharmacologically minimize hypertensive episodes that may be triggered by intubation. Although we have IV anti-hypertensives in our emergency carts, we are not liscenced to treat hypertension, and we are not equipped for this case. I certainly would not plan to perform any procedures on such a patient until an internist consideres her optimized for the procedure.

    At this point, perhaps getting in communication with her GP would be a reasonable next step.

    Interested to see how others handle such situations. .


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