Requests for sedation for travel or procedure

The specific issues regarding sedation before a flight:

–          Prescribing medications to help someone go on holiday (get on a flight) is not counted as NHS work i.e. at the expense of the taxpayer. There are multiple readily accessible courses such as “Flying with Confidence, by British Airways” or “Fearless Flyer, by EasyJet” designed to help patients overcome a fear of flying without needing medications.

–          The use of sedation on a flight entails additional medical risks
• Patients may experience a paradoxical increased effect and become more sedated, which can in rare cases cause agitation and distress and behaviour that is not normal for the patient. This can occur even without alcohol (and we know some travellers like to consume alcohol before or on the flight). This can endanger the patient and risk the passengers and crew; worse case is the flight having to be diverted and the patient gets in trouble with the authorities.
• Oversedation may occur, this means the patient may not be as responsive if the plane suffers a problem and emergency procedures need to be observed and the instructions of the cabin crew followed quickly to ensure every one’s safety.
• Oversedation may also mean the patient walks about less, which could increase the risk of a blood clot (deep vein thrombosis), these can be fatal in rare cases.
• The use of sedatives like this can also invalidate an insurance policy if not declared, and these medications may not be legal at your intended destination, they can be confiscated and/or get the traveller into unnecessary trouble.

The specific issues of using sedation prior to a medical procedure:

–          The medication should be administered and monitored by the radiology team following a thorough risk assessment. This follows the guidelines from the Royal College of Radiologists which states that they should be doing this. This means the GP is not the right person to prescribe the medications.

–          For other invasive procedures, sedation should be handled by the treating team and not by the GP.

–          We are aware of at least 1 report of a case (nationally) where a patient went into an MRI scanner and suffered a respiratory arrest (they stopped breathing) because they went in having taken sedatives (from the GP), and the MRI team administered additional sedatives without knowing the patient was already on them (either the patient didn’t tell them or wasn’t asked), so suffered respiratory depression (they stopped breathing).

The specific issues of using sedation prior to a dental procedure:

–          Dentists can prescribe sedation if indicated for their patients and they are best positioned to risk assess the patient.   This includes both NHS and private practice. If a Dentist is unsure, they may contact the GP for advice if the patient has a complex medical history, but final prescribing rests with the DENTIST.

The practice will no longer issue sedating medications i.e. benzodiazepines for use prior to dental procedures, any medical procedure or investigation, or for the relief of fear of flying or other phobic states.  This is effective as of the policy date.

–          Requests for sedation for travel or procedure « Carterknowle & Dore Medical Practice

–          Royal College of Radiology – Sedation, analgesia and anaesthesia – New publication: Sedation, analgesia and anaesthesia in radiology, third edition | The Royal College of Radiologists

–          Flying with Confidence – Flying with confidence | Information | British Airways

–          Fearless Flyer – Fear of Flying Course – Fearless Flyer

–          Dental BNF formulary – Dental Practitioners’ Formulary | BNF | NICE

–          Journal article of a patient who experience respiratory arrest in the MRI – Chapter 57. Respiratory Arrest in the Magnetic Resonance Imaging Suite | Management of the Difficult and Failed Airway, 2e | AccessAnesthesiology | McGraw Hill Medical

This policy will be updated with any changes to practice position of legislation.   Any change of policy will be reflected in this document.

If you have specific questions about this, please contact the practice via email: SHECCG.Carterknowle@nhs.net