Dr. Wiley says liquid
valium placed under
the patient's tongue
has a long onset, mak-
ing it less than ideal
for relatively fast out-
patient procedures,
while liquid midazolam has a brief onset, but can have variable effect
due to how much of the drug is administered and how much patients
actually swallow.
Administering midazolam in a sublingual tablet ensures the adminis-
tration of a full, accurate dose, according to Dr. Wiley, leading to a
more consistent and predictable sedative effect. The total length of
action is about an hour, he says, so patients are typically fully recov-
ered after spending about 15 minutes in post-op.
Nurses, too, appreciate not having to fret about sticking older
patients multiple times to find usable veins. "I'll occasionally joke with
my nurses by telling them we're out of the tablets," says Dr.
Greenwood. "You can see their shoulders slump."
Jay Horowitz, CRNA, president of Quality Anesthesia Corp. in
Sarasota, Fla., isn't completely sold on the time-saving potential of
oral sedation. He recognizes its appeal, but says he can't count on
the variability of its onset in individual patients, especially when
sedating patients in high-volume practices.
Mr. Horowitz is often in the OR with ophthalmic surgeon T. Hunter
Newsom, MD, owner of Newsom Eye in Tampa, Fla. "He's a world-
class surgeon and he's fast — he can safely perform excellent cataract
surgery in about 4 minutes," says Mr. Horowitz. "I need to keep pace,
and the onset of action of any oral sedative is variable. I don't think it
can match the predictability of popping in an IV."
J U L Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 1
Nurses can time the
administration of sublingual
sedation so patients feel calm
before heading to the OR.
