Benzodiazepines & Procedures

Practice Policy in relation to prescription of sedatives for patients attending hospital or dental appointments, for imaging investigations or other procedures.

Sometimes we are asked to prescribe ‘a low dose sedative’ for patients attending hospital or dental appointments, for imaging investigations or other procedures. These are the reasons we do not prescribe this medication:

  1. Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic (too low a dose to be effective) for most adults for any effective sedation.  Conversely sedatives can have the opposite response in patients, and even very small doses can cause increased agitation in some patients.
  2. A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being no longer appropriate.
  3. GPs are not regularly involved, skilled, trained or appraised in sedation skills.
  4. All hospital consultants and dentists, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs for these medications. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10. Dentists have similar prescriptions, although you may need to get a private prescription if your dentist is not an NHS dentist.
  5. Sedated patients should be regularly monitored, and this is not likely to be arranged if a GP issues the prescriptions
  6. The Royal College of Radiologists‘ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well trained staff involved and the monitoring of sedated patients.
  7. During the course of any investigation or procedure, other medications or contrast may be needed. The clinician in charge of the procedure knows which medications are likely to be needed and any interactions or risks associated with them in combination with sedatives.