Oral Sedation

Consent for Oral Sedation

Effects and Risks associated with the medication Halcion (Triazolam):

• Blurred vision, slurred speech, dizziness, unstable walking, amnesia
• Drowsiness possibly lasting up to 8 hours after taking the medication
  Do not take with anti-fungal medications. This can cause prolonged drowsiness
  Do not take with any other types of sleeping aids
• Possible nausea and vomiting
• Oral sedation taken while pregnant or nursing could be harmful or fatal to the unborn/born child

I acknowledge and understand the following:

• The above effects and risks of taking this medication
• I am not pregnant (to the best of my knowledge) or nursing
• I am unable to drive to and from my appointment.  I am unable to drive for the remainder of the day.  I have arranged a responsible family member or friend (no Taxi, Uber, Lyft, etc.) to drive me to and from my appointment. My driver does not need to be present during the entire procedure but will provide a contact telephone number in case of an emergency
• I am unable to work the same day as my procedure
• Vital signs will be closely monitored during the procedure; however, any respiratory or cardiovascular complications could result in transportation by ambulance to a nearby hospital
• Treatment during my procedure may require modification due to existing conditions that are only evident when the surgical site has been exposed. I understand Dr. VanWinkle will treat my dental condition as he deems necessary while I am sedated
• Post-surgical instructions have been explained to me and will be reviewed with my driver on the day of procedure

Directions for taking oral sedation drug:

• Take with water only 1 hour before your appointment  
• Do not drink caffeine or fruit juices of any type the day of your procedure
• Do not eat 6 hours prior to your appointment