Know your drugs
Who should not have IV sedation in an office
Sorted by the reason rather than alphabetically, because the reasons behave differently — some move the patient to a hospital, some move the appointment, and some are not about the patient at all.
Most IV sedation contraindication lists are alphabetical, which hides the only thing that matters: why each item is on the list, and therefore what you do about it. Sorted by reason there are four patient categories and one that is not about the patient at all — an airway you would struggle to rescue, a stomach that is not empty, physiological reserve that is not there, and a drug history that changes what your agents will do — plus the venue, the monitoring and the escort, which decide as much as any of them. Two of these have moved recently: GLP-1 receptor agonists delay gastric emptying — most markedly during dose escalation and where there are gastrointestinal symptoms, though population studies have not yet shown a rise in clinically apparent aspiration — and patients do not think of them as medication, while obstructive sleep apnea carries roughly 1.7-fold odds of respiratory adverse events and 3.3-fold odds of needing an airway intervention during ambulatory sedation, on wide confidence intervals and no dental studies. One item that is routinely on the list deserves re-examining: a propofol contraindication for egg or soy allergy has not held up in the adult series that has tested it, though sixty patients is a small denominator, that was a specific patient population, the labelling still carries it, and the paediatric evidence is thinner. And the Mallampati score predicts a difficult airway poorly enough that it should not be the whole of an airway assessment — which is an argument about weight, not an argument for omitting it where a permit requires it.
The rest of this piece is for clinicians
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This piece is education for clinicians, not advice for any patient. It describes conditions, precautions and the reasoning behind decisions at the level of the condition; it does not give step-by-step operative technique, and it is not a substitute for the judgement of the treating clinician, the patient's physicians, or the guidance of the relevant professional bodies. Reading it creates no clinician–patient or consulting relationship, and nothing here is direction to any reader about a patient in front of them.
Drug doses, maximums and formulations change and differ between references and package inserts — verify every figure against a current primary source before you rely on it. Where a position here differs from current product labelling that is stated in the text, and the labelling, not this page, is the reference. Guidance cited is drawn from several countries and professional bodies; which applies to you is a question for your own regulator and permit. Passages describing occupational exposure, equipment or staffing are general background rather than an occupational-health assessment of any workplace.