Who should not have IV sedation in an office

In short

Organize the reasons someone should not have office-based IV sedation by what actually goes wrong, not by diagnosis: an airway you cannot rescue if it closes (obstructive sleep apnea roughly doubles the odds of a respiratory adverse event and more than triples the odds of needing an airway intervention in ambulatory sedation); a stomach that is not empty (GLP-1 agonists reliably delay gastric emptying, but population evidence has not shown a clear rise in aspiration, and guidance has shifted from routine interruption toward continuation with mitigation — the real risk is a patient who does not disclose the drug because they do not think of it as a medication); a physiologic reserve that is not there for the sedation depth planned; a drug or supplement history that changes which agents are safe; and reasons that belong to the room, not the patient. The Mallampati score, which many intake forms lean on heavily, is poorly sensitive, inconsistently scored between observers, and often cannot be assessed at all in young or uncooperative children — it should not carry the weight it is given. One item is coming off my own list: propofol in a patient with a stated egg or soy allergy, which the adult evidence does not support as a real cross-reactivity risk, though pediatric evidence for that specific question is thinner.