[Here is a useful Resource For Parents from The Society For Pediatric Sedation.]
I recently read the NY Times article Should Kids Be Sedated for Dental Work?.
It is a disturbing article because it cites two young children who died from procedural sedation or general anesthesia performed for dental care.
The most disturbing part of the article, I thought, was that in both cases the deaths occurred while the children were being cared for by fully qualified anesthesiologists. In neither case was the operating dentist doing the procedure and also doing the anesthesia.
The sedation practioners in both cases were competent anesthesiologists.
It is not possible from news reports to determine what went wrong.
However, pediatric sedation and analgesia and general anesthesia are both high risk procedures even when the care is given by highly competent practitioners
But if children are not given medications to relieve the pain and stress of a medical procedure, the children may not be able to have a needed medical procedure. And performing painful or frightening medical procedures on pediatric patients without sedation and analgesia can be very risky.
The best we can do is review Resource (2) Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.
The above article details best practice for pediatric sedation and analgesia.
The article also discusses things that can go wrong in pediatric procedural sedation and analgesia.
And the article provides guidance on the ways to avoid the complications [cardiovascular instablity, hypoxia, hypoventilation, apnea, and laryngospasm] or to recognize them promptly and fix them if they do occur.
Resources:
(1) Should Kids Be Sedated for Dental Work? NY Times
By CATHERINE SAINT LOUISAUG. 24, 2017
(2) Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016 [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatrics. 2016 Jul;138(1). pii: e20161212. doi: 10.1542/peds.2016-1212.
(3) Supplemental Information for Resource (2) above. [PDF]
- APPENDIX 1: RECOMMENDED DISCHARGE CRITERIA
- APPENDIX 2: ASA PHYSICAL STATUS CLASSIFICATION*
- APPENDIX 3: DRUGS† THAT MAYBE NEEDED TO RESCUE A SEDATED
PATIENT - APPENDIX 4: EMERGENCY EQUIPMENT THAT MAY BE NEEDED
TO RESCUE A SEDATED PATIENT†, ‡
(4) How safe is deep sedation or general anesthesia while providing dental care? [PubMed Abstract]. J Am Dent Assoc. 2015 Sep;146(9):705-8. doi: 10.1016/j.adaj.2015.04.005.
(5) Trends in death associated with pediatric dental sedation and general anesthesia [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Paediatr Anaesth. 2013 Aug;23(8):741-6. doi: 10.1111/pan.12210. Epub 2013 Jun 14.
(6) 14-month-old girl dies following dental visit By Calily Bien
Published: March 30, 2016, 12:46 pm Updated: March 31, 2016, 8:34 am
(7) Lawsuit: Toddler’s death during dental work was part of Medicaid scheme
KXAN Staff Published: February 28, 2017, 9:52 pm
(8) Texas Dental Board clears Austin dentist of any wrongdoing in toddler’s death
By Calily Bien Published: April 26, 2017, 5:53 pm Updated: April 26, 2017, 9:25 pm
(9) OHSU-trained dentist worked on Austin toddler who died after dental surgery
(10) Austin Children’s Dentistry
(11) APD Releases 911 Call of Dental Procedure Emergency
(12) Texas toddler died from anesthesia complications from DrBicuspid.com
By DrBicuspid Staff July 14, 2016:
A 14-month-old toddle died from complications of anesthesia during oral surgery at a dental practice in Austin, TX, according to the medical examiner.
The child, Daisy Lynn Torres, died March 29, 2016 from “complications of anesthesia while being treated for dental caries” at Austin Children’s Dentistry, the Travis County Medical Examiner’s Office told DrBicuspid.com.
The girl was being treated by Michael Melanson, DMD, and anesthesiologist David Williams, MD, clinic spokeswoman Sarah Marshall told DrBicuspid.com.
She was given propofol, nitrous oxide, and sevoflurane at concentrations that are typical for patients undergoing general anesthesia, according to the autopsy report.
(13) California family seeks answers after 3-year-old dies following routine dental procedure June 19, 2017; Los Angeles Times
(14) Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Scand J Trauma Resusc Emerg Med. 2016 Aug 2;24:97. doi: 10.1186/s13049-016-0291-7.
(15) Procedural Sedation and Analgesia in Children: Perspectives from
Paediatric Emergency Physicians [Full Text PDF]. Proceedings of Singapore Healthcare: Volume 19, Number 2, 2010
(16) A Medical Crisis Management Simulation Activity for Pediatric Dental Residents and Assistants [PubMed Abstract] [Full Text HTML] [Full Text PDF]. J Dent Educ. 2011 Jun;75(6):782-90.
