3 year old boy dies during dental procedure

[dannyboy1]

I’ve done over 10k anesthetics and never failed to secure an airway. Isn’t that what we are trained to do?

This. I have yet to come across the patient who could not be ventilated with 2 hands and an oral/nasal airway with paralytics on board, and, like all of us I have had my share of no neck, bearded fatties. To not be able to ventilate a 3 year old is unimaginable.

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[VA Hopeful Dr]

Yeah but ask a pediatric dentist or even peds EM how often they see them.

I'll do that and get back to you

 

[deleted126335]

Still waiting to see what drugs were given and dosages, was supplemental oxygen given, what monitoring and equipment were used and what was available. About the only things that I can think of that might be defensible are undiagnosed cardiac problem and anaphylaxis.

 

[T-burglar]

If you have two people, a mask strap, an oral airway, and a way to densely paralyze, there is almost no patient that exists that you cannot mask ventilate.

There are exceptions but a healthy 3 year old isn’t one of them

this makes me incredibly sad. I don’t know what is with some people in medicine that don’t care enough about the life of a child to just be safe .

 

[DirtDocMD]

Yeah but ask a pediatric dentist or even peds EM how often they see them.

Yeah, but again, how many of those require a general anesthetic?? I’ve got pedi dentists in town who wanna do TONS of “rehab” cases, requiring general anesthesia and all the involved risks, to “prevent abscesses” in kids who obviously AREN’T needing an OR suite and general anesthesia for “abscesses”.

Should we “rehab” 100 kids to prevent 1 abscess? How about 1000??

“Ooooh, but it affects their self esteem!!!”

Yep, and so does a mouth full of metal teeth.
Again, I’m not saying ALL these cases are unnecessary, but I’ve seen enough of these cases on Medicaid kids (because middle class folks aren’t paying $3-$5k cash to have a mouth full of caps put on disposable baby teeth), to realize that there’s some “shenanigans” going on.

Bottles full of juice and poor parenting didn’t get invented, yesterday. These kinds of businesses didn’t really exist until Medicaid programs started footing the bill for it. The ADA should be doing a better job on pedi guidelines, and guidelines for “surgery centers” such as these, in dental offices..(and I’m gonna bet this CRNA wasn’t following ASA guidelines for monitoring...)

 

[coffeebythelake]

and I’m gonna bet this CRNA wasn’t following ASA guidelines for monitoring...

Almost invariably cutting corners with these office based disasters.

 

[GaseousClay]

ugh so tragic for this poor kid. we need to blast ASA twitter with this story. they always post meaningless BS.

 

[propadope]

Yeah, but again, how many of those require a general anesthetic?? I’ve got pedi dentists in town who wanna do TONS of “rehab” cases, requiring general anesthesia and all the involved risks, to “prevent abscesses” in kids who obviously AREN’T needing an OR suite and general anesthesia for “abscesses”.

Should we “rehab” 100 kids to prevent 1 abscess? How about 1000??

“Ooooh, but it affects their self esteem!!!”

Yep, and so does a mouth full of metal teeth.
Again, I’m not saying ALL these cases are unnecessary, but I’ve seen enough of these cases on Medicaid kids (because middle class folks aren’t paying $3-$5k cash to have a mouth full of caps put on disposable baby teeth), to realize that there’s some “shenanigans” going on.

Bottles full of juice and poor parenting didn’t get invented, yesterday. These kinds of businesses didn’t really exist until Medicaid programs started footing the bill for it. The ADA should be doing a better job on pedi guidelines, and guidelines for “surgery centers” such as these, in dental offices..(and I’m gonna bet this CRNA wasn’t following ASA guidelines for monitoring...)

Been doing anaesthesia for peds dental for 15 years and I see day after day: rampant decay, neglect, abscesses, children in pain etc…. ECC Early Childhood Caries is the most common chronic childhood disease according to the Surgeon General. Decay is preventable but systemically things are not improving. Parents need to take responsibility. Dentists, pediatricians, schools, the government need to do a better job educating and screening. In a perfect world these kids shouldn’t be in this position but they are. Treatment should be attempted conservatively but if the child is unable to cooperate what choice is left? General anaesthesia comes with risk and is and should be a last resort.

 

[Aheadbyacentury]

only things that I can think of that might be defensible are undiagnosed cardiac problem and anaphylaxis.

Thats why they are pinning their hats on anaphylaxis and the cheek swelling.. The medical examiner should be able to corroborate the cheek swelling.
It wasnt anaphylaxis btw.. And if it were anphylaxis,, to what?

Boy, 3, dies at dentist after 'unanticipated reaction to medicine,' report says

A 3-year-old Kansas boy died after what police said was an “unanticipated reaction to medicine” given to him during a dental procedure, a local report said.

www.foxnews.com

here is an article saying he had a reaction to the medicine... Whatever!!

 

[Southpaw]

Thats why they are pinning their hats on anaphylaxis and the cheek swelling.. The medical examiner should be able to corroborate the cheek swelling.
It wasnt anaphylaxis btw.. And if it were anphylaxis,, to what?

Boy, 3, dies at dentist after 'unanticipated reaction to medicine,' report says

A 3-year-old Kansas boy died after what police said was an “unanticipated reaction to medicine” given to him during a dental procedure, a local report said.

www.foxnews.com

here is an article saying he had a reaction to the medicine... Whatever!!

saying it was a reaction to a medication (which is treatable) also personally absolves (makes them feel less responsible, like it was beyond their control) the parties involved to what was most likely oversedation/obstruction/airway issue recognized too late. Either way, treatable. There’s no excuse here.

 

[deleted126335]

Thats why they are pinning their hats on anaphylaxis and the cheek swelling.. The medical examiner should be able to corroborate the cheek swelling.
It wasnt anaphylaxis btw.. And if it were anphylaxis,, to what?

Boy, 3, dies at dentist after 'unanticipated reaction to medicine,' report says

A 3-year-old Kansas boy died after what police said was an “unanticipated reaction to medicine” given to him during a dental procedure, a local report said.

www.foxnews.com

here is an article saying he had a reaction to the medicine... Whatever!!

To whatever a good expert witness can sell...

 

[linkin06]

If you have two people, a mask strap, an oral airway, and a way to densely paralyze, there is almost no patient that exists that you cannot mask ventilate.

There are exceptions but a healthy 3 year old isn’t one of them

this makes me incredibly sad. I don’t know what is with some people in medicine that don’t care enough about the life of a child to just be safe .

I frequently will just turn on a pressure mode and set it to like 15 and put the vent on while i two hand mask. i don't have the biggest hands, but usually i can still two hand mask the horrible OSA patients. better than the RN over bagging or under bagging.

 

[deleted697535]

So for those who do office dental what do you use?

Ive been doing quite a bit recently adults only. Wondering what recipes ppl have.

Obviously oxygenated is good i believe

 

[dannyboy1]

Yeah, but again, how many of those require a general anesthetic?? I’ve got pedi dentists in town who wanna do TONS of “rehab” cases, requiring general anesthesia and all the involved risks, to “prevent abscesses” in kids who obviously AREN’T needing an OR suite and general anesthesia for “abscesses”.

Should we “rehab” 100 kids to prevent 1 abscess? How about 1000??

“Ooooh, but it affects their self esteem!!!”

Yep, and so does a mouth full of metal teeth.
Again, I’m not saying ALL these cases are unnecessary, but I’ve seen enough of these cases on Medicaid kids (because middle class folks aren’t paying $3-$5k cash to have a mouth full of caps put on disposable baby teeth), to realize that there’s some “shenanigans” going on.

Bottles full of juice and poor parenting didn’t get invented, yesterday. These kinds of businesses didn’t really exist until Medicaid programs started footing the bill for it. The ADA should be doing a better job on pedi guidelines, and guidelines for “surgery centers” such as these, in dental offices..(and I’m gonna bet this CRNA wasn’t following ASA guidelines for monitoring...)

Who cares if the surgery was necessary or not. A healthy 3 y/o should not die of a lost airway under anesthesia. Simple as that. We do unnecessary plastics cases all the time. Can you imagine fu(king up the anesthetic and then trying to blame the surgeon because the procedure was unnecessary?

 

[coffeebythelake]

Who cares if the surgery was necessary or not. A healthy 3 y/o should not die of a lost airway under anesthesia. Simple as that. We do unnecessary plastics cases all the time. Can you imagine fu(king up the anesthetic and then trying to blame the surgeon because the procedure was unnecessary?

This makes me think of the Rex Meeker case

 

[propadope]

So for those who do office dental what do you use?

Ive been doing quite a bit recently adults only. Wondering what recipes ppl have.

Obviously oxygenated is good i believe

I tried to answer this in the thread you had started a few weeks ago

 

[deleted697535]

I tried to answer this in the thread you had started a few weeks ago

Thank you. Trying to get a few more responses.
I got a few colleagues that do all kinds of drugs in their special mix. Remi, precedex, ketamine, midaz... Patients dont seem to like it at all from what im seeing when theyve been coming back for their repeat procedure.

I just been using prop for 99% of cases and it works great. I dont really understand why ppl make it more complicated

 

[propadope]

Thank you. Trying to get a few more responses.
I got a few colleagues that do all kinds of drugs in their special mix. Remi, precedex, ketamine, midaz... Patients dont seem to like it at all from what im seeing when theyve been coming back for their repeat procedure.

I just been using prop for 99% of cases and it works great. I dont really understand why ppl make it more complicated

Like anything it depends on the patient, procedure, what level of anaesthesia and what equipment you have available

 

[deleted697535]

Like anything it depends on the patient, procedure, what level of anaesthesia and what equipment you have available

Im mean sure but does it?

As i said ive done 100s this year maybe more, and still 99.9% prop only. Always the same.

Young strong men, schizo on a lot of weed and maybe more... Same results

Old fairly frail people same. Just sometimes a lot more sometimes barely any. And it goes great..

The guy the next day runs like 6 infusions.
I dont even do that for cardiac

 

[GassYous]

Im mean sure but does it?

As i said ive done 100s this year maybe more, and still 99.9% prop only. Always the same.

Young strong men, schizo on a lot of weed and maybe more... Same results

Old fairly frail people same. Just sometimes a lot more sometimes barely any. And it goes great..

The guy the next day runs like 6 infusions.
I dont even do that for cardiac

Yeah prop only is the cleanest anesthetic. Patients wake up fast, clean and happy the majority of the time.

 

[propadope]

Im mean sure but does it?

As i said ive done 100s this year maybe more, and still 99.9% prop only. Always the same.

Young strong men, schizo on a lot of weed and maybe more... Same results

Old really frail people same. Just sometimes a lot more sometimes barely any. And it goes great..

The guy the next day runs like 6 infusions.
I dont even do that for cardiac

How deep? Not a huge fan of straight propofol on those young weed smokers but it also depends on the procedure. Wisdom teeth can be quite stimulating even with adequate local. Fillings and root canal are not. Bad gaggers or pts with severe anxiety can have high requirements

 

[propadope]

Yeah prop only is the cleanest anesthetic. Patients wake up fast, clean and happy the majority of the time.

One person’s needlessly complex polypharmacy is another person’s multimodal. Propofol does accumulate over time and sometimes giving adjuncts to lower your infusion rates/total dosage can be beneficial.

 

[deleted697535]

How deep?

Very.
procedures range from 2 mins to 4hr45 min yest
Never had a problem with accumulation. it might be something in theory but ive not seen anything. not that im really looking tbh... is there a max dose of ppf in a non-icu/peds setting?

 

[propadope]

Very.
procedures range from 2 mins to 4hr45 min yest
Never had a problem with accumulation. it might be something in theory but ive not seen anything. not that im really looking tbh... is there a max dose of ppf in a non-icu/peds setting?

Intubated and paralyzed?

 

[deleted697535]

Intubated and paralyzed?

no never.

 

[propadope]

no never.

To both?

 

[Justice4all]

Dental office: inhalational, IV then tube. Mobile dental setup with RN for pacu. No paralysis and no opioids.

 

[coffeebythelake]

Dental office: inhalational, IV then tube. Mobile dental setup with RN for pacu. No paralysis and no opioids.

U carry dantrolene? Full ASA monitors including body temp?

 

[Southpaw]

U carry dantrolene? Full ASA monitors including body temp?

I've done office dental in two different setups though I no longer do it. I was one of several anesthesiologists involved. My answer is GETA, yes to full monitors, and yes to dantrolene. I've heard of offices (dentists...) wanting to take shortcuts and I can definitely envision how CRNAs and even some anesthesiologists can be cornered into poor/unsafe arrangements. I've read SDN long enough and seen enough of these articles to say no ****ing way to that nonsense.

 

[Justice4all]

Skin temp and dantrolene is available. And patients family are called and preop-Ed before the day. No surprise and I usually cancel a case for one reason or other.

 

[DirtDocMD]

Who cares if the surgery was necessary or not. A healthy 3 y/o should not die of a lost airway under anesthesia. Simple as that. We do unnecessary plastics cases all the time. Can you imagine fu(king up the anesthetic and then trying to blame the surgeon because the procedure was unnecessary?

Wasn’t trying to derail the thread, but when more bullschidt cases are done, you’re at risk for more bullschidt outcomes. Again, you have pedi dentists herding these kids through like cattle, and usually getting away with it BECAUSE most kids are so healthy and anesthesia is USUALLY safe.

“Hey! It’s no big deal! We do hundreds of these a month! He’ll be fine! Gotta fix those teeth!”

General anesthesia should ALWAYS be a big deal, and the fact that folks “get away with” getting fast and sloppy at the plastic surgeon’s/dentist’s/GI “most of the time”, is why so many of them get comfortable herding patients in this way, many times without legit medical justification.

My partner had to cancel a pedi dental on the table just this week, because he AND another partner couldn’t intubate the kid. He had a fungating mass making it impossible to intubate. Luckily, they COULD bag the kid. Schidt happens...

I’ll personally cancel a knee replacement way quicker than a perfed bowel. Why? One can sit around for another 2-3 years. The other NEEDS surgery.

I wouldn’t be surprised, if a review of this dentist’s files were done, that he’s 2-3 times more likely to recommend “surgery” to Medicaid pt’s who have the same issue as an “uninsured” or $1000 cap middle classer.

Why??? The same reason he’s using some cut-rate corner cutting CRNA in his office....
$$$$$$$


This case was a $$$$ issue, as much as it was a medical issue..

 

[propadope]

Dental office: inhalational, IV then tube. Mobile dental setup with RN for pacu. No paralysis and no opioids.

I do the same but switch to propofol infusion + nitrous. Bolus of precedex at the start

 

[dannyboy1]

Wasn’t trying to derail the thread, but when more bullschidt cases are done, you’re at risk for more bullschidt outcomes. Again, you have pedi dentists herding these kids through like cattle, and usually getting away with it BECAUSE most kids are so healthy and anesthesia is USUALLY safe.

“Hey! It’s no big deal! We do hundreds of these a month! He’ll be fine! Gotta fix those teeth!”

General anesthesia should ALWAYS be a big deal, and the fact that folks “get away with” getting fast and sloppy at the plastic surgeon’s/dentist’s/GI “most of the time”, is why so many of them get comfortable herding patients in this way, many times without legit medical justification.

My partner had to cancel a pedi dental on the table just this week, because he AND another partner couldn’t intubate the kid. He had a fungating mass making it impossible to intubate. Luckily, they COULD bag the kid. Schidt happens...

I’ll personally cancel a knee replacement way quicker than a perfed bowel. Why? One can sit around for another 2-3 years. The other NEEDS surgery.

I wouldn’t be surprised, if a review of this dentist’s files were done, that he’s 2-3 times more likely to recommend “surgery” to Medicaid pt’s who have the same issue as an “uninsured” or $1000 cap middle classer.

Why??? The same reason he’s using some cut-rate corner cutting CRNA in his office....
$$$$$$$


This case was a $$$$ issue, as much as it was a medical issue..

Not sure what the case has to do with the anesthesia outcomes. This was not a 70 year old diabetic coming for TKA that would benefit from cardiac workup. This was, by all accounts, a perfectly healthy 3 year old that died because anesthesia couldn’t manage the airway. Sure there is always a “risk with general anesthesia “. That is primarily because there are a lot of shady providers out there, not some inherent risk. The answer to these problems is not to do less cases (and turn away business) it is to be competent.

 

[coffeebythelake]

In unrelated news,

Woman Breaks Into Dentist's Office, Extracts 13 Teeth From Anesthetized Patient

We have no idea why.

futurism.com

How does this even happen? Is no one watching the anesthetized patient?

 

[propadope]

Wasn’t trying to derail the thread, but when more bullschidt cases are done, you’re at risk for more bullschidt outcomes. Again, you have pedi dentists herding these kids through like cattle, and usually getting away with it BECAUSE most kids are so healthy and anesthesia is USUALLY safe.

“Hey! It’s no big deal! We do hundreds of these a month! He’ll be fine! Gotta fix those teeth!”

General anesthesia should ALWAYS be a big deal, and the fact that folks “get away with” getting fast and sloppy at the plastic surgeon’s/dentist’s/GI “most of the time”, is why so many of them get comfortable herding patients in this way, many times without legit medical justification.

My partner had to cancel a pedi dental on the table just this week, because he AND another partner couldn’t intubate the kid. He had a fungating mass making it impossible to intubate. Luckily, they COULD bag the kid. Schidt happens...

I’ll personally cancel a knee replacement way quicker than a perfed bowel. Why? One can sit around for another 2-3 years. The other NEEDS surgery.

I wouldn’t be surprised, if a review of this dentist’s files were done, that he’s 2-3 times more likely to recommend “surgery” to Medicaid pt’s who have the same issue as an “uninsured” or $1000 cap middle classer.

Why??? The same reason he’s using some cut-rate corner cutting CRNA in his office....
$$$$$$$


This case was a $$$$ issue, as much as it was a medical issue..

How do you know it was a BS case?

 

[deleted697535]

To both?

Never to both. I've never intubated in a dental office and definitely never paralysed.
Do you routinely intubate and why?


In the two places iv worked they said they've not intubated anyone in their 5 to 6 year existence.

We have a mac blade kit, sux, roc, portable but ancient anesthesia machine, lmas etc...

I dont do peds dental i was thinking abiut it but Maybe after this thread ill stay with the oldr folk

 

[DirtDocMD]

Not sure what the case has to do with the anesthesia outcomes. This was not a 70 year old diabetic coming for TKA that would benefit from cardiac workup. This was, by all accounts, a perfectly healthy 3 year old that died because anesthesia couldn’t manage the airway. Sure there is always a “risk with general anesthesia “. That is primarily because there are a lot of shady providers out there, not some inherent risk. The answer to these problems is not to do less cases (and turn away business) it is to be competent.

“Competent” providers don’t agree to work at “dental mills”, doing (often unnecessary) cases with unsecured airways, lack of proper equipment, and (likely) lack of staff (PACU/etc).

Maximizing profits and cutting costs= bad outcomes.

Guess I’ll just leave at this:

I don’t feel the “risk” of dead children, injured children, and the billions in $$$ of cost to taxpayers and parents, is often worth it, so a kid can have nice baby teeth or to line some pedi dentist’s pocket.

The kids that DO need care (1/2-2/3, in my opinion), should be done in a safe environment by providers looking to provide safe care, NOT merely assist in “cutting anesthesia expenditures”.

Our job is to provide safe care. Sometimes the “safe” thing, as a profession, is NOT to simply provide a “service” for every provider that asks for it, without question.

It’s easy to say “I’d never lose an airway!”. We have a LOT more help/equipment in a surgery center/hospital, than this guy had. Not defending him. HE agreed to take a bad job, in a bad facility, and likely made bad clinical decisions.

LOTS of bad decisions, here, with a failure to “secure the airway”, being the last (but not only).

Take care.

 

[Justice4all]

Never to both. I've never intubated in a dental office and definitely never paralysed.
Do you routinely intubate and why?


In the two places iv worked they said they've not intubated anyone in their 5 to 6 year existence.

We have a mac blade kit, sux, roc, portable but ancient anesthesia machine, lmas etc...

I dont do peds dental i was thinking abiut it but Maybe after this thread ill stay with the oldr folk

Peds anesthesia here. I am intubating these kids.

 

[deleted697535]

Peds anesthesia here. I am intubating these kids.

Thank you. Office peds dental or OR, or both?
Intubate every kiddo or case by case?
Or what decisions do you make on this?

One group wants me to do peds so im weighing it up.

 

[coffeebythelake]

Thank you. Office peds dental or OR, or both?
Intubate every kiddo or case by case?
Or what decisions do you make on this?

One group wants me to do peds so im weighing it up.

These young kids laryngospasm so easily and then you add on top of this all the secretions and blood from dental work in an austere environment , it is just asking for badness without a secured airway IMO

 

[Justice4all]

I ve done office Peds as side gig: intubated no paralysis, no opioids no infusion

at academic center: intubated morphine no paralysis

 

[GassYous]

One person’s needlessly complex polypharmacy is another person’s multimodal. Propofol does accumulate over time and sometimes giving adjuncts to lower your infusion rates/total dosage can be beneficial.

Thank you. Office peds dental or OR, or both?
Intubate every kiddo or case by case?
Or what decisions do you make on this?

One group wants me to do peds so im weighing it up.

Don't do peds. Doesn't pay more and it is a lot easier to mess it up.

 

[coffeebythelake]

Don't do peds. Doesn't pay more and it is a lot easier to mess it up.

Lets qualify this statement. It is easier to mess up when cutting corners. Peds anesthesia is safe when it is done right.

 

[propadope]

Never to both. I've never intubated in a dental office and definitely never paralysed.
Do you routinely intubate and why?


In the two places iv worked they said they've not intubated anyone in their 5 to 6 year existence.

We have a mac blade kit, sux, roc, portable but ancient anesthesia machine, lmas etc...

I dont do peds dental i was thinking abiut it but Maybe after this thread ill stay with the oldr folk

Yes I routinely intubate or place flexible LMAs. Shared airway with water, blood, foreign bodies. Plus the high likelihood that the dentist and or assistant will push down on the mandible or tongue causing airway obstruction. Without a tube you need to constantly chin lift, jaw thrust etc if they are deep (even with a NPA in place) This is a huge pain and stressful for everyone. I much prefer to be out of the way and let the dentist work with fewer interruptions.

 

[DirtDocMD]

How do you know it was a BS case?

“

“No problem. All I do is dental. I have the DRE because I like nitrous. But I think the other two options are better if you are going air/oxygen. One option that is nice on the DRE is it has low flow flowmeters but at the expense of size and weight”

You, in 2015....

If all I did was dental, maybe I’d be more likely to defend them, too. Buh bye....

 

[coffeebythelake]

“

“No problem. All I do is dental. I have the DRE because I like nitrous. But I think the other two options are better if you are going air/oxygen. One option that is nice on the DRE is it has low flow flowmeters but at the expense of size and weight”

You, in 2015....

If all I did was dental, maybe I’d be more likely to defend them, too. Buh bye....

Come on, a ton of surgeries in any given hospital OR or surgicenter are "BS" elective cases. You think cosmetic rhinoplasty or breast augs aren't? The problem here is the lax culture of safety that seem to happen with cosmetic and dental office based anesthesia.

 

[propadope]

Come on, a ton of surgeries in any given hospital OR or surgicenter are "BS" elective cases. You think cosmetic rhinoplasty or breast augs aren't? The problem here is the lax culture of safety that seem to happen with cosmetic and dental office based anesthesia.

In my opinion only 1/2 to 2/3 are non BS cases.

 

[pgg]

“

“No problem. All I do is dental. I have the DRE because I like nitrous. But I think the other two options are better if you are going air/oxygen. One option that is nice on the DRE is it has low flow flowmeters but at the expense of size and weight”

You, in 2015....

If all I did was dental, maybe I’d be more likely to defend them, too. Buh bye....

Isn't he a dentist? I could be misremembering that.

 

[propadope]

Isn't he a dentist? I could be misremembering that.

Sure am! With any profession there are going to be greedy people with poor ethics. But to claim that a lot of these cases are not necessary without any evidence is ridiculous. Either the regulations have to be stricter, better enforced or people are not following them. Unfortunately if you take a job with risk, you better know what you are getting into. I think we can all agree on that

 

[GaseousClay]

This murse is furious someone posted this tragic story on Twitter. Now claiming there are thousands more stories he can post about doctors.