3 year old boy dies during dental procedure

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

sevo00

Full Member
Lifetime Donor
5+ Year Member
Joined
Nov 17, 2018
Messages
879
Reaction score
1,720

Just saw this on the news. Sad. According to the article the Dental office uses a solo CRNA group to administer anesthesia during their cases.
not a lot of info given out...

my first impressions are LAST or unrecognized hypoventilation ( like an unrecognized spasm)

imagine this code with a 3 yo kid in the dentists office with the dentist and the CRNA trying to save him - scary..

was the kid intubated? after he coded was he intubated? how much local was given? were there appropriate monitors?

despite what the article is implying, kids and humans in general do not just have an allergic reaction to medications and instantly code and die..

as tragic as this is, i would indeed bet that the care provided to him was substandard. it takes a lot of negligence to have a 3yo die from sedation

i have read some comments from oral surgeons, no one mentioning substandard anesthesia care. im sure the crna lobbies are fighting any mention of this scary situation.. the EXACT situation you need an anesthesiologist to handle
 
not a lot of info given out...

my first impressions are LAST or unrecognized hypoventilation ( like an unrecognized spasm)

imagine this code with a 3 yo kid in the dentists office with the dentist and the CRNA trying to save him - scary..

was the kid intubated? after he coded was he intubated? how much local was given? were there appropriate monitors?

despite what the article is implying, kids and humans in general do not just have an allergic reaction to medications and instantly code and die..

as tragic as this is, i would indeed bet that the care provided to him was substandard. it takes a lot of negligence to have a 3yo die from sedation

i have read some comments from oral surgeons, no one mentioning substandard anesthesia care. im sure the crna lobbies are fighting any mention of this scary situation.. the EXACT situation you need an anesthesiologist to handle


Sounds like he was not intubated. As you suggest, it was probably an airway issue and he’d probably still be alive if he was intubated. What is the most common cause of arrest in kids?

From the article….

“The report went on to say that around 7:50 a.m. “they gave [redacted] the [redacted] and that is when his right cheek swelled up” and the boy’s heart rated started to slow. The report noted that the boy was given something, although the details were redacted from the report, “to try to increase his heart rate when his pulse stopped and they started CPR.”
 
Last edited:
not a lot of info given out...

my first impressions are LAST or unrecognized hypoventilation ( like an unrecognized spasm)

imagine this code with a 3 yo kid in the dentists office with the dentist and the CRNA trying to save him - scary..

was the kid intubated? after he coded was he intubated? how much local was given? were there appropriate monitors?

despite what the article is implying, kids and humans in general do not just have an allergic reaction to medications and instantly code and die..

as tragic as this is, i would indeed bet that the care provided to him was substandard. it takes a lot of negligence to have a 3yo die from sedation

i have read some comments from oral surgeons, no one mentioning substandard anesthesia care. im sure the crna lobbies are fighting any mention of this scary situation.. the EXACT situation you need an anesthesiologist to handle
I agree! It sounds like an airway oversedation of some sort and the inability of the "PROVIDER" to just hip check the dentist out of the ****ing area and just intubate until it was too late..
 
The report noted that the boy was given something, although the details were redacted from the report, “to try to increase his heart rate when his pulse stopped and they started CPR.”
The drug they were probably looking for the speed the heart rate up was fu cking OXYGEN. which doesnt come in IV FORM. Some people wish it did .
 
you cant ask for something you dont know about or you think you are getting already.

I did appreciate the article pointing out an actual anesthesiologist wasn't involved and per the group's webpage it's a group of independent CRNAs out there winging it playing physician with kids getting anesthesia. Because anesthesia is so safe, right?
 
Would love to know what monitors, equipment, and medications are available in these settings. Also curious of the dose and type of local used.
 
I did appreciate the article pointing out an actual anesthesiologist wasn't involved and per the group's webpage it's a group of independent CRNAs out there winging it playing physician with kids getting anesthesia. Because anesthesia is so safe, right?

Another notch under the AANA belt. I'm sure they are so proud of themselves
 
Would love to know what monitors, equipment, and medications are available in these settings. Also curious of the dose and type of local used.
Agreed. Lots of information not known. Sometimes these places just use nitrous as sedation with no IV. Did this kid spasm and they couldn’t ventilate, goes hypoxic, arrests then can’t give epi because no IV and didn’t have the presence of mind to give IM? Was it gas inhalation then IV sedation? Did they have paralytics? Monitors?
 
Agreed. Lots of information not known. Sometimes these places just use nitrous as sedation with no IV. Did this kid spasm and they couldn’t ventilate, goes hypoxic, arrests then can’t give epi because no IV and didn’t have the presence of mind to give IM? Was it gas inhalation then IV sedation? Did they have paralytics? Monitors?

I don't even like doing cases near the airway that have all the equipment and an anesthesia machine.
 
Another notch under the AANA belt. I'm sure they are so proud of themselves
The CRNA will blame the dentist (LAST or allergic reaction, take your pick). The dentist will blame anesthesia. No way to know with certainty what actually happened. A large settlement check will be written because of the horrific outcome and the world will keep on spinning. Unspeakably tragic but this will not change anything….
 
The CRNA will blame the dentist (LAST or allergic reaction, take your pick). The dentist will blame anesthesia. No way to know with certainty what actually happened. A large settlement check will be written because of the horrific outcome and the world will keep on spinning. Unspeakably tragic but this will not change anything….

When $ is involved, these practices will always go for the cheapest option. And someone that can be ordered around without the pushback. Its never about safety. The dentist skims off the CRNAs collections. The dentist has already factored in this "never happened before" event into his cost of doing business. I'm glad the news article explicitly makes the distinction between ANESTHESIA NURSE vs. ANESTHESIOLOGIST. We need more people in the public to know the difference
 
Last edited:
The CRNA will blame the dentist (LAST or allergic reaction, take your pick). The dentist will blame anesthesia. No way to know with certainty what actually happened. A large settlement check will be written because of the horrific outcome and the world will keep on spinning. Unspeakably tragic but this will not change anything….
The fault lies with the anesthetist. The CRNA was there to safely sedate, and correctly resuscitate the patient.
LAST is a treatable clinical situation. My guess would be that this was a ventilation/oxygenation problem. Also easily treatable. None of us know the exact scenario, and likely never will. I would also add that I work with CRNAs and consider them a disaster waiting to happen.
 
Would love to know what monitors, equipment, and medications are available in these settings. Also curious of the dose and type of local used.

Agreed. Lots of information not known. Sometimes these places just use nitrous as sedation with no IV. Did this kid spasm and they couldn’t ventilate, goes hypoxic, arrests then can’t give epi because no IV and didn’t have the presence of mind to give IM? Was it gas inhalation then IV sedation? Did they have paralytics? Monitors?

From their website…..


“Pediatric
bg--image.png

Goal​

To allow your child’s dental procedure to be accomplished, in an office setting, safely and comfortably.

Methods​

An intravenous (i.v.) catheter is started and connected to tubing and i.v. fluid. In most cases we will ask one of the parents to sit in the dental chair with the child on their lap. The parent will help keep the child looking away from the anesthetist (often with the help of another family member) while the i.v. is started. Your child will experience only a slight sting. Typical reactions range from mild suprise to a little crying. Medications can then be swiftly given to have the child sleeping within seconds.

In children who are unable to tolerate this, we will administer an intramuscular injection of medications (see below) which will allow us to place an i.v. without them being aware of it. We will ask the child to give the parent a ‘big bear hug”, and the parent should hug the child tightly, keeping their arms clear of the upper part of the buttocks. The injection will be administered quickly. The medication does not sting and the reactions of children can vary greatly. Many children don’t cry, some cry mildly, and some respond vigorously. Within several minutes the child will be unaware of his/her surroundings and an i.v. can be safely placed. Occasionally, a parent will prefer to tell the child that they will be getting a shot. We will be happy to do this, but our experience leads us to favor the surprise approach, as the child doesn’t become apprehensive and doesn’t tighten muscles prior to the injection.

After the i.v. is placed, it will be used to administer sedative drugs and any additional drugs which may be necessary. It also provides access in the unlikely event that emergency drugs need to be administered. Parents are allowed back in the sedation room while sedation is initiated but then will be asked to return to the waiting area during the procedure.

Medications​

Intramuscular Ketalar (ketamine) and Versed (midazolam) may be used if the patient is uncooperative. This combination of drugs works quickly and the child will become unresponsive within several minutes. They will typically stare blankly and become flaccid. They may also drool and become teary-eyed. These are normal responses to the medication and are not cause for alarm.

I.V. medication is typically composed of an amnestic/hypnotic called Diprivan (propofol). This is given according to the patient’s weight and is administered by an infusion pump, which can be adjusted on a moment-to-moment basis. These drugs are very short acting and, therefore, wear off very quickly. Supplemental oxygen is usually given as well.

Dental restoration carries a high incidence of post-operative nausea and vomiting (PONV). For this reason, anti-nausea drugs are given through the i.v. in all cases as a preventative measure. The overall occurrence of PONV with our protocol is extremely low. When it occurs, it is usually self-limiting – meaning vomiting may occur once or twice, and the nausea subsides. Unchecked vomiting in a child can be a very serious problem. If your child experiences PONV at home which lasts for more than two hours, notify your dentist, who will prescribe an anti-nausea suppository.

Monitoring​

An EKG monitors the heart rhythm. A pulse oximeter monitors blood oxygen levels. Respiration is monitored by capnography and direct observation. An automatic blood pressure monitor is also used. Close observation is employed.

Recovery and Post-op​

Patients are usually ready to leave the office within one hour of the conclusion of the procedure. They will be able to sit without any undesirable symptoms, their vital signs will be stable, they will be responding in an appropriate fashion, and will display appropriate , but diminished, physical coordination. Children are discharged when still somewhat drowsy and will usually require carrying. They must have adult supervision for the remainder of the day and should not be allowed to participate in any activities in which lack of coordination or alertness would endanger them.”

 
The fault lies with the anesthetist. The CRNA was there to safely sedate, and correctly resuscitate the patient.
LAST is a treatable clinical situation. My guess would be that this was a ventilation/oxygenation problem. Also easily treatable. None of us know the exact scenario, and likely never will. I would also add that I work with CRNAs and consider them a disaster waiting to happen.
Agree that this was almost certainly an airway event. It just cannot be proven beyond a reasonable doubt. Could have it been LAST or anaphylaxis? Yup. LAST is notoriously difficult to resuscitate and can require prolonged CPR and cardiopulmonary bypass, which is just not gonna happen in a dentist office…
 
The fault lies with the anesthetist. The CRNA was there to safely sedate, and correctly resuscitate the patient.
LAST is a treatable clinical situation. My guess would be that this was a ventilation/oxygenation problem. Also easily treatable. None of us know the exact scenario, and likely never will. I would also add that I work with CRNAs and consider them a disaster waiting to happen.

LAST is easily treatable?
 
Agree that this was almost certainly an airway event. It just cannot be proven beyond a reasonable doubt. Could have it been LAST or anaphylaxis? Yup. LAST is notoriously difficult to resuscitate and can require prolonged CPR and cardiopulmonary bypass, which is just not gonna happen in a dentist office…

Really wonder if their anesthesia carts carry intralipid (or suxx or other essentials)
 
What is crazy to me is that these stories repeat over and over and over across time.

There are large cash profits to be made by the dentist who offers general anesthesia to his patients.

Anyone who's ever worked one of these gigs or thought about working one knows the dentists skimp on monitoring equipment, space and time for recovery, personnel to monitor in recovery - and of course, the biggest savings are in what kind of person they pay $hourly rate to provide the anesthesia. It's the Wild Wild West out there.

What is crazy to me is that somehow these stories don't repeat weekly. I have no doubt that the near misses occur that often. 🙁

We can (and should) shake our heads at the unsupervised CRNAs working these jobs. But we should be screaming at the dentists.
 
There are large cash profits to be made by the dentist who offers general anesthesia to his patients.

Anyone who's ever worked one of these gigs or thought about working one knows the dentists skimp on monitoring equipment, space and time for recovery, personnel to monitor in recovery - and of course, the biggest savings are in what kind of person they pay $hourly rate to provide the anesthesia. It's the Wild Wild West out there.

What is crazy to me is that somehow these stories don't repeat weekly. I have no doubt that the near misses occur that often. 🙁

We can (and should) shake our heads at the unsupervised CRNAs working these jobs. But we should be screaming at the dentists.

They will portray us as standing on the grave of a child for our own interests.
 
There are large cash profits to be made by the dentist who offers general anesthesia to his patients.

Anyone who's ever worked one of these gigs or thought about working one knows the dentists skimp on monitoring equipment, space and time for recovery, personnel to monitor in recovery - and of course, the biggest savings are in what kind of person they pay $hourly rate to provide the anesthesia. It's the Wild Wild West out there.

What is crazy to me is that somehow these stories don't repeat weekly. I have no doubt that the near misses occur that often. 🙁

We can (and should) shake our heads at the unsupervised CRNAs working these jobs. But we should be screaming at the dentists.

CRNAs do it because anesthesiologists would be unwilling to do it under those office based **** conditions. We anesthetize young kids all the time at the children's hospital and IMO that is where these young kids should be when they get dental work.
 
Exactly, maybe the real question is why this whole process isn’t better regulated?

Again it's all about $. Dentists don't want it to change because it hurts their bottom line. Having a dead kid every once in a while is baked into their cost of doing business.
 
I never understood why it makes sense that an extremely rare event blocks the ability to stock an emergency drug used for an immediately life threatening common issue.
Makes no sense. Also a moot point now that you can just use roc + suggamadex.
 
CRNAs do it because anesthesiologists would be unwilling to do it under those office based **** conditions. We anesthetize young kids all the time at the children's hospital and IMO that is where these young kids should be when they get dental work.
Working around the airway always fraught with nothing but hazard!!!
 
CRNAs do it because anesthesiologists would be unwilling to do it under those office based **** conditions. We anesthetize young kids all the time at the children's hospital and IMO that is where these young kids should be when they get dental work.
I don’t think it needs to be at a Children’s hospital. But a hospital nonetheless.
@ProwlerturnGas used to drive around doing dental anesthesia in the Pacific NW. They provided their own equipment and it was all docs.
Problem is, when **** goes south, you are ALONE without any help. No other docs around to assist just you. And the boss was all about rush, rush, rush. No Thanks.
 
Does this stuff get talked about on the Dental forums? Im curious what they think when cases like this happen.
 
Everyone keeps talking about LAST. The article talks about a cheek blowing up and the patient bradying down.
Does LAST cause swelling?

I think the cheek blowing up is probably red herring. Still thinking hypoxemic arrest
 
I think the cheek blowing up is probably red herring. Still thinking hypoxemic arrest
That or anaphylaxis. Either way oxygenate whichever way is the safest. And treat anaphylaxis if the case.

LAST? These pediatric dentists have been doing this for years but mistakes in calculations do happen or maybe their techs do all the drawing up of drugs. If that’s what it was, well poor kid. That’s a tough one.
 
Agree that this was almost certainly an airway event. It just cannot be proven beyond a reasonable doubt. Could have it been LAST or anaphylaxis? Yup. LAST is notoriously difficult to resuscitate and can require prolonged CPR and cardiopulmonary bypass, which is just not gonna happen in a dentist office…
"Beyond a reasonable doubt" doesn't enter into this at all. The standard is "preponderance of the evidence" or "more likely than not". That will be a slam-dunk in this case.

At least in this case (not that it helped) it sounds like they immediately called 911, rather than the fools in Colorado who sat on their brain-dead patient all day prior to transport to the hospital.
 
I've read at least 3-4 of these cases on this forum in the past year or two and all of them involved independent CRNAs. Have there been any equally egregious errors of anesthesiologists? If not, the ASA needs to start a national ad campaign that uses these cases as an example and reason to have an anesthesiologist involved in their care.
 
I don’t think it needs to be at a Children’s hospital. But a hospital nonetheless.
@ProwlerturnGas used to drive around doing dental anesthesia in the Pacific NW. They provided their own equipment and it was all docs.
Problem is, when **** goes south, you are ALONE without any help. No other docs around to assist just you. And the boss was all about rush, rush, rush. No Thanks.
Yep, have performed anesthesia on many children in peds dental offices. No longer do this job and haven’t for several years. I will say that if we only did these in a hospital, there would be a tremendous unmet need for these kids. Hospitals and quite frankly, anesthesiologists don’t want to do these cases. Dentists should absolutely only use BC anesthesiologists to do these. However, these tragedies happen with anesthesiologists too.

I am very skeptical that this was LAST. This was a loss of airway and ventilation. Probably kid was under anesthetized, but not awake, laryngospasm and fell off the cliff rather quickly. He was 3 yo. The margin is very thin.
 
Yep, have performed anesthesia on many children in peds dental offices. No longer do this job and haven’t for several years. I will say that if we only did these in a hospital, there would be a tremendous unmet need for these kids. Hospitals and quite frankly, anesthesiologists don’t want to do these cases. Dentists should absolutely only use BC anesthesiologists to do these. However, these tragedies happen with anesthesiologists too.

I am very skeptical that this was LAST. This was a loss of airway and ventilation. Probably kid was under anesthetized, but not awake, laryngospasm and fell off the cliff rather quickly. He was 3 yo. The margin is very thin.
Agreed. Also very strange that they wouldn’t be able to ventilate the kid especially if paralytic available. How hard can it be to mask ventilate a 3 year old?
 
I've read at least 3-4 of these cases on this forum in the past year or two and all of them involved independent CRNAs. Have there been any equally egregious errors of anesthesiologists? If not, the ASA needs to start a national ad campaign that uses these cases as an example and reason to have an anesthesiologist involved in their care.
But if it were an anesthesiologist that this happened to, I could more easily say "Things happen, we did the best we could" .

When there is no anesthesiologist involved, and we are compromising on a lower cost substandard option, its hard to NOT think "Could it have been different with someone with a higher level of training present?" As a parent I would always wonder that. With the anesthesiologist I would feel that at least everything had been done with the most skilled provider possible.
 
That or anaphylaxis. Either way oxygenate whichever way is the safest. And treat anaphylaxis if the case.

LAST? These pediatric dentists have been doing this for years but mistakes in calculations do happen or maybe their techs do all the drawing up of drugs. If that’s what it was, well poor kid. That’s a tough one.

Not an anesthesiologist. Not a dentist.

Multiple teeth extraction for an infected gum. (The part that hasn't been mentioned yet is that there are a lot of pediatric dentistry scammers out there; if true then this at least seems to be indicated.)

“they gave [redacted] the [redacted] and that is when his right cheek swelled up”

30 minutes in. A reasonable dentist should be finished around that time. Sounds to me like they gave an IV antibiotic, there was anaphylaxis and they were late in recognizing it.

According to the report, the doctor who performed the dental procedures said he had never seen anything like this in his career, especially in someone without any known allergies.

This sure sounds to me that the dentist thought it was anaphylaxis. Could he be wrong? Absolutely.

But the timing, the reported observations, and these statements to me sound like they were unable to treat anaphylaxis in a sedated patient. That to me at least is actually worse that not being able to deal with LAST or more involved anesthesia complications.
 
Top