Tragic death during dental procedure

[The kitchen sink]

After dental patient dies following routine procedure, widow calls for changes to anesthesia requirements

The North Carolina Dental Board is considering making sweeping changes to the way sedation dentistry is performed. The death of a well respected and greatly loved cardiologist in Wilmington during a routine dental procedure helped spur this movement.

www.wect.com

Extremely sad story and unfortunate loss of life.
Thoughts?

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[shepardsun]

An unfortunate loss of life is when someone dies of cancer or gets in a car accident.
This was a clean kill manslaughter.

 

[GassYous]

Anesthesia is easy and safe until it isn't. Every time I start to get complacent, I get a few cases that remind me just how dangerous our jobs can be.

 

[Agast]

Oh sh1t the dentist went straight to slash trach and skipped CPR completely

 

[chessknt]

You would think a cardiologist would at least have respect for the dangers of anesthesia and how untrained dentists are in that regard but apparently he too did not think the risks required training.

I see this all over the place from endo centers to dentists the cavalier approach to delivering anesthetics with no backup or training.

 

[anbuitachi]

I don't see them changing the rules. Would be severe backlash . How will dentist get the anesthesia money??

 

[Urzuz]

I’ve always thought that our field will continue to get encroached upon / eroded until we have a “Libby Zion” type case, where the wrong person dies/suffers at the hands of an untrained provider (be it a solo CRNA or a dentist), and the family has the willingness and means to make national news out of it. One can only hope that a clean assassination on a respected cardiologist brings about at least some change. RIP

You would think a cardiologist would at least have respect for the dangers of anesthesia and how untrained dentists are in that regard but apparently he too did not think the risks required training.

I see this all over the place from endo centers to dentists the cavalier approach to delivering anesthetics with no backup or training.

I don’t think that’s fair at all, and quite frankly is in poor taste to put blame on the victim. You have no idea what kinds of discussions took place before the procedure, what the dentist told the victim regarding his sedation credentials, who he even said was going to be doing the sedation, etc. Keep your eye on the ball and focus your attention on who actually deserves the blame in this scenario.

 

[deleted875186]

The article mentions increased cost passed on to patients if an anesthesiologist is required, but most of these dentists and oral surgeons are already charging cash for it. My wife had sedation at an oral surgery office for wisdom teeth years ago, procedure took less than 30 mins, IV versed and fentanyl, charged $500 for the “sedation”. I was freaked out by the setup, they had crappy monitors, old crappy ambu, the oral surgeon reassured me on doses of versed and fentanyl they would use, but honestly still felt uncomfortable, would probably never do it again for a family member or myself.

 

[Urzuz]

The article mentions increased cost passed on to patients if an anesthesiologist is required, but most of these dentists and oral surgeons are already charging cash for it. My wife had sedation at an oral surgery office for wisdom teeth years ago, procedure took less than 30 mins, IV versed and fentanyl, charged $500 for the “sedation”. I was freaked out by the setup, they had crappy monitors, old crappy ambu, the oral surgeon reassured me on doses of versed and fentanyl they would use, but honestly still felt uncomfortable, would probably never do it again for a family member or myself.

And that’s the point I was making to @chessknt above. The cardiologist and his wife may have had a very similar discussion with the dentist, and they may have elected to proceed just as you did with your wife. If in some alternate reality your wife (God forbid) had suffered from some complication, we would have been blaming the dentist, not you.

 

[chessknt]

I’ve always thought that our field will continue to get encroached upon / eroded until we have a “Libby Zion” type case, where the wrong person dies/suffers at the hands of an untrained provider (be it a solo CRNA or a dentist), and the family has the willingness and means to make national news out of it. One can only hope that a clean assassination on a respected cardiologist brings about at least some change. RIP



I don’t think that’s fair at all, and quite frankly is in poor taste to put blame on the victim. You have no idea what kinds of discussions took place before the procedure, what the dentist told the victim regarding his sedation credentials, who he even said was going to be doing the sedation, etc. Keep your eye on the ball and focus your attention on who actually deserves the blame in this scenario.

He is a trained medical professional who knows what sedation is. Unless the anesthetic was administered without consent or there was a dose mistake he agreed to allow a dentist to monitor a moderate sedation. I have personally refused this exact some proposition on myself and my family members exactly because I understand the risks that they don’t talk about or downplay.

 

[chessknt]

And that’s the point I was making to @chessknt above. The cardiologist and his wife may have had a very similar discussion with the dentist, and they may have elected to proceed just as you did with your wife. If in some alternate reality your wife (God forbid) had suffered from some complication, we would have been blaming the dentist, not you.

I am not blaming him I am just saying he had the knowledge to at least see that risks existed and still chose to ignore them. He isn’t a car mechanic who has no idea what versed is.

 

[Blockit]

I’m still failing to understand why this guy needed anything more than local for an implant.

 

[deleted875186]

And that’s the point I was making to @chessknt above. The cardiologist and his wife may have had a very similar discussion with the dentist, and they may have elected to proceed just as you did with your wife. If in some alternate reality your wife (God forbid) had suffered from some complication, we would have been blaming the dentist, not you.

Agreed, and I as a family member would feel horribly guilty. The “canned consent” the oral surgeon gave was very loose and quick, only after pointed questions did I get more info. Unless the cardiologist was interventional, no way he’s had any real experience with anesthesiologists and appreciated any of the risks. Most internists don’t really know the risks of anesthesia.

 

[epidural man]

That’s so weird. I always thought (and have witnesses myself) that Narcan and flumazenil reverse the effects of these respiratory depressing drugs that likely were used.

I must have been misinformed.

 

[jwk]

So looking at the picture in the article, this is an OMFS office. Oral surgeons know a lot more about anesthesia and airway management than a general dentist. But a trach in an oral surgery office and no CPR? Really? Gotta be missing some details.

 

[Southpaw]

So looking at the picture in the article, this is an OMFS office. Oral surgeons know a lot more about anesthesia and airway management than a general dentist. But a trach in an oral surgery office and no CPR? Really? Gotta be missing some details.

I think it’s really difficult to rely on training if you haven’t routinely been doing it post-training. It’s also likely that the limited anesthesia training the OMFS never included an anesthesia overdose/airway disaster that they had to manage with no help around. Stress can make people think very unclearly.

 

[The kitchen sink]

I think it’s really difficult to rely on training if you haven’t routinely been doing it post-training. It’s also likely that the limited anesthesia training the OMFS had never included an anesthesia overdose/airway disaster that they had to manage with no help around. Stress can make people think very unclearly.

They probably don’t have much experience with anesthesia or airway complications or with running a code. All of the things you need an anesthesiologist for.

 

[90sportsfan]

Unfortunately, this is not uncommon:

Mother of teen who died after dental surgery advocates for dental safety

The mother of a Howard County teenager who died after dental surgery wants to see all pediatric dental procedures that use general anesthesia take place in hospitals someday. But for now, Cathy Gar…

www.baltimoresun.com

Man Dies After Being Given Too Much Anesthesia During Dental Surgery: Coroner

A Lake County dentist is the subject of an investigation by the state’s attorney’s office after a patient died following a dental procedure in early June.

www.nbcchicago.com

 

[HemeOncHopeful19]

Sounds like there is even more to this story, I clicked on a link in the article OP linked and apparently this OMFS dude was diverting Fentanyl?

 

[90sportsfan]

We've had many threads on this forum over the past years about the fact that dental sedation is dangerous especially when performed by the dentist who has minimal training and frankly no business doing it. For dentists it's all about the extra cash from offering sedation services without the equipment and expertise to actually deal with issues that come up. Having an anesthesia provider in the room means that +++ extra cash doesn't end up in the dentist's pocket. This is just another sad reminder that these dentists consider $ more important than lives.

This is pretty common. It seems like at least once a year there is a story about anesthesia gone wrong in a dental office that results in death. Although, I don't know that dentists necessarily do this directly for the money. I think it's more indirect. It's my understanding that for wisdom tooth extraction (and other invasive procedures, which I guess implant placement could qualify as?), many patients want to be completely sedated; so by offering that service, they get to keep the patient in their office rather losing them to a dentist down the road that offers sedation. I'm not sure they are necessarily doing it just for extra money that sedation offers because I'm guessing not too many people want/use it.

The thing that makes this case more interesting is that the dentist was an OMFS, so they should have more training. Although he was just a plain DDS. There are more OMFS programs now that are longer residencies and where the dental trainees get an MD. Not sure if those programs provide more in-depth medical training or not though. I'd be interested to know.

Maybe this is a sign that the training programs need to have more of a focus on general anesthesia/sedation. As someone mentioned, it's probably easy enough to learn, but the issue is, do they know what to do when things go wrong and there are complications??? That's the real key.

I also posted a link where an oral surgeon had a young 17 year old die from anesthesia, although there was an Anesthesiologist MD with him in the office during the procedure (he made the news, but both were sued). So maybe this points to bigger issues with the setup of doing this in a small outpatient dental office???

 

[Arch Guillotti]

That’s so weird. I always thought (and have witnesses myself) that Narcan and flumazenil reverse the effects of these respiratory depressing drugs that likely were used.

I must have been misinformed.

Guys like this are giving propofol and ketamine.

 

[GassYous]

I’ve always thought that our field will continue to get encroached upon / eroded until we have a “Libby Zion” type case, where the wrong person dies/suffers at the hands of an untrained provider (be it a solo CRNA or a dentist), and the family has the willingness and means to make national news out of it. One can only hope that a clean assassination on a respected cardiologist brings about at least some change. RIP



I don’t think that’s fair at all, and quite frankly is in poor taste to put blame on the victim. You have no idea what kinds of discussions took place before the procedure, what the dentist told the victim regarding his sedation credentials, who he even said was going to be doing the sedation, etc. Keep your eye on the ball and focus your attention on who actually deserves the blame in this scenario.

We already had that case. It involved Michael Jackson. I still have patients mention it regularly and are nervous about going under due to it. Ironically he had a cardiologist doing his sedation. I remember reading threads here from gi docs trying to justify their use of propofol and as soon as the MJ case hit the presses all that talk immediately stopped.

Our omfs do 3rd and 4th year of medical school, at least one year of gen surg and six months of anesthesia where they sit the room like our residents.

 

[narcotics999]

That’s so weird. I always thought (and have witnesses myself) that Narcan and flumazenil reverse the effects of these respiratory depressing drugs that likely were used.

I must have been misinformed.

Probably Larynospasm.

 

[Arch Guillotti]

Probably Larynospasm.

I would guess oversedation and loss of airway. The NC Dental board judgement is an interesting read to say the least.

 

[anbuitachi]

We already had that case. It involved Michael Jackson. I still have patients mention it regularly and are nervous about going under due to it. Ironically he had a cardiologist doing his sedation. I remember reading threads here from gi docs trying to justify their use of propofol and as soon as the MJ case hit the presses all that talk immediately stopped.

Our omfs do 3rd and 4th year of medical school, at least one year of gen surg and six months of anesthesia where they sit the room like our residents.

omfs residents are allowed to be in the room alone like anesthesia residents?
does this apply to every resident? sometimes i have peds/ed/ICU people rotating in anesthesia, i can just leave them alone?

 

[nimbus]

Oh sh1t the dentist went straight to slash trach and skipped CPR completely

At least the dentist recognized it was probably an airway problem and not the ubiquitous, generic, and unhelpful “bad reaction to anesthesia”.

 

[GassYous]

omfs residents are allowed to be in the room alone like anesthesia residents?
does this apply to every resident? sometimes i have peds/ed/ICU people rotating in anesthesia, i can just leave them alone?

No because those are rotators but these guys do basically every case except cardiac and maybe peds. Treated like ca1s.

 

[anaesthetic]

omfs residents are allowed to be in the room alone like anesthesia residents?
does this apply to every resident? sometimes i have peds/ed/ICU people rotating in anesthesia, i can just leave them alone?

I mean, you can do whatever you want with your rooms. There are anesthesia residents I’ve worked with that I wouldn’t leave alone in a room.

 

[coffeebythelake]

At least the dentist recognized it was probably an airway problem and not the ubiquitous, generic, and unhelpful “bad reaction to anesthesia”.

slash trach? wonder if the dentist even knows where to cut? they have scalpels? What happened to good ol' mask ventilation?

 

[coffeebythelake]

This is pretty common. It seems like at least once a year there is a story about anesthesia gone wrong in a dental office that results in death. Although, I don't know that dentists necessarily do this directly for the money. I think it's more indirect. It's my understanding that for wisdom tooth extraction (and other invasive procedures, which I guess implant placement could qualify as?), many patients want to be completely sedated; so by offering that service, they get to keep the patient in their office rather losing them to a dentist down the road that offers sedation. I'm not sure they are necessarily doing it just for extra money that sedation offers because I'm guessing not too many people want/use it.

The thing that makes this case more interesting is that the dentist was an OMFS, so they should have more training. Although he was just a plain DDS. There are more OMFS programs now that are longer residencies and where the dental trainees get an MD. Not sure if those programs provide more in-depth medical training or not though. I'd be interested to know.

Maybe this is a sign that the training programs need to have more of a focus on general anesthesia/sedation. As someone mentioned, it's probably easy enough to learn, but the issue is, do they know what to do when things go wrong and there are complications??? That's the real key.

I also posted a link where an oral surgeon had a young 17 year old die from anesthesia, although there was an Anesthesiologist MD with him in the office during the procedure (he made the news, but both were sued). So maybe this points to bigger issues with the setup of doing this in a small outpatient dental office???

Was there a dedicated staff member managing the sedation? I would never think about doing a complex procedure while also doing sedation in the periphery. Vigilance is the key. Doesn't matter how much training they have in resuscitation or rescuing the airway if they are 5 minutes too late in recognizing a problem.

 

[anbuitachi]

I mean, you can do whatever you want with your rooms. There are anesthesia residents I’ve worked with that I wouldn’t leave alone in a room.

i mean aren't there rules... ? im not talking about breaking the rules. like i can leave the patient alone in the room if i want under anesthesia, but prob not allowed

 

[IMGASMD]

i mean aren't there rules... ? im not talking about breaking the rules. like i can leave the patient alone in the room if i want under anesthesia, but prob not allowed

They have an MD/DO, right? So they can practice medicine. Even if they’re residents, they will be practicing on your license…..

when I was a student, there was some very cavalier attendings that would leave me in the room. Probably not allowed, but are there “rules” or “regulations”? I am not sure.

 

[coffeebythelake]

Embattled oral surgeon Dr. Mark Austin permanently surrenders NC dental license

One year after a prominent Wilmington doctor died during a dental procedure in the care of Dr. Mark Austin, Austin has permanently surrendered his dental license. An investigative panel for the North Carolina State Board of Dental Examiners found Austin’s actions resulted in his patient’s death.

www.wect.com

 

[gcc322]

I mean, you can do whatever you want with your rooms. There are anesthesia residents I’ve worked with that I wouldn’t leave alone in a room.

Where I trained the OMFS residents did 6 months of anesthesia. First one paired with an anesthesia resident in the room, the last 5 months on their own.

 

[undalay]

Giving anesthesia in medical Offices, dental clinics without adequate resuscitation equipment, space and post sedation nursing care is a recipe for unmitigated disaster.

 

[coffeebythelake]

My personal experience working with a number of omfs residents and surgeons: clueless about physiology and about anesthesia.

 

[nimbus]

i mean aren't there rules... ? im not talking about breaking the rules. like i can leave the patient alone in the room if i want under anesthesia, but prob not allowed

Offices are the Wild West. Even doctors do crazy stuff with ancient inadequate equipment in them.

 

[coffeebythelake]

Offices are the Wild West. Even doctors do crazy stuff with ancient inadequate equipment in them.

We do some "office based anesthesia" in our outpatient center. No anesthesia machine, but we have a stocked anesthesia cart with drugs, suction, oxygen supply, basic monitors, airway equipment and ambubag for PPV. Basically everything that is needed to deal with an emergency. It is NOT an expensive set up (probably less than $2500) and it doesn't take up much room. Sadly even this is too much to ask for from many dental offices.

 

[DocVapor]

Where I trained the OMFS residents did 6 months of anesthesia. First one paired with an anesthesia resident in the room, the last 5 months on their own.

Oh, great. Just enough to become really effing dangerous.

 

[coffeebythelake]

Oh, great. Just enough to become really effing dangerous.

Yeqh no kidding. Less anesthesia training than a newbie CA1 and the dental board gives them a rubber stamp to go sedating patients

 

[nimbus]

slash trach? wonder if the dentist even knows where to cut? they have scalpels? What happened to good ol' mask ventilation?

From your link, it looks like he tried and failed.

 

[IMGASMD]

Not sure what cps is… but seems like he tried many things.

 

[coffeebythelake]

This is the late Dr Patel. Not a large man. By his external airway anatomy I wouldn't have expected his airway to be difficult to mask ventilate or intubate. Was he overly sedated and became apneic? Did he laryngospasm?

So again goes to question how adept the dentist was at with these basic anesthesia knowledge and skills. And if he can't mask ventilate or intubate despite his 6 months of anesthesia training, or go through a quick 5 second differential diagnosis for hypoxemia, what makes him think he knows how to do a crash trach?

 

[nimbus]

View attachment 349691

This is the late Dr Patel. Not a large man. By his external airway anatomy I wouldn't have expected his airway to be difficult to mask ventilate or intubate. So again goes to question how adept the dentist was at with these basic anesthesia skills. And if he can't mask ventilate or intubate despite his 6 months of anesthesia training what makes him think he knows how to do a crash trach?

Joan Rivers didn’t look like a difficult airway either.

 

[coffeebythelake]

Joan Rivers didn’t look like a difficult airway either.

Remind me, she died from laryngospasm? Did they have suxx in the facility? Bottom line is unexpected things can happen unexpectedly, and bad outcomes do happen from time to time. It is q testament to the need for adequate equipment, monitoring and trained staff. would a patient rather have an experienced dedicated anesthesia provider doing the anesthesia... vs someone with a 6 month course and a rubber stamp certification who is doing both the dental procedure and the anesthesia?

 

[nimbus]

Remind me, she died from laryngospasm? Did they have suxx in the facility? Bottom line is unexpected things can happen unexpectedly, and bad outcomes do happen from time to time. It is q testament to the need for adequate equipment, monitoring and trained staff. would a patient rather have an experienced anesthesia provider doing the anesthesia vs someone with a 6 month course and a rubber stamp certification from the dental board?

I think it was. She was having GI endoscopy at an endoscopy center in Manhattan. Then an ENT wanted to do a last minute laryngoscopy. At some point she arrested. There were multiple board certified anesthesiologists present.

 

[ValentineD]

This is the late Dr Patel. Not a large man. By his external airway anatomy I wouldn't have expected his airway to be difficult to mask ventilate or intubate. Was he overly sedated and became apneic? Did he laryngospasm?

So again goes to question how adept the dentist was at with these basic anesthesia knowledge and skills. And if he can't mask ventilate or intubate despite his 6 months of anesthesia training, or go through a quick 5 second differential diagnosis for hypoxemia, what makes him think he knows how to do a crash trach?

The really insane thing is that he got his dental license in 2001. I confess to not know the nuances of how OMFS training and licensure works, but it could have theoretically been ~20 years since he even attempted BMV or intubation. Really not surprised he whiffed.

 

[coffeebythelake]

I think it was. She was having GI endoscopy at an endoscopy center in Manhattan. Then an ENT wanted to do a last minute laryngoscopy. At some point she arrested. There were multiple board certified anesthesiologists present.

I dont think there is a ton of details about what happened, but it was an Indian woman anesthesiologist who reportedly expressed concern that the ENT was doing an unconsented VC biopsy while Rivers was sedated without a secured airway. Ultimately had a rapid deterioration when she laryngospasmed, unclear if suxx was available (many office based places don't), was ultimately intubated but too late.

 

[Radetzky]

Sad story, another anesthesia death. Seems like only a matter of time before they impose changes on our profession.

https://www.wect.com/2022/02/03/after-dental-patient-dies-following-routine-procedure-widow-calls-changes-anesthesia-requirements/?fbclid=IwAR1DfQsCrjxhFMesJ07WNMzPmhbUSTgbpc8GeA7sbCyeNbGYvTXt43_Unj4

forums.studentdoctor.net

The dental surgeons seem worried

 

[nimbus]

How common is sedation for dental implants? I have 2 family members who have them and none ever got sedation.