Yet another dental sedation death

[coffeebythelake]

Pierce County dentist suspended after patient dies allegedly from procedure

A Pierce County dentist has been suspended after allegedly killing a patient during a procedure.

www.kiro7.com

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[Dr. Anonymouss]

Pierce County dentist suspended after patient dies allegedly from procedure

A Pierce County dentist has been suspended after allegedly killing a patient during a procedure.

www.kiro7.com

Will this lead to eventual change of dental offices requiring a licensed anesthesia provider or will they just chalk this one up to either a freak accident or provider incompetence. Not too familiar with dental anesthesia but it seems like it’s been done this way for a long time.

 

[coffeebythelake]

Nothing ever changes with these dentists. The story is always the same. Improper monitoring, delayed recognition of patient in distress, and poor skills to deal with emergencies. They always try to blame the individual dentist for cutting corners, etc when the system is the problem. They want business as usual, and if it means offing a patient every once and again its OK because $$$. No dentist ought to be allowed to both perform the procedure and administer the anesthetic at the same time.

 

[geauxg8rs]

Nothing ever changes with these dentists. The story is always the same. Improper monitoring, delayed recognition of patient in distress, and poor skills to deal with emergencies. They always try to blame the individual dentist for cutting corners, etc when the system is the problem. They want business as usual, and if it means offing a patient every once and again its OK because $$$. No dentist ought to be allowed to both perform the procedure and administer the anesthetic at the same time.

You’re just anti dentite

 

[Coffee PRN]

The issue is nurse sedation/non-anesthesia sedation in general. It's less safe, and has a much higher rate of arrest 2/2 to hypoxia than having an anesthesiologist properly managing.

 

[Dr. Rude]

The issue is nurse sedation/non-anesthesia sedation in general. It's less safe, and has a much higher rate of arrest 2/2 to hypoxia than having an anesthesiologist properly managing.

How many non-anesthesia sedation cases are done in dental offices on an annual basis? How many adverse/catastrophic events would be avoided by having anesthesia personnel? How many would more would be caused by "pushing it" since we now have a trained anesthesiologist or CRNA we don't need to do this in the surgicenter or hospital?

Or put another way:

"A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one."

 

[NumTacos]

You can look up some of the details under provider search on the DOH site. Patient was a sick guy getting teeth pulled prior to valve replacement. The dentist classified the patient as an ASA II, if the statement of charges is correct, he's easily a 4. The patient's PCM signed off of "medical clearance". The patient only received oral and IV benzos, dosage wasn't indicated. Reversal was attempted with flumazenil . After 40 minutes of resuscitation, patient expired.

 

[Dr. Rude]

You can look up some of the details under provider search on the DOH site. Patient was a sick guy getting teeth pulled prior to valve replacement. The dentist classified the patient as an ASA II, if the statement of charges is correct, he's easily a 4. The patient's PCM signed off of "medical clearance". The patient only received oral and IV benzos, dosage wasn't indicated. Reversal was attempted with flumazenil . After 40 minutes of resuscitation, patient expired.

epi in the local?

 

[NumTacos]

Doesn't look like it, but could have been local anesthetic toxicity.

 

[PpfSuxTube]

You can look up some of the details under provider search on the DOH site. Patient was a sick guy getting teeth pulled prior to valve replacement. The dentist classified the patient as an ASA II, if the statement of charges is correct, he's easily a 4. The patient's PCM signed off of "medical clearance". The patient only received oral and IV benzos, dosage wasn't indicated. Reversal was attempted with flumazenil . After 40 minutes of resuscitation, patient expired.

Thanks for that. Why can't it just be plain old hypoxemia?
Some of our TAVIs go apneic with 2mg midaz. Kicking with 1mg, almost respiratory arrest with the second mg... not often but once every few months maybe.

I try to never bolus those anymore but the proceduralists are so fast nowadays that the infusions don't have time to hit steady state

 

[Dr. Rude]

View attachment 378678
Doesn't look like it, but could have been local anesthetic toxicity.

Local anesthetic toxicity? NFW.

 

[nimbus]

You can look up some of the details under provider search on the DOH site. Patient was a sick guy getting teeth pulled prior to valve replacement. The dentist classified the patient as an ASA II, if the statement of charges is correct, he's easily a 4. The patient's PCM signed off of "medical clearance". The patient only received oral and IV benzos, dosage wasn't indicated. Reversal was attempted with flumazenil . After 40 minutes of resuscitation, patient expired.

Local anesthetic toxicity? NFW.

Unlikely to be LAST for a dental extraction but a little intravascular epi could cause decompensation in a critical AS patient.

FWIW these pre-SAVR/pre-TAVR dental extractions tend to be hot potatos in our relatively high acuity practice. There was an intraoperative death a few years ago at another hospital we staff. “Tag, you’re it!”

I actually feel kinda bad for the dentist. He probably didn’t want to do the case either.

 

[coffeebythelake]

This was a case not suitable for a free standing dental office.

 

[nimbus]

Will this lead to eventual change of dental offices requiring a licensed anesthesia provider or will they just chalk this one up to either a freak accident or provider incompetence. Not too familiar with dental anesthesia but it seems like it’s been done this way for a long time.

There is not an adequate supply of “licensed anesthesia providers” for that to happen unless we import thousands from countries that are worse off than us.

 

[nimbus]

This was a case not suitable for a free standing dental office.

But “cleared” by the patient’s PCP who was a PA.


Reading these allegations, this patient would have been a very hot potato, more or less a grenade, where I work.

 

[coffeebythelake]

There is not an adequate supply of “licensed anesthesia providers” for that to happen unless we import thousands from countries that are worse off than us.

And yet somehow we are able to deal with the surgence of NORA and greatly expand the number of cases and anesthetiIng locations with minor difficulty. I would also take a sedation trained nurse over some untrained MA or whoever dentists usually use to administer the drugs and watch thr patient.

This was a case of poor patient selection, poor judgement by the dentist and poor monitoring vigilance. The PA deserves some blame too.

 

[repititionition]

There is not an adequate supply of “licensed anesthesia providers” for that to happen unless we import thousands from countries that are worse off than us.

of course there is. the second variable, unspoken, is time.

It would just require delaying some care.

 

[PpfSuxTube]

Almost no one 'needs' sedation for dental work. It's just greed and hubris. That would solve your supply issues instantly.

Let's be honest i don't think a new valve was gonna do much for this dudes quality of life either so it's all nonsense really.

 

[kb1900]

Wonder if the PA will continue to sign off these “clearances” for asa “2”s with CHF, pulmonary fibrosis and valvulopathy

 

[kb1900]

Almost no one 'needs' sedation for dental work. It's just greed and hubris. That would solve your supply issues instantly.

Let's be honest i don't think a new valve was gonna do much for this dudes quality of life either so it's all nonsense really.

The vast vast majority of anesthesiologists though could safely provide anesthesia and life saving interventions if needed for a case like this. And also have enough judgement to withhold uncessecaary sedation if risk was greater than benefit. And also realize that this is a case that shouldn’t happen in the office if adamant about sedation.

A dentist on the other hand..

 

[coffeebythelake]

Almost no one 'needs' sedation for dental work. It's just greed and hubris. That would solve your supply issues instantly.

Let's be honest i don't think a new valve was gonna do much for this dudes quality of life either so it's all nonsense really.

Agree that many patients don't need dental sedation. It is a lucrative "product" that dentists sell to pad their bottom line. My wife had her wisdom teeth taken out with local only. It was a little bit uncomfortable but totally doable.

The problem is when patients demand unreasonable things, "i want to be completely knocked out", and that is coupled by a healthcare professional willing to offer it without adequately assessing the risk involved "sure we will knock you out"

Methinks a lot of dentists also want their patients to be completely still doing the more complicated procedures and dismiss drugs like versed as being very safe and easily reversible.