Sedation Tragedy

Her name was Diamond. The little 5 year old who died the other day. She had lapsed into a coma after receiving sedative medications for treatment in a Chicago dental office. We don't yet know what happened. Reports are that she received medications via three different routes including IV. We do not know if the child had any predisposing medical conditions. It appears she went into a deep sedative state and lost her respiratory function; she stopped breathing on her own. We don't yet know what occurred.

This is a very rare event, in fact:

No child has ever died as the result of any dental sedation that has been done in accordance with the Academy of Pediatric Dentistry's guidelines. I know in our state (Alabama) you can only intentionally put the child in a state of conscious sedation (not deep sedation), otherwise you have to follow different protocols, equipment and licensure requirements, like a hospital. I personally have never know of any severe complications in our area.

Most kids do quite well without any kind of extra medication to accomplish treatment. However, sometimes medications are needed to help kids to be comfortable and cooperate to accomplish treatment. Sometimes it is even necessary to do treatment under General Anesthesia in the Hospital. Many times, however, the hospital is not an option due to lack of insurance coverage, limited treatment needs, or parental preference. The option of in office conscious sedation has been a good option to help kids and parents. After extensive training and experience, I use this valuable method of providing treatment nearly every day and am very confident in the use of medications to relieve discomfort, reduce anxiety and provide a safe environment through concious sedation. Every time a parent puts their child in my care, I pray I have the knowledge, skill, and compassion to keep that child safe. Things can be unpredictable. Bad things can happen to anyone, but knowing that, like the Boy Scout motto says: be prepared. God willing, this will never happen again no matter what the reason.

More information here: Sedation in Pediatric Dentistry

Update August 17, 2007: I just saw a news piece on Fox News. Now I like Fox News, but the "news report" was a little overboard. Although the story alluded to the incident with Diamond, most of the story really had little to do with that particular incident. One of the physicians speculated that Diamond had a pre-existing medical condition (which is not improbable). However, the headline of the story was "is laughing gas safe?". What? Patients are awake during nitrous oxide administration. The doctors on the program did give a rational answer that it is safe. In fact, it likely had nothing to do with this unfortunate incident. These very rare problems tend to arise with over-dosage of much stronger medications and the interaction between them combined with pre-existing unknown medical conditions and improper monitoring of the patient. Even local anesthetic can interact with other medicines to create an adverse reaction. I think this news piece will just create unnecessary anxiety in parents that is not based on any scientific or rational information.

Update December 2007: In "Pediatric Dentistry Today" Sept. 2007, Volume XLIII, Number 5, it was reported the child had very large dosages of multiple oral and IV medications. My conclusion is that it was primarily an overdose situation that was not monitored nor handled correctly all along the way.