Adverse Events during Pediatric Dental Anesthesia and Sedation: A Review of Closed Malpractice Insurance Claims.
ABSTRACT The purpose of this study of closed malpractice insurance claims was to provide descriptive data of adverse events related to child sedation and anesthesia in the dental office.
The malpractice claims databases of two professional liability carriers were searched using pre-determined keywords for all closed claims involving anesthesia in pediatric dental patients from 1993-2007.
The database searches resulted in 17 claims dealing with adverse anesthesia events of which 13 involved sedation, 3 involved local anesthesia alone, and 1 involved general anesthesia. Fifty-three percent of the claims involved patient death or permanent brain damage; in these claims, the average patient age was 3.6 years, 6 involved general dentists as the anesthesia provider, and 2 involved local anesthesia alone. Local anesthetic overdoses were observed in 41% of the claims. The location of adverse event occurrence was in the dental office where care was being provided in 71% of the claims. Of the 13 claims involving sedation, only 1 claim involved the use of physiologic monitoring.
Very young patients (≤ 3-years-old) are at greatest risk during administration of sedative and/or local anesthetic agents. Some practitioners are inadequately monitoring patients during sedation procedures. Adverse events have a high chance of occurring at the dental office where care is being provided.
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ABSTRACT: Recognizing the inconsistencies in sedation practices, the Society for Pediatric Sedation convened this meeting to begin the process of defining quality as it relates to the field of pediatric sedation. Millions of procedures are performed each year on children. Caring for children, even for routine procedures, can be challenging. Children may not have the ability to follow commands, tolerate painful stimuli, or even lie still for a diagnostic study. Therefore, pharmacologic sedation with medications designed to blunt the awareness of the patient and provide relief of pain and anxiety is necessary. A multidisciplinary group of sedation providers and quality methodology experts met in November 2011. Through 2 days of didactics, small workgroups, and consensus discussions, the attendees met the objectives of exploring quality in pediatric sedation around the Institute of Medicine's (IOM, ) six aims of quality: Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. The conference findings outlined in this document address the Agency for Healthcare Research and Quality's (AHRQ) mission of improving quality healthcare for all Americans, especially for underrepresented groups such as children. The conference outlines a key next step in defining and achieving quality in pediatric procedural sedation.Journal for Healthcare Quality 08/2013; DOI:10.1111/jhq.12033
Article: Fatal visit to the dentist.[Show abstract] [Hide abstract]
ABSTRACT: A 23-year-old woman was mortally afraid of dental interventions and decided to have her four wisdom teeth removed by outpatient surgery under endotracheal anaesthesia. According to the files, the patient was categorized as ASA I and Mallampati II, and surgery was considered an elective routine intervention. Soon after initiation of anaesthesia, O2 saturation and blood pressure dropped, and the young woman died shortly afterwards in spite of immediate resuscitation measures. At first, an allergic reaction to succinylcholine, which had been administered as a muscle relaxant, was suspected. Autopsy and histological examination showed haemorrhagic pulmonary oedema and a defined lesion in the midportion of the oesophageal mucosa in spite of correct placement of the endotracheal breathing tube. Ultimately, misintubation into the oesophagus, which had not been noticed at first, was determined as cause of death.Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 11/2013; DOI:10.1007/s00414-013-0930-8 · 2.69 Impact Factor