Anesthesia is used in dentistry within various settings including hospital surgery centers and dentists' offices. Adherence to the accepted standards for levels of quality is critical in all settings. When using anesthetics, consistent and accurate monitoring is necessary using current equipment deemed suitable for the procedure. The Doctors Company, a medical liability insurer, studied related claims and determined that inadequate monitoring of patients under anesthesia was the third leading reason for malpractice claims related to this type of care.
Common allegations include insufficient observation of vital signs and both slow & poor quality reactions to these signs. Insufficient monitoring has lately generated significant demand for improved and integrated monitoring equipment and protocols. In many cases, the equipment and procedure were sufficient; however, the information was not properly interpreted by clinical operators.
Case in Columbia, Maryland
The Baltimore Sun reported on a tragic case of medical malpractice in Howard County Circuit Court. Jennifer Olenick, a 17-year-old, underwent a dental procedure involving her wisdom teeth conducted by anesthesiologist, Dr. Krista Michelle Isaacs, and oral surgeon, Dr. Domenick Coletti. A standard dose of anesthesia was initially administered; however, she required an additional amount to be “fully anesthetized”.
The claim states they demonstrated negligence by a failure to resuscitate Olenick when her heart rate reached a dangerously low level of only 40 beats per minute. The emergency response team said Olenick lacked a pulse and was believed to have experienced a significant and “irreversible brain injury”. Maryland's Chief Medical Examiner declared the cause of death was a lack of oxygen (hypoxia) while under anesthesia. Cathy Garger, her mother, is promoting awareness of these types of deaths across the country.
Research in Child Dental Sedation
Sedation is widely used in dental care involving children, and pediatric dentistry training emphasizes it. Nearly 20% of children need sedation to conduct efficient and safe child dental treatment. Those also at risk for problems involving sedatives are the elderly. Recently, several unfortunate such events were publicized leading to state legislative initiatives and investigations. A Texas review panel investigated 78 incidents and found 19 were handled improperly. Six of these led to death or severe injury, while four involved children less than eight years of age. California's Dental board also conducted research in 2016, revealing nine deaths among children related to anesthetics from 2010 to 2015.
New Risk Management Guidelines in Pediatric Dentistry
The American Academies of Pediatrics and Pediatric Dentistry issued guidelines relating to proper monitoring for pediatric dental care involving anesthesia such as:
- Monitoring equipment must be maintained and operating correctly
- The monitors must be properly placed on the patient
- A separate individual is assigned for patient monitoring who maintains constant communication with the dentist
- Alarms must be correctly set
- Alarms must be immediately responded to and assessed
- Take vital signs prior to any procedure to establish a comparative baseline
- Prior to discharge, the patient's blood pressure should be within 20% of the baseline measurement
- Objects or tools exposed to the patient need to be sanitized after each usage