Citing recent deaths of children undergoing dental procedures and oral surgery, Michael Wong, JD (Executive Director, PPAHS) singled out the case of six-year-old Caleb Sears.
In an article published August 14, 2016, Annie Kaplan, MD, Patricia Salber, MD, MBA, and Mr. Wong describe what happened to Caleb. “Caleb Sears was a healthy six-year-old boy who was looking forward to ice cream treats after his elective dental surgery. Before his dental extraction, Caleb’s parents were told that, despite being generally safe, intravenous anaesthesia has a risk of serious complications, including brain damage and death. What they weren’t told was that anaesthesia standards of practice vary in different settings. And, most importantly, that the risk goes up substantially when the oral surgeon is responsible for monitoring the effects of anaesthesia at the same time that he is doing the operation.”
To ensure the safety of children before, during and after sedation for diagnostic and therapeutic procedures, the American Academy of Paediatrics (AAP) and the American Academy of Paediatric Dentistry (AAPD) guidelines state that there must be a clinician present other than the practitioner whose sole responsibility is to monitor the patient’s vital signs:
“The use of moderate sedation shall include the provision of a person, in addition to the practitioner, whose responsibility is to monitor appropriate physiologic parameters and to assist in any supportive or resuscitation measures, if required.
“During deep sedation, there must be one person whose only responsibility is to constantly observe the patient’s vital signs, airway patency and adequacy of ventilation and to either administer drugs or direct their administration.”
Mr. Wong emphasised recommendations for patients and their families to ensure greater safety during elective dental procedures involving anaesthesia, saying that if the clinician does not answer these questions to their satisfaction, patients and their families should consider finding another clinician to perform the procedure:
- Prior to a procedure involving moderate sedation or general anaesthesia, patients and their families should ask their dentist or oral surgeon whether they will use a clinician with training in anaesthesia – separate from the dentist doing the procedure – to administer and monitor the anaesthesia consistent with recent paediatric guidelines.
- They should also ask what type of monitoring equipment (capnography, EKG and continuous pulse oximetry) will be used during the procedure.
- Finally, they should inquire about the type of resuscitation equipment and emergency plan is available in the office where the procedure is being performed just in case there is an adverse event.