Morbidity and Mortality from Pharmacosedation and General Anesthesia in the Dental Office

Krippaehne, James A.; Montgomery, Michael T.

doi:10.1097/00132586-199308000-00071

Cited by 8 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although most complications associated with sedation procedures are minor, some deaths have occurred. 15,16 In the 964 periodontal procedures reviewed in this article, 18 complications, all minor, were noted, for a rate of 1.87%, similar to that reported by Rodgers. 14 Although this article and others have documented the safety of intravenous dental sedation, 1-3,12-14 clinicians must remain diligent in the safe application of this procedure because the risk of death is always present when medications are introduced to patients intravenously.…”

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

Holtzclaw¹,

Hinze²,

Burnham

et al. 2014

Clin Adv Periodontics

View full text Add to dashboard Cite

Introduction: Numerous articles have documented the safety of intravenous moderate sedation when used as an adjunct for dental procedures. These articles have traditionally focused on surgical procedures and demonstrate significant differences in duration for periodontal versus oral surgery cases. Periodontal procedures typically last longer than oral surgery procedures, and, when using intravenous moderate sedation, these time differences can be critical because longer procedures require additional medication use and place patients in prolonged periods of altered consciousness. Case Series: The goal of this retrospective review is to analyze intravenous moderate sedation records from multiple private practicing periodontists to evaluate a variety of data and how they relate to periodontal procedures. Evaluated data included patient demographics, procedure type, procedure duration, medication dosages, fluid administration, hemodynamic changes, respiratory changes, and complications. Intravenous sedation cases performed during the past 5 years at five private periodontal practices were evaluated. Conclusions: Intravenous moderate sedation using fentanyl and versed is a safe and effective adjunct for periodontal surgical procedures with minimal complications. Predictable changes in hemodynamic and respiratory levels will ensue when using these agents. Finally, practitioners using intravenous moderate sedation should schedule an additional 30 minutes of procedure time to account for preoperative and postoperative patient management.

show abstract

Section: Discussionsupporting

confidence: 74%

“…j Improper use of sedation medications in terms of dosage and administration may result in severe consequences up to and including patient death. 15,16…”

Section: Discussionmentioning

confidence: 99%

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

Holtzclaw¹,

Hinze²,

Burnham

et al. 2014

Clin Adv Periodontics

View full text Add to dashboard Cite

show abstract

“…The literature on dental anesthesia complications has focused on specific anesthesia providers in adult age groups , procedural locations , or the general dental population . Few publications have characterized the risk factors associated with the use of sedation and general anesthesia in pediatric dentistry . We sought to understand pediatric anesthesia–related mortality risks in light of the evidence that increasing numbers of children were receiving anesthesia for dental procedures .…”

Section: Introductionmentioning

confidence: 99%

Trends in death associated with pediatric dental sedation and general anesthesia

Lee

Milgrom

Starks

et al. 2013

Pediatric Anesthesia

139

View full text Add to dashboard Cite

Background Inadequate access to oral health care places children at risk for caries. Disease severity and inability to cooperate often result in treatment with general anesthesia (GA). Sedation is increasingly popular and viewed as lower risk than GA in community settings. Currently, few data are available to quantify pediatric morbidity and mortality related to dental anesthesia. Objective Summarize dental anesthesia-related pediatric deaths described in media reports. Methods Review of media reports in the Lexis-Nexis Academic database and a private foundation website. Settings Dental offices, ambulatory surgery centers, and hospitals. Patients U.S.-based children (≤ 21 y.o.) who died subsequent to receiving anesthesia for a dental procedure between 1980–2011. Results Most deaths occurred among 2 –5 year-olds (n=21/44); in an office setting (n=21/44), and with a general/pediatric dentist (n=25/44) as the anesthesia provider. In this latter group, 17/25 deaths were linked with a sedation anesthetic. Conclusions This series of media reports likely represent only a fraction of the overall morbidity and mortality related to dental anesthesia. These data may indicate an association between mortality and pediatric dental procedures under sedation, particularly in office settings. However, these relationships are difficult to test in the absence of a database that could provide an estimate of incidence and prevalence of morbidity and mortality. With growing numbers of children receiving anesthesia for dental procedures from providers with variable training, it is imperative to be able to track anesthesia-related adverse outcomes. Creating a national database of adverse outcomes will enable future research to advance patient safety and quality.

show abstract

“…However, comparisons between studies are difficult due to the wide variability of drugs and techniques of administration as well as the reliability of the documentation. For example, hospitals provide the most accurate and complete records, but the distinction between anesthetic and surgical complications may not be clear.67 In addition, the validity of surveys that rely on the memories of practitioners for specific information concerning anesthetic/sedative techniques and patient responses should most certainly be questioned.67 M and M reviews support the association between greater risk of mortality with general anesthesia, particularly for cases treated in a hospital environment.67 68 Anesthetic mortality rates in the United Kingdom have been estimated to be 1:29,000 for both hospital in-patients and out-patients and 1: 248,000 for cases performed in the dental office and community clinics.68 Lower outpatient mortality rates in the range of 1: 500,000 to 1:1,000,000 have been reported for oral and maxillofacial surgeons surveyed in the United States.67 69 Anesthetic mortality rates have generally been shown to be higher in patients who are classified as ASA Class III and IV, but anesthetic deaths have also been reported in young, healthy patients.67-7071 The four most frequent causes of death due to general anesthesia relate to problems with airway management, ventilation, blood volume management, and arrhythmias.67 A strong association was found between the use of combination drugs and multiple routes of administration during a single sedation appointment and the occurrence of significant complications including death.67 71 In a more detailed report of 13 closed-claim cases, the main cause of morbid events was hypoxia secondary to airway obstruction or respiratory depression; all patients died, with the exception of one who suffered brain damage. The majority of these cases involved deep sedation/general anesthesia with methohexital and nitrous-oxide/ oxygen as primary agents.70 Many of the anestheticor sedation-related deaths occurred in dental offices that were either poorly equipped with physiologic monitoring devices, especially the pulse oxirneter, or failed to utilize those monitors that were present.7071 It should be noted that most of these dental offices would likely not meet current physiologic monitoring standards.…”

Section: Outcomes Assessment: Morbidity and Mortality (M And M)mentioning

confidence: 99%

Periodontal Implications: Anxiety

Mills

1996

Ann Periodontol

View full text Add to dashboard Cite

1. Monitoring significantly improves patient outcomes. 2. Observing and communicating with the patient is the most important means of monitoring the patient's status during sedation. 3. Monitoring of ventilations along with the assessment of oxygen saturation via a pulse oximeter is significant in preventing hypoxemia. 4. The use of supplemental oxygen is recommended. 5. Monitoring of blood pressure and pulse is highly recommended for assessing hemodynamic status. 6. Use of electrocardiograms is recommended for the patients with cardiovascular disorders.

show abstract

Morbidity and Mortality from Pharmacosedation and General Anesthesia in the Dental Office

Cited by 8 publications

References 0 publications

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

Trends in death associated with pediatric dental sedation and general anesthesia

Periodontal Implications: Anxiety

Contact Info

Product

Resources

About