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Risks involved in Procedural Sedation

A 5-year old girl was on life support at a hospital after a routine visit to the dentist. She had suffered a heart attack after receiving intravenous sedation.//

Procedural sedation is done usually done to eliminate pain and anxiety during routine medical and dental procedures. The mother, Ommettress Travis, of the girl, Diamond Brownridge told the WLS – TV that an oral sedative, an IV sedative and nitrous oxide gas were given to her daughter at a Chicago dental clinic. During the treatment the mother was asked to go out of the room and when she returned, she found Diamond lying lifeless.

Diamond had visited the dental clinic on Saturday to get 2 cavities fixed and 4 lower teeth capped. On Monday night the girl was reported to be brain dead with severely damaged vital organs. Diamond’s family has been asked to decide as to when to take her off the life support.

This is a tragic case of dangers of procedural sedation. This procedure is often used in ERs while aligning broken bones or sewing wounds in kids. It is used in several dental procedures too.

"Procedural sedation can make an ER or dental experience much better," said Dr. Roger Humphries, chairman of emergency medicine at the University of Kentucky Hospital in Lexington. He said, "Procedures that were once performed in the operating room can now often be done in doctors' offices and emergency rooms, which saves time, money and hospital resources.

"Procedural sedation is a very good tool in certain situations and under very close observations. It's used frequently at the University of Kentucky emergency room during the alignment of bones and the closure of cuts — such as facial lacerations and finger or toe lacerations in children — that would be difficult to repair with only a local anesthetic. "But, all patients need to be monitored continuously while receiving procedural sedation. At the University of Kentucky ER, there is a physician present who monitors the patient throughout the procedure. There is also a nurse who monitors the patient and keeps a close record of vital signs and medications given. The tools needed to treat complications are kept in the room and are available very quickly, "he explained.

About probable complications, Humphries said "breathing problems are the most common and most significant complication, especially in children." "There are very specific guidelines that must be followed when deciding when it should be used and who is the right patient," he said.

Other constant health problems, allergies, patient’s last diet, physical factors like weight and other conditions that may increase the risk of complications are some of the points included in the guidelines.
"There is no safety net when using sedation in an office," said Dr. Lee Winter, chief of anesthesiology at New York Downtown Hospital. He said, "Hospitals have access to lifesaving equipment — the tools needed to fix or reverse major problems — and the staff to handle the rare complications that can arise with sedation." "In an office, sometimes all we can do is call 911," he added.

Stan Cohen, an office manager at Cohen Dental and Implant Center in New York and a former paramedic who performs and monitors the sedation during the procedures, said "Most private offices are held to high standards and training when it comes to sedation. We undergo thorough training and have very strict guidelines to be able to perform these procedures in our office. We have all the tools available in our office to deal with the common complications associated with sedation."

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