The day before my six-year old nephew, Caleb, passed away my sister-in-law and I had taken our kids to buy them new bicycles. Caleb was the oldest and could ride circles around his little sister and my girls. I remember his smiling face as he deftly showed his younger sister and cousins how amazing it is to ride a bike.<\/p>\n
The next day Caleb had an appointment at an oral surgeon\u2019s office to have a mesiodens tooth extracted under general anesthesia.\u00a0 My family understood that all anesthesia carries risk, but did not understand the differences in safety precautions and risk when anesthesia is administered by dentists and oral surgeons. My brother and sister in law trusted the oral surgeon and followed his advice when he recommended general anesthesia for the procedure.<\/p>\n
Caleb went in to the oral surgeons office for this elective procedure the next morning. Moments after, my sister in law sent me a text, \u201cHelp! 911 Lost airway. Come to Children\u2019s Hospital Oakland now,\u201d I met my family in the Emergency department moments after Caleb was admitted. The Emergency Medicine attending had immediately intubated Caleb, the ED team had paralyzed him and was working to stabilize his heart. What felt like moments later, the EM attending pulled me into the hallway and recited his condition: \u201cHe was possibly without an airway for 45 minutes but we don\u2019t know,\u201d Then: \u201cAll his teeth were broken. A surgical airway had been attempted and failed. He coded 3 times in the ambulance.\u201d I saw in the attending physician\u2019s eyes and knew in my heart that my nephew was gone.<\/p>\n
Grief takes many forms. For me, I needed to find out what had happened. I already knew my nephew did not have an allergic reaction or some latent heart defect. He was not a high-risk patient. He should not have died. I analyzed Caleb\u2019s medical records and learned the oral surgeon had both operated on Caleb and administered his anesthesia in a private office. There was no separate anesthesia provider, not even a nurse. And this is normal; oral surgeons call it the \u201coperator-anesthetist model\u201d of sedation. Caleb\u2019s oral surgeon pushed propofol, ketamine, fentanyl, and versed, then went to work on Caleb\u2019s teeth. The manual notations showed no one noticed Caleb\u2019s oxygen saturation drop until it hit 60%. I could picture the oral surgeon\u2019s desperation as he failed to intubate and his panic that led him to futilely cut into Caleb\u2019s throat looking for an airway. An anesthesia provider would have noticed immediately and deployed any number of interventions to maintain airflow until Caleb could maintain his own airway. How could an oral surgeon operating alone be the standard of practice?<\/p>\n
Prompted by that question, I started digging into the state of dental anesthesiology. The California Dental Board informed me that they did not track the number of deaths caused by dental anesthesia. Nor do any other state dental boards. I also searched the medical and dental literature. What I learned was chilling: despite the surfeit of research on anesthesia outcomes in hospitals and ambulatory surgery centers, the dental community had not one paper systemically looking into near misses or adverse outcomes from dental anesthesia. Instead the dental journals bemoan the lack of evidence on this topic. Yet several medical papers that studied anesthesia across medical and dental clinical contexts, noted a trend in death associated with dental anesthesia.<\/p>\n
Eventually, I turned to media reports and found nearly twenty stories about children dying from dental anesthesia in the past decade. I asked Facebook\u2019s Physician Mom\u2019s Group if they had seen adverse outcomes from dental anesthesia; hundreds of doctors around the country responded. One replied that any time they hear of an ED admission related to anesthesia they assume it\u2019s from a dental office. Many others agreed. These stories are likely only a small sample of the total number of adverse outcomes. Yet the standard of care and applicable regulations remained the same: woefully inadequate.<\/p>\n
Ultimately, finding out what happened could not assuage my grief because what I learned was how preventable Caleb\u2019s death really was. Each time I felt tears in my eyes missing my nephew, I\u2019d tell myself: \u201cI can change this.\u201d<\/p>\n