hypoxic ischemic encephalopathy in a 5 yo after dental anesthesia

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A 5 years old came out of dental extraction with what appears to be hypoxic ischemic encephalopathy. There was mentioning of a nurse anesthetist but no anesthesiologist. I thought a pediatric general anesthesia would typically involve a pediatric anesthesiologist?
 
This is the only reference to the anesthesia provider: "He [the father] questioned the hospital whether this was a medical malpractice or a misdiagnosis, but the nurse in charge of the anesthesia scolded him, saying he could not make a mistake by injecting at the proper dosage."
 
Poorly written article.

I feel for them.

There are only two hospitals on Staten Island, so 50-50 where this happened.
 
IMGASMD said:
Don’t think so.

Pretty sure University hospital is with NAPA. Richmond, I am not sure.
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They did not mention the hospital by name. Unclear to me still wheter this was a surgery center or an actual hospital.
"After the accident, the doctors did not provide any explanation. He questioned the hospital whether this was a medical malpractice or a misdiagnosis, but the nurse in charge of the anesthesia scolded him, saying he could not make a mistake by injecting at the proper dosage;"

Either way, this is potentially a 50-70 million dollar lawsuit depending on the details that come out in discovery. . NY state last time I checked did not have a cap on malpractice. This is bad. There is precedence of jury trials returning 50 million dollar judgements in Obstetrics in NY State. This is along the same lines.
 
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The article did mention some other doctors came from other departments and immediately after OR, transferred to ICU.

I tried to also look for other news outlets, couldn’t find any other article.
 
How do his teeth look?? Do they look good? It’s REALLY important we fix those teeth that were gonna fall out, anyway. All the Pedi dentists say so....
 
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OptionOffense said:
They did not mention the hospital by name. Unclear to me still wheter this was a surgery center or an actual hospital.
"After the accident, the doctors did not provide any explanation. He questioned the hospital whether this was a medical malpractice or a misdiagnosis, but the nurse in charge of the anesthesia scolded him, saying he could not make a mistake by injecting at the proper dosage;"

Either way, this is potentially a 50-70 million dollar lawsuit depending on the details that come out in discovery. . NY state last time I checked did not have a cap on malpractice. This is bad. There is precedence of jury trials returning 50 million dollar judgements in Obstetrics in NY State. This is along the same lines.
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Even in micra states where noneconomic damages are capped, there have been 8 figure judgements, especially for kids who end up needing a lifetime of care.
 
DirtDocMD said:
How do his teeth look?? Do they look good? It’s REALLY important we fix those teeth that were gonna fall out, anyway. All the Pedi dentists say so....
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It’s not as simple as that. Caries can cause pain, infections, etc. Perhaps you’ve never had a tooth ache. It’s pretty distracting.
 
IlDestriero said:
It’s not as simple as that. Caries can cause pain, infections, etc. Perhaps you’ve never had a tooth ache. It’s pretty distracting.
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I’m not bitter enough to think they NEVER need surgery. I’m also not naive enough to think that all these kids coming in, getting 5-10 cap/crowns “dental rehabs”, to the tune of $3-$5k in taxpayer Medicaid, need all that, either.

When folks do thousands of “non-indicated” surgeries each year, you’re going to end up with unnecessary morbidity and mortality.

If pedi dentists were doing the 3-5 kids that NEED work, and not herding in the 10-15 (messing with non-painful cavities in teeth that will soon go bye-bye), the kids could be taken care of in a safer fashion.
 
DirtDocMD said:
I’m not bitter enough to think they NEVER need surgery. I’m also not naive enough to think that all these kids coming in, getting 5-10 cap/crowns “dental rehabs”, to the tune of $3-$5k in taxpayer Medicaid, need all that, either.

When folks do thousands of “non-indicated” surgeries each year, you’re going to end up with unnecessary morbidity and mortality.

If pedi dentists were doing the 3-5 kids that NEED work, and not herding in the 10-15 (messing with non-painful cavities in teeth that will soon go bye-bye), the kids could be taken care of in a safer fashion.
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That is not for us to make the decision to be honest. Thats up to the patient and the dentist. If the patient is willing to take the risk of having their 2 year old anesthetized by sally, ken, dwight, kyle, chad, megan nancy the nurse doctor of anesthesia and have transparent, robust informed consent more power to them. Good luck. Hopefully this kinda thing doesnt happen often. The family will undoubtedly file suit and a very large one at that. Medical Mapractice lawyers are salivating at the thought of getting this case.
 
OptionOffense said:
That is not for us to make the decision to be honest. Thats up to the patient and the dentist. If the patient is willing to take the risk of having their 2 year old anesthetized by sally, ken, dwight, kyle, chad, megan nancy the nurse doctor of anesthesia and have transparent, robust informed consent more power to them. Good luck. Hopefully this kinda thing doesnt happen often. The family will undoubtedly file suit and a very large one at that. Medical Mapractice lawyers are salivating at the thought of getting this case.
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I don’t think ANYONE (who isn’t a med professional) thinks the “risk” of taking their 2 y/o for cavities includes “death” or being put in a vegetative state.

We don’t hear of this happening very often with kids getting appendectomies, or getting a closed reduction on their radius/ulna, etc.

The REASON we keep hearing about so many “pedi dentals gone wrong”, is often because VOLUME.

Dentists keep herding these kids in like cattle, and there is pressure to get them in and out too fast. That’s when more mistakes get made.

I’ll stop with this post. Maybe the kid got an air embolus? Maybe there was an allergic reaction? Then again, maybe it was a laryngospasm/bloody airway/trying to get to PACU to get to the other 15 kids scheduled in that room??

Ask the parent NOW, “Was it worth the risk??”.

We’ve run off probably 75% plus of our pedi dental. It wasn’t worth the risk. Not financially, and certainly not to the health of the children, for what was often no more than a “cosmetic” procedure.

DirtDoc out.....
 
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DirtDocMD said:
I don’t think ANYONE (who isn’t a med professional) thinks the “risk” of taking their 2 y/o for cavities includes “death” or being put in a vegetative state.
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Irregardless of what anyone thinks, the risk is there. Again, the plaintiffs attorneys will undoubtedly spend a great deal of time and effort sorting out whether or not the plaintiffs were informed. As they should! And then trying to prove negligence.
 
OptionOffense said:
That is not for us to make the decision to be honest. Thats up to the patient and the dentist. If the patient is willing to take the risk of having their 2 year old anesthetized by sally, ken, dwight, kyle, chad, megan nancy the nurse doctor of anesthesia and have transparent, robust informed consent more power to them. Good luck. Hopefully this kinda thing doesnt happen often. The family will undoubtedly file suit and a very large one at that. Medical Mapractice lawyers are salivating at the thought of getting this case.
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*IF* actual informed consent took place
Which means discussing risks
 
OptionOffense said:
Irregardless of what anyone thinks, the risk is there. Again, the plaintiffs attorneys will undoubtedly spend a great deal of time and effort sorting out whether or not the plaintiffs were informed. As they should! And then trying to prove negligence.
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Based on the news outlet which reported this event, as well as the family’s responses in the article, how much do you think they were “informed….”?
Was there a consent or a “certified” translator that was involved.

But I am sure that’s a whole different discussion.

nimbus said:
Even in micra states where noneconomic damages are capped, there have been 8 figure judgements, especially for kids who end up needing a lifetime of care.
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Being botanical as the article eluded to. The kid just came to this country recently. It’s very sad.
 
IlDestriero said:
It’s not as simple as that. Caries can cause pain, infections, etc. Perhaps you’ve never had a tooth ache. It’s pretty distracting.
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We had a guy with an infected molar that swole up and blocked his airway, earning him an emergency trach and an extended ICU course w just about every complication you could imagine. Bad luck to be sure, but it gave me a whole new respect for dental hygiene 😀
 
This article seems bogus. If this did happen, seems like the procedure actually was done in Shidao. The article is most likely a translation from Chinese to English.

Either way, there are lots of pediatric dental misadventures. Fast turnover and production pressure are likely to blame. Poor Pacu care as well. Throw in rampant pediatric obesity and it gets worse.
 
Prometheus2772 said:
This article seems bogus. If this did happen, seems like the procedure actually was done in Shidao. The article is most likely a translation from Chinese to English.

Either way, there are lots of pediatric dental misadventures. Fast turnover and production pressure are likely to blame. Poor Pacu care as well. Throw in rampant pediatric obesity and it gets worse.
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A lot of dental anesthetics are also performed by the dentist themselves doing some pretty shady sedation **** with unprotected airways. Although it seems an anesthesiologist or nurse anesthetist was involved in this case...
 
DirtDocMD said:
The REASON we keep hearing about so many “pedi dentals gone wrong”, is often because VOLUME.

Dentists keep herding these kids in like cattle, and there is pressure to get them in and out too fast. That’s when more mistakes get made.
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Stop the dentists from herding them in. The cases are all crappy. The only way is to stop them is from bringing the cases in the first place. They would overrun the place if they could.
 
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Prometheus2772 said:
This article seems bogus. If this did happen, seems like the procedure actually was done in Shidao. The article is most likely a translation from Chinese to English.

Either way, there are lots of pediatric dental misadventures. Fast turnover and production pressure are likely to blame. Poor Pacu care as well. Throw in rampant pediatric obesity and it gets worse.
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I re-googled the story. Still only one source. There was another one citing a “Quebec Media” reported this; but essentially the same article, with a little editing.

I cannot imaging, a five year old boy became brain dead in a major hospital (since there are only two on SI) not being picked up anywhere else.

Not saying it’s fake news, but I am at least a little skeptical.
 
Arch Guillotti said:
Stop the dentists from herding them in. The cases are all crappy. The only way is to stop them is from bringing the cases in the first place. They would overrun the place if they could.
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There’s no stopping greed. They’ll just find more dental anesthesiologists and cowboy OMFS grifters who apparently perform MAC cases better than us.
 
IMGASMD said:
I re-googled the story. Still only one source. There was another one citing a “Quebec Media” reported this; but essentially the same article, with a little editing.

I cannot imaging, a five year old boy became brain dead in a major hospital (since there are only two on SI) not being picked up anywhere else.

Not saying it’s fake news, but I am at least a little skeptical.
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I think it was done in China as well.
I’ve worked with a few Chinese anesthesiologists who came over for a year or two for research fellowships. They were a nice, smart, hard working group. If you think we are overworked, ask a Chinese anesthesiologist about their schedule over there. It’s crazy, and for very low income.
 
IlDestriero said:
I think it was done in China as well.
I’ve worked with a few Chinese anesthesiologists who came over for a year or two for research fellowships. They were a nice, smart, hard working group. If you think we are overworked, ask a Chinese anesthesiologist about their schedule over there. It’s crazy, and for very low income.
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I believe you are both correct. Quote from the article “On the 15th of this month at 6:00 am, the parents with the child arrived at a hospital in Shidao and at eight o’clock in the operation room began to remove the tooth, the doctor said that it would be over in about an hour and a half.”

Shidao is definitely not in Staten Island…
 
propadope said:
I believe you are both correct. Quote from the article “On the 15th of this month at 6:00 am, the parents with the child arrived at a hospital in Shidao and at eight o’clock in the operation room began to remove the tooth, the doctor said that it would be over in about an hour and a half.”

Shidao is definitely not in Staten Island…
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It’s very confusing especially after reading the article for the third time.

“Dao” = island.

So at first I just assumed they had a translation error, somewhere along the line.

But I think you guys are right, if the surgery took place in China, more parts of the story would make more sense.
 
I figured it was translated because vegetative got turned into botanical. Or the author is not a native English speaker and used the good old thesaurus tool in ms word and didn't realize his error.
 
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