Boy Dies During Dental Procedure

Doctors sedated 6-year-old boy who later went into cardiac arrest.

ByLauren Cox
May 15, 2010, 12:02 PM

May 17, 2010— -- A grieving family in Richmond, Va., is still looking for answers after a trip to the dentist resulted in the death of their 6-year-old boy.

Jacobi Hill went to the Virginia Commonwealth University's dental clinic on Tuesday morning to get a few crowns on his teeth, his grandparents told ABC News affiliate WRIC-TV in Richmond. The family said his pediatrician cleared him for sedation the day before.

But something went wrong during the procedure and Hill suffered a cardiac arrest. The staff at the VCU Medical Center was unable to revive him.

"This is just unexpected, and it's hurtful," Hill's grandfather John Suggs told WRIC. "You just want someone to tell you what's going on -- what happened and how it happened."

"I just know he's my baby. He was only 6 years old, and I was robbed of his life. ... I just want him back so bad," Hill's grandmother Carolyn Suggs said.

A spokeswoman for Virginia Commonwealth University declined to give interviews about what went on during the procedure, but released a statement instead.

"Virginia Commonwealth University wants to understand what happened in connection with the tragic event involving a pediatric patient," the statement said. "Our internal investigation continues, and we are awaiting the results of the autopsy conducted by the Virginia Office of the Medical Examiner.

"We have been in contact with the patient's family, and we will continue to be available to them. VCU complies with requirements governing the administration of general anesthesia during dental procedures, and professional emergency care is immediately available in our dental clinics and facilities."

Children are frequently sedated for many medical procedures, from imaging tests to dental work.

A prospective study of 25,433 sedations with the drug propofol by the Pediatric Sedation Research Consortium found that the vast majority -- 22, 068 cases -- of children were being sedated for magnetic resonance imaging tests, known as MRIs.

Children Are Often Sedated for Medical Treatment

About 6 percent of sedations had complications, but no deaths occurred in the study. In light of the study, which was reported at a scientific meeting this month, some pain specialists called for better understanding of which drugs to use to sedate children.

"To use that (propofol) to keep a child still ... there are other methods," Dr. Lonnie Zeltzer, a pediatric anesthesiologist at the University of California Los Angeles told "It's an overuse."

VCU officials did not release which drugs were used to sedate Hill, or whether the sedation was involved with his death.

But doctors say rare cases such as Hill's point out there are always risks when using powerful medications on young children, no matter how well medicine has managed to fine-tune safety procedures.

"The statistics of something bad happening in anesthesia are very rare. It's a disastrous thing when something bad happens," said Dr. Eduardo Fraifeld, a board certified anesthesiologist and president of the American Academy of Pain Medicine.

"The similar thing would be childbirth -- when you go back in history and look at old gravestones, it's clear childbirth was a major cause of death in young women," Fraifeld said. "Now it happens so rarely, that it's a disastrous thing."

Fraifeld said part of the anesthesiologists' job is not just to administer the right amount of medicine to leave people unconscious and pain-free, but to also constantly monitor numerous vital signs during the operation.

"We don't just monitor breathing but the depth of the respiration, heart rate, responses to stimulation -- are they holding still or are they moving around -- blood loss, urinary output, monitoring medications," Fraifeld said. "There's a whole lot that you're looking and you're doing it all at once."

Without hearing more about Hill's case, Fraifeld said it would be impossible to tell what could have caused the tragedy.

"Worst case scenario is almost anything can go wrong," Fraifeld said. Previous deaths have been caused by an allergic reaction to medicine, an undiagnosed heart condition, or when patients vomit during the procedure and choke, he said.

Dentists Weigh the Risks and Benefits of Sedation

Counting deaths from anesthesia may be difficult because of litigation, but a study published in the journal Anesthesia and Analgesia counted very few child deaths from cardiac arrest. The study, which collected anonymous reports from 80 medical institutions in the United States, counted a total of 193 pediatric cardiac arrests due to anesthesia between 1998 and 2004.

Dentists say they always have to consider the odds when treating a child who has an infection that could threaten their ability to eat properly.

"Our typical resident graduates with over 400 sedations -- so a lot of kids need to be sedated, this is not uncommon," said Dr. Kevin Donly, chairman of pediatric dentistry at the University of Texas Health Science Center in San Antonio.

Donly said the cavity rates for children age 2 to 5 has increased for the first time since dentists have been keeping track. If these children aren't treated by age 5, Donly said it's possible they may need crowns.

And with a wriggling, crying or even completely uncooperative child, sometimes dentists turn to sedating children.

"When you're a 6-year-old, it's hard to sit through a procedure in the dentist chair," Donly said. "Some kids are more afraid of needles than others and you have to sedate them."

Donly said infection is a real threat with very deep cavities that would require a crown after a filling to stabilize the tooth. If the infection goes on, the child may have serious problems eating and be in a lot of pain.

"We always sit with every parent and patient -- we go through all the risks and we give them informed consent," Donly said. "It's no different than if your kid had chronic earaches and you have to have them put under general anesthesia to put tubes in.

"You play the odds, and ask for yourself if this is the right thing to do for my child," he said.

But dentists say sedation will probably always have to be a risk-benefit analysis.

"There's always a risk of some unknown condition that no one knows about and then under the stress of surgery or anesthesia that condition raises its head," said Dr. Joel Weaver of the American Dental Society of Anesthesiology.

"Again, the dentist has to weigh the risk versus benefits," he said. Weaver mentioned that overdoses during dental sedations are "far less than 1 percent."

The Associated Press contributed to this report

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