The Dangers of Procedural Sedation

Sept. 28, 2006 — -- How much are we willing to risk for more comfort and less anxiety when we undergo routine medical procedures at the dentist's or doctor's, or when we visit hospital emergency rooms?

That question surfaces after a 5-year-old Chicago girl, Diamond Brownridge, died Thursday after she fell into a coma after being sedated for a routine dental procedure last weekend.

Diamond's mother, Ommettress Travis, reportedly said that her daughter received an oral sedative, an IV sedative and nitrous oxide gas at a Chicago dental clinic. The mother was asked to leave the room during the treatment, and when she returned a half hour later, she found her daughter lying on her side in the chair. Diamond wasn't breathing, she claims. She was taken to a local hospital and put on life support, where she remained for five days before she died.

The dentist, who has not been charged.

This is a tragic example of what can go wrong with a practice called procedural sedation, which is intended to remove some of the discomfort and anxiety surrounding routine medical and dental procedures.

In emergency rooms, doctors often use procedural sedation when they align broken bones or sew up wounds in children, for example. Dentists use it in many of their routine procedures, such as the ones Diamond recently had done.

"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 that 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," said Humphries. 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, he emphasized, all patients need to be monitored continuously while receiving procedural sedation. At the University of Kentucky ER, Humphries said, 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.

Regarding possible complications, Humphries said that "breathing problems are the most common and most significant complication, especially in children."

Humphries did note that procedural sedation is not used for every patient or for every procedure. Any patient with health problems that could increase the risk of dangerous side effects from procedural sedation will be sent to the operating room where an anesthesiologist is on hand

"There are very specific guidelines that must be followed when deciding when it should be used and who is the right patient," said Humphries. These guidelines include other ongoing health problems, any allergies, when the person last ate, physical characteristics such as weight, and any other conditions that may increase the risk of complications.

But when used in a doctor's office, the risk of complications is greater, said medical experts.

"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 that 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," Winters said.

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," Cohen said. "We have all the tools available in our office to deal with the common complications associated with sedation."

Cohen said that they are trained to deal with complications and have everything necessary to stabilize the patient and get them to a hospital if there is a serious complication.