How Far Are We Willing To Go: The Dangers of Sedation

Sept. 25, 2006 — -- A 5-year-old girl is in critical condition in the pediatric intensive care unit at Chicago's Children's Memorial Hospital, on life support after being sedated for a routine dental procedure on Saturday.

The girl's fate and the circumstances surrounding her hospitalization have brought to light the potential dangers of a practice known in the medical community as procedural sedation -- sedating patients for routine medical or dental procedures to ease anxiety and help alleviate pain.

Ommettress Travis told ABC affiliate WLS-TV in Chicago that her daughter, Diamond Brownbridge, went in to a Chicago dental clinic for a procedure to fix two cavities and cap four of her lower teeth. Travis said her daughter received an oral sedative, an IV sedative and nitrous oxide gas.

According to WLS, the mother was asked to leave the room during the treatment, and when she returned 30 minutes later, she found her daughter lying on her side in the chair -- not breathing. Brownbridge is scheduled to undergo testing to evaluate her brain function, but doctors at the hospital told Travis the outlook is not good -- her chances for a full recovery are very unlikely.

It's a tragic example of what can go wrong with procedural sedation. As Brownbridge's situation shows, it can have dire consequences. So just how far are we willing to go to be less anxious and more comfortable during procedures at dentists' or doctors' offices and emergency rooms?

Must Be Closely Monitored

Patients receiving procedural sedation are given medication that puts them into an unconscious state. But unlike more serious procedures that require general anesthesia, patients continue breathing on their own, so there is no need for equipment that provides breathing assistance.

Doctors say procedural sedation has a very important role in modern medicine, but they say it must be monitored closely.

"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.

Humphries noted that because of procedural sedation, medical procedures once limited to the operating room can now be performed in office settings and ERs, saving time, money and hospital resources. And more importantly, it can make very painful procedures much more comfortable and safer for patients.

Humphries said the two most common uses for procedural sedation in the University of Kentucky emergency room are alignment of broken bones and closure of cuts that would be difficult to repair with only local anesthesia.

But procedural sedation is not used for every patient or every procedure. Any patient at risk for a bad side effect will have procedures performed in an operating room by an anesthesiologist, Humphries said.

"Procedural sedation is a very good tool in certain situations and under very close observations," he said. "There are very specific guidelines that must be followed when deciding when it should be used and who is the right patient."

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 a problem. The more people are exposed to sedation, the more chances there are for complications, especially in an office.

"There is no safety net when using sedation in an office," said Dr. Lee Winter, Chief of Anesthesiology at New York Downtown Hospital.

Winter said that, unlike many doctors' and dentists' offices, hospitals have access to life-saving equipment and staff available to deal with the rare complications seen in procedural sedation.

"In an office, all we can do is call 911," said Winter.

Offices Often Not Equipped

Winter's concern is that a problem at an office is more difficult to address and the tools needed to fix or reverse the problem may not be available. This means a patient with a severe complication will not receive complete care until they arrive at a hospital which may take several minutes.

Humphries said breathing problems are the most common and most significant complication involved with procedural sedation, especially in children.

He said all patients need to be monitored continuously while receiving procedural sedation. At the UK hospital, there is a physician present who monitors every patient receiving procedural sedation. 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.

Overall, procedural sedation offers doctors a safe way to perform procedures that were once very painful or caused people to be very nervous. Doctors note, however, that this should only be used for a select group of patients in a well-monitored setting.