Mortality and Morbidity in Office-Based General Anesthesia for Dentistry in Ontario.

Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved the review of incidents, and phase II involved a survey of DS/GA providers. In phase I, cases involving serious injury or death for dentistry under DS/GA, sourced from the Office of the Chief Coroner of Ontario and from the Royal College of Dental Surgeons of Ontario (RCDSO), were reviewed. Phase II involved a survey of all RCDSO-registered providers of DS/GA in which they were asked to estimate the number of DS/GAs administered in 2015 and the number of years in practice since 1996. Clinician data were pooled to establish an overall number of DS/GAs administered in dental offices in Ontario from 1996 to 2015. Prevalence was calculated using phase I (numerator) and phase II (denominator) findings. The estimated prevalence of mortality in the 20-year period from 1996 to 2015 was 3 deaths in 3,742,068 cases, with an adjusted mortality rate of 0.8 deaths per 1 million cases. The estimated prevalence of serious morbidity was 1 injury in 3,742,068 cases, which adjusts to a serious morbidity rate of 0.25 per 1 million cases. The mortality rate found in this study was slightly lower than those published by earlier studies conducted in Ontario. The risk of serious morbidity was found to be low and similar to other studies investigating morbidity in office-based dental anesthesia.

How safe is deep sedation or general anesthesia while providing dental care?

BACKGROUND: Deep sedation and general anesthesia are administered daily in dental offices, most commonly by oral and maxillofacial surgeons and dentist anesthesiologists. METHODS: The goal of deep sedation or general anesthesia is to establish a safe environment in which the patient is comfortable and cooperative. This requires meticulous care in which the practitioner balances the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics. RESULTS: Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month. CONCLUSIONS: Airway compromise is a significant contributing factor to anesthetic complications. The American Society of Anesthesiology closed claim analysis also concluded that human error contributed highly to anesthetic mishaps. The establishment of a patient safety database for anesthetic management in dentistry would allow for a more complete assessment of morbidity and mortality that could direct efforts to further increase safe anesthetic care. PRACTICAL IMPLICATIONS: Deep sedation and general anesthesia can be safely administered in the dental office. Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained anesthetic team. Achieving a highly trained anesthetic team requires emergency management preparation that can foster decision making, leadership, communication, and task management.

Trends in death associated with pediatric dental sedation and general anesthesia.

BACKGROUND: Inadequate access to oral health care places children at risk of caries. Disease severity and inability to cooperate often result in treatment with general anesthesia (GA). Sedation is increasingly popular and viewed as lower risk than GA in community settings. Currently, few data are available to quantify pediatric morbidity and mortality related to dental anesthesia. OBJECTIVE: Summarize dental anesthesia-related pediatric deaths described in media reports. METHODS: Review of media reports in the Lexis-Nexis Academic database and a private foundation website. SETTINGS: Dental offices, ambulatory surgery centers, and hospitals. Patients :US-based children (≤21 years old) who died subsequently receiving anesthesia for a dental procedure between 1980-2011. RESULTS: Most deaths occurred among 2-5 year-olds (n = 21/44), in an office setting (n = 21/44), and with a general/pediatric dentist (n = 25/44) as the anesthesia provider. In this latter group, 17 of 25 deaths were linked with a sedation anesthetic. CONCLUSIONS: This series of media reports likely represent only a fraction of the overall morbidity and mortality related to dental anesthesia. These data may indicate an association between mortality and pediatric dental procedures under sedation, particularly in office settings. However, these relationships are difficult to test in the absence of a database that could provide an estimate of incidence and prevalence of morbidity and mortality. With growing numbers of children receiving anesthesia for dental procedures from providers with variable training, it is imperative to be able to track anesthesia-related adverse outcomes. Creating a national database of adverse outcomes will enable future research to advance patient safety and quality.

Anesthesia morbidity and mortality experience among Massachusetts oral and maxillofacial surgeons.

PURPOSE: To document the incidence of specific complications and the mortality rate for office anesthesia administered by fully qualified oral and maxillofacial surgeons in the state of Massachusetts. MATERIALS AND METHODS: A survey questionnaire was mailed to the 169 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons. Using a specific method for follow-up, a 100% response was obtained. RESULTS: The frequency of office anesthetic complications occurring in 2004 were consistent with our previous studies. There was 1 office death, for a mortality rate of 1/1,733,055. The incidence of other specific anesthetic-related complications is documented. CONCLUSION: From the data presented here, we conclude that outpatient anesthesia in the oral and maxillofacial surgery office continues to be a safe therapeutic modality.

Illinois dental anesthesia and sedation survey for 2006.

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.

Summary of the California blue ribbon panel report on anesthesia.

At the request of the Dental Board of California, a panel reviewed mortality data from the Dental Board, lawsuits from a major California malpractice insurance company, anesthesia regulations from other states, and the published scientific literature. In California between 1991 and 2000, there were 12 deaths related to general anesthesia permits, 0 deaths related to conscious sedation permits, and 8 deaths related to nonpermit holders (four deaths with oral sedation in children and four deaths with local anesthesia alone). The panel was concerned about the increased use of repeated oral or sublingual doses of sedatives and recommended a certificate process. The panel recommended a standing committee to access significant anesthesia/sedation-related misadventures and to determine how such mishaps could be prevented. The data reviewed and recommendations made are summarized in this report.

Mortality risks associated with pediatric dental care using general anesthesia in a hospital setting.

The purpose of the present study was to the review the literature and survey the risk of mortality associated with general anesthesia in children in a hospital setting. An 8-item, one page, survey was sent to all (928) southeast regional hospital members of the American Hospital Association (AHA). A response rate of 41% was established. They reported 22,615 dental cases using general anesthesia on children the ages 1 to 6 years and there were no deaths associated with anesthesia reported by responding hospitals. It was concluded that no deaths were reported among more than 22,000 cases over a 10-year period. This provides valuable information on the safety using general anesthesia for pediatric dental care.

Adverse events with outpatient anesthesia in Massachusetts.

PURPOSE: This retrospective study documented the frequency of various complications associated with outpatient anesthesia. PATIENTS AND METHODS: A questionnaire was mailed to the 157 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS) and all members responded. Morbidity data were obtained for the calendar year 1999. Mortality data included 1999 and the preceding 4 years. This continues our long-term survey of ambulatory oral surgical office deaths in Massachusetts since 1984. The data include anesthesia-related complications and all office deaths for the patients treated by these oral and maxillofacial surgeons. RESULTS: The most common complication in our survey continues to be syncope, which occurred in 1 in 160 patients receiving local anesthesia. The incidences of other specific anesthetic problems are given. Two treatment-related deaths occurred among approximately 1,706,100 patients treated during the 5-year period of 1995 through 1999, for a mortality rate of 1/853,050. CONCLUSIONS: The results of this retrospective practitioner survey documented the specific incidence of untoward anesthetic events with outpatient anesthesia and found a mortality rate consistent with the 6 similar mortality studies since 1980. These 7 retrospective reviews found 34/28,399,193 outpatient deaths for an overall dental anesthesia mortality rate of 1/835,000.

Morbilidad relacionada con la anestesia odontológica / Dental anesthesia-related morbidity

Todos los procedimientos anestésicos tienen la posibilidad de producir alteraciones locales y/o sistémicas generadoras de morbilidad y mortalidad. Específicamente para la práctica dental ha sido reportada una incidencia de morbilidad del 3.5 al 5.7 por ciento derivada de los bloqueos anestésicos y de una mortalidad de 1:10,000 con consecuencia de alguna complicación anestésica. La identificación oportuna de los tipos de severidad en la morbilidad anestésica prevendrá el índice de mortalidad. El mayor riesgo en la aplicación de la anestesia sobre el paciente odontológico es su relativa seguridad, la que puede dar lugar a que el dentista cometa errores en función de la confianza que con ella ha adquirido

Mortality and morbidity with outpatient anesthesia: the Massachusetts experience.

PURPOSE: This study documented the incidence of mortality and morbidity for outpatient anesthesia delivered by oral and maxillofacial surgeons in Massachusetts. MATERIALS AND METHODS: A questionnaire was mailed to the 151 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons, and all members responded. Information regarding the incidence of specific anesthetic morbidity was reported for 1 year (1994), and the incidence of mortality for 5 years (1990 to 1994) was requested. RESULTS: Approximately 1,500,000 patients underwent office treatment in the 5-year period without an office anesthetic death. The most common complication was syncope occurring in 1 of every 142 patients receiving local anesthesia. In patients undergoing general anesthesia, laryngospasm occurred 10 times more frequently than bronchospasm. The incidence of other specific anesthetic complications are documented. CONCLUSION: The results of this study suggest that the incidence of death associated with office anesthesia, although small initially, has decreased.