Kleutersterfte in de tandartsstoel na algehele anesthesie
Bij (zeer jonge) patiënten is soms een behandeling onder algehele anesthesie geïndiceerd. Volgens collega mw. E.C.M. Bouvy-Berends past men in Nederland meestal in deze gevallen de relatief veilige lichte/matige sedatie (lachgassedatie, oraal midazolam) toe en geen intraveneuze techniek. In de Verenigde Staten, en in mindere mate ook in het Verenigd Koninkrijk, gebruiken tandartsen echter wel sedatietechnieken, vaak intravenous, de zogeheten ’multiple drugs techniques’, wat in feite neerkomt op algehele anesthesie. De soms akelige gevolgen blijken nauwelijks in kaart te zijn gebracht.
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. Summarize dental anesthesia-related pediatric deaths described in media reports. 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. 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.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.
Lee HH, Milgrom P, Starks H, Burke W. Trends in death associated with pediatric dental sedation and general anesthesia. Paediatr Anaesth 2013; 23: 741-746. doi: 10.1111/pan.12210 Epub 2013 Jun 14.