Mari Hudson writes in What's New Doc
While there are no official statistics for deaths from paediatric anaesthesia in level 1 and 2 hospitals, anecdotal evidence shows an alarming trend since all dental anaesthesia for children was downscaled to level 1 hospitals a few years ago.
Junior doctors who have worked at level 1 and 2 hospitals during their community service have reported their shock at the methods used to administer anaesthesia and the resulting deaths.
Although it is considered the norm to protect the airway by intubation (or laryngeal mask insertion) in most paediatric dental cases, this rarely happens in level 1 hospitals. A mask is just held over the child’s face, then removed so the dentist can extract the teeth. Only when the child turns blue is the mask replaced.
Hospital authorities typically order halothane, which is cheaper than the more modern sevoflurane. Yet halothane is more likely to cause ventricular dysrhythmias in a stressed, hypoxic child, which could result in death.
Moreover, the department of health decided four years ago that all dental procedures should be performed in level 1 hospitals. Previously children could be treated in level 2 hospitals where more anaesthetic expertise was present.
“Moving paediatric dental anaesthesia from level 2 to level 1 institutions showed an amazing lack of knowledge regarding the dangers of paediatric dental anaesthesia,” says Dr Gillian Lamacraft, specialist aneasthetist at the UFS.
This is an edited extract of an article first published in What’s New Doc, 2nd issue, March 2009. What’s New Doc is a publication for medical doctors, produced in association with Health24.
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