Morbidity and mortality from pharmacosedation and general anesthesia in the dental office

Morbidity and mortality (M&M) statistics have been used to determine the safety of pharmacosedation and general anesthesia for dental procedures. Although relevant, these data often do not describe what actually caused the problems. Descriptive data are needed to understand etiologic factors and to accurately set malpractice insurance rates, establish legislative regulations, and determine means of prevention. The purpose of this study was to characterize the factors involved in causing M&M in a national data base of dental patients who received either pharmacosedation or general anesthesia. Letters were sent to all state dental boards requesting detailed information on cases associated with M&M during the last 15 years. Follow-up letters and telephone contacts were made with noncompliant boards. Forty-three cases were reported from nine states, with mortality comprising 81.4% of the cases. The mean patient age was 18 years, with a range from 2 to 42 years. Seventy-five percent of the cases were classified as American Society of Anesthesiologists (ASA) class I, 21% as ASA II, and 4% as ASA III. The mean number of pharmacological agents used was three, with a range from one to seven. In 32% of the cases heart rate was monitored, in 23% respiration was monitored, in 23% blood pressure was monitored, in 8% tissue oxygen saturation was monitored, and in 4% heart rhythm was monitored. Fifty-nine percent of the practitioners performed basic life support as a part of resuscitative efforts, 21% performed some measure of advanced cardiac life support, and in 45% of the cases narcotic reversal was attempted.(ABSTRACT TRUNCATED AT 250 WORDS)