Opioid Safety, Respiratory Compromise

No Child Should Ever Die from Elective Dental Anesthesia

By Annie Kaplan, MD, Michael Wong, JD (Executive Director, PPAHS), and Patricia Salber, MD, MBA (Editor-in-Chief,  The Doctor Weighs In)

Caleb Sears was a healthy 6-year-old boy who was looking forward to ice cream treats after his elective dental surgery. Before his dental extraction, Caleb’s parents were told that, despite being generally safe, intravenous anesthesia has a risk of serious complications, including brain damage and death. What they weren’t told was that anesthesia standards of practice vary in different settings. And, most importantly, that the risk goes up substantially when the oral surgeon is responsible for monitoring the effects of anesthesia at the same time that he is doing the operation.

6-year old Caleb Sears stopped breathing after receiving several different kinds of IV anesthetics during tooth extraction.

6-year old Caleb Sears stopped breathing after receiving several different kinds of IV anesthetics during tooth extraction.

To ensure the safety of children before, during, and after sedation for diagnostic and therapeutic procedures, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) guidelines state that there must be a clinician present other than the practitioner whose sole responsibility is to monitor the patient’s vital signs:

“The use of moderate sedation shall include the provision of a person, in addition to the practitioner, whose responsibility is to monitor appropriate physiologic parameters and to assist in any supportive or resuscitation measures, if required…

“During deep sedation, there must be 1 person whose only responsibility is to constantly observe the patient’s vital signs, airway patency, and adequacy of ventilation and to either administer drugs or direct their administration.”

To read the complete article, please go to The Doctor Weighs In.


Annie Kaplan, MD

Annie Kaplan, MD

Annie Kaplan MD is Caleb Sears’ aunt. She has been instrumental in Caleb’s Law.org’s effort to make pediatric dental anesthesia safer. For more information, please go to www.calebslaw.org

Patricia Salber, MD, MBA

Patricia Salber, MD, MBA

Patricia Salber, MD is an internist and emergency physician and host of The Doctor Weighs In. She is also a media advisor to PPAHS.

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