The doctor told why you can die in the dentist’s chair after anesthesia
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Deaths after anesthesia in the dentist’s office are rare, but have a wide resonance. The worst thing is that most often they concern children. Recently, a 15-year-old teenager died in one of the capital’s dental clinics. After the introduction of general anesthesia, he began to suffocate – unfortunately, it was not possible to save him.
The cause of such a reaction is most often a genetic disease malignant hyperthermia, which is often not detected in time. Who should be careful? Can deaths be avoided? This was told to MK by the anesthesiologist-resuscitator of the city of Moscow Vladimir Stanislavovich Kochkin.
Reports that another patient of the dental clinic died during an operation using general anesthesia appear in the media regularly. And most of the victims are children. Naturally, such deaths are surrounded by myths. What is really happening?
Dr. Kochkin told us about the most common myths in this area and gave a scientific explanation for the events.
MYTH 1: Children develop allergies from general anesthesia, which leads to death.
In fact, it is possible that some cases are caused by allergies. But if we are talking about pediatric inhalation anesthesia, then most often the cause of negative consequences is malignant hyperthermia (MH). This is a hereditary disease that is passed down from generation to generation, which manifests itself in response to certain drugs. They are called trigger drugs. What is this reaction? From the outside, we can see a sharp increase in body temperature, rapid pulse and breathing, problems with muscles – they become as if constrained. Numerous processes take place in the body at this time, leading to the destruction of muscles. This is what causes severe consequences up to death.
MYTH 2: Inhalation anesthesia is dangerous only for boys, girls do not have problems.
Yes, boys are the most likely to suffer from malignant hyperthermia – about four times more often than girls. But this disease, unlike other genetic pathologies, is transmitted to people of both sexes. Therefore, the reason is not in the gender of the patient, but in the muscles. Since the main blow falls on them, the greater the muscle mass, the stronger the reaction. And in males, regardless of age, purely physiologically, muscles are usually better developed, muscle mass is greater. Therefore, they suffer more often.
MYTH 3: problems with inhalation anesthesia occur in children, adults are not afraid of it.
This is not true either. The fact that we hear more often about cases that have occurred with children is due to a simple reason: adults are usually offered other types of anesthesia. Inhalation anesthesia is the world standard for children. Because injection techniques often lead to very strong stressful conditions in a child. Naturally, when there are strict contraindications, no one will “put a mask” on the baby, doctors will look for an alternative. But if contraindications are not presented, inhalation anesthesia is optimal.
MYTH 4: if such a “terrible” reaction occurs during anesthesia, nothing can be done, there are no drugs.
Indeed, there were no drugs before. But now there is, including from last year in our country, a drug whose administration at the first signs of malignant hyperthermia reduces the risk of injury and death from 80% to 5%. It is already used in the practice of dentists: a 19-year-old patient was recently saved, who developed a reaction to anesthesia at the Clinical Center for Maxillofacial Plastic Surgery and Dentistry of the Moscow State Medical University named after A.I. Evdokimov.
MYTH 5: If an unforeseen reaction of the body occurs during anesthesia, only the worst scenario is possible.
Also incorrect. There may be several scenarios. First, malignant hyperthermia has at least three forms of flow. With the classic fulminant, when everything happens rapidly and pronouncedly, yes, without drugs for the treatment of MH, the risk of mortality is high. But this form, fortunately, is the least common – one case in 62 thousand anesthesias using a combination of drugs and one case in 85 thousand anesthesias if one anesthetic drug is used. Most often – one case in 45 thousand anesthesias – there is an abortive form of malignant hyperthermia. It is mild, with incomplete clinical manifestations. And it’s easier to deal with.
MYTH 6: An acute reaction to anesthesia is always unexpected and impossible to prevent.
This is wrong. It is absolutely possible to prevent the manifestation of malignant hyperthermia. If you follow two rules. First, do a genetic screening. It will show the state of the genes responsible for the development of the disease. There is also a specific test that doctors may suggest when in doubt. At the household level, the presence of “death from anesthesia” among relatives of any degree of distance or non-standard reactions to anesthesia should cause alertness. And “strange” reactions to coffee: from darkening of the nails and an unusual skin condition to muscle stiffness and fever. Secondly, it is necessary to discuss in detail the existing history with the anesthesiologist-resuscitator. And if the doctor sees no contraindications for inhalation anesthesia, inquire about the presence in the clinic or hospital of a drug for the treatment of an MH crisis, which will save the patient’s life if malignant hyperthermia still manifests itself.
Newspaper headline:
Death at the dentist’s shoulder
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