Girl, 9, dies after falling asleep in car on way home from dentist

Irish Daily Mirror

2 days ago

A nine year old lass tragically passed away just hours after falling asleep in the car on her way home from the dentist.
Silvanna Moreno first complained of toothache in October last year, according to the post-mortem report, and was eventually referred for surgery. Following a consultation, the operation was scheduled for March this year.
On the morning of March 17, the day before the procedure, Silvanna had a fever of 101 degrees, as per the postmortem report. She took Children's Tylenol and her symptoms seemed to subside.
The following morning, she "complained of a headache" but did not seem distressed - and around 10am local time, she was put under anaesthesia for the procedure, which lasted about three hours.
The Dreamtime Dentistry in Vista, California confirmed that the procedure was carried out under general anaesthesia due to her young age and acute situational anxiety. After the procedure, she was taken to a room to recover, during which time she was described as being "out of it" and "incomprehensibly mumbling," according to the postmortem report, reports the Mirror.
Silvanna left the office in a wheelchair but was reportedly able to stand up and be helped into the backseat of a car. On the drive home she fell asleep and when they got home, she stayed asleep for about an hour and a half before her snoring began "quieting and slowing."
Moreno's family were checking on her regularly, but when she became "unresponsive," they dialled 999 at 4:46pm. They performed CPR until the emergency services arrived and took her to hospital.
Despite efforts by Rady Children's Hospital staff, Silvanna could not be saved and was declared deceased at 5:44pm local time.
Her death was attributed to methemoglobinemia following recent nitrous oxide use, according to the San Diego County Medical Examiner's Office (SDCME) postmortem report.
On Friday, May 30, a representative for Dreamtime Dentistry stated, that they were "not aware of a fever nor any illness" and that Silvanna had a normal temperature on the day of the dental work.
"Dreamtime Dentistry's records show that the patient's mother completed and signed a pre-operative check-in form indicating 'NO' when asked if the patient was sick. Dr. Watkins follows standard protocol. Had he been informed of any recent fever or illness, especially within 24 hours of the procedure, it would have been rescheduled until the patient was healthy."
Dr. Ryan Watkins himself previously said that Silvanna was a "healthy nine-year-old with a history of regular medical checkups" and had undergone a "thorough review of her medical and dental history" prior to the treatment. Watkins also noted that "all medications were administered according to manufacturer guidelines based on Silvanna's age and weight."
Watkins explained that Silvanna "never exhibited" any signs of methemoglobinemia during or after the procedure. Watkins noted that Silvanna was under observation "until she was awake with stable vital signs" and upon being released to her mother's care, the child was reportedly "awake, alert, and with all protective reflexes intact," having been checked for a range of assessments including "oxygenation, respiratory stability, consciousness, post operative pain, nausea and vomiting, and gait."
The report from the medical examiner also listed several contributing factors to her demise, notably the "administration of dexamethasone, glycopyrrolate, hydromorphone, isoflurane, ketorolac, midazolam, ondansetron, propofol, and sevoflurane."
Dreamtime Dentistry defended the use of these medications, asserting they are "standard anesthesia drugs commonly used in pediatric dental sedation procedures" and maintained that "any interactions or negative side effects were not due to dosage but instead due to her rare but undiagnosed/undetected medical condition."
Watkins said, "While the Medical Examiner has ruled this an accident, we take this outcome with the utmost seriousness. We are conducting a thorough internal review of this case and are consulting with leading experts in dental anesthesia to ensure we continue to provide the safest possible care for our patients." He stated that "While the Medical Examiner has ruled this an accident, we take this outcome with the utmost seriousness. We are conducting a thorough internal review of this case and are consulting with leading experts in dental anesthesia to ensure we continue to provide the safest possible care for our patients,".
Furthermore, Watkins said, "we extend our deepest condolences to Silvanna's family and ask for continued respect for their privacy during this time of grief."
The family of young Silvanna Moreno has created a GoFundMe page to gather funds for the funeral of their 'bright and joyful' daughter, sharing touching memories in their plea for support. The fundraiser's description highlighted her vibrant spirit: "Silvanna was a bright and loving third grader at Sherman Elementary School in San Diego. She was the sunshine in every room she entered, always greeting staff and classmates with a big smile and an even bigger hug. Her friends describe her as kind, caring, and always happy, a true friend to everyone she met. She was also an amazing big sister to Roberto, showing love and devotion every day."