Things turned ugly in Bangalore on Wednesday after a young boy of almost three years old who had gone to the dentist after complaining of toothache died following a suspected overdose of anaesthesia. Angry family members of the deceased child vandalised the two-floor Annayya Health Care centre and beat up the dentist, Dr Raviraj GA and the anaesthetist Dr Raghavendra. The child Shirish was the younger son of businessman Lokesh KS and homemaker Asha and the family lodged a complaint against Dr Raviraj and the hospital staff with the police. The two docs who were beat up also filed counter-complaints of assault against the family. Police are waiting for the postmortem report before taking action.
According to the boy's mother Asha, the boy complained of toothache in his upper jaw. 'The pain did not subside. A neighbour told me that a tablet was enough for kill the pain. To learn what was causing it, I took him to the Annayya Health Care Centre, near my house, at around 7.30am on Wednesday. Dr Raviraj came around 8am. He examined the boy and said he needed to undergo root canal treatment immediately,' she told reporters. At the clinic Asha claims she saw an assistant of Dr Raviraj injecting anaesthesia into her son's mouth and a few minutes later Dr Raviraj and others wheeled him into the ward.
'I asked the staff what was happening, but none of them, including Dr Raviraj, gave an answer. But the body language of the staff suggested something was wrong. I wasn't allowed go anywhere near Shirish,' Asha said. She alleges that Dr Raviraj and his assistants gave Shirish more injections as he lay motionless on the hospital bed. Dr Raviraj came to Asha at 10 am and told her boy had suffered a cardiac arrest. 'I was shocked and immediately called my husband, Lokesh. Dr Raviraj told us Shirish was not responding to treatment,' Asha said.
Lokesh says that he received no satisfactory answers from any of the doctors and the boy was shifted to Garden City Hospital. There too Lokesh claims they met a blank wall and docs said nothing to him. Around 1.30 pm, a junior doctor informed Lokesh and Asha that their son was dead. Brushing aside allegations of an anaesthesia overdose, Dr Raviraj said: 'The boy may have vomited and swallowed and this may have caused a cardiac arrest. We treated the boy only after examining his condition,' Dr Raviraj claimed.
By then family members had gathered at the Annanya Health Care Centre and allegedly assaulted Dr Raviraj, consultant anaesthetist Dr Raghvendra and vandalised the property. The child's body was sent to KIMS for a post-mortem and was then handed over the family for his last rites.
The police have said that they won't arrest anyone until the post-mortem is done and it establishes wrong treatment or diagnosis on part of the docs. 'The postmortem report will be sent to a team of medical experts and based on their opinion, we will proceed,' a senior investigating officer.
How this terrible tragedy could have happened
There are various different scenarios which explain how this could have happened. Giving local anaesthesia especially to a child so young is a complicated process. Because of the sensitive nature of anaesthesia many paediatric dentists actually prefer giving general anaesthesia (to the whole body) rather than local anaesthesia. Also another problem is that children tend to get hysterical on the dentist's chair especially when their mother isn't there. In these scenarios, docs end up giving more than one injection. Instead what needs to be done is to involve the parents, calm the child and explain to them what they're doing.
How local anaesthesia overdose can turn lethal?
Local anaesthesia in dentistry is administered either as an infiltration (usually for the upper teeth) and as a nerve block (for the lower teeth). The most commonly used anaesthetic is lidocaine (or lignocaine). Again, they can be injected with or without epinephrine in them. According to the American Association of Paediatric Dentistry, the max dosage of lidocaine is about 4.4 mg/kg of body weight. The boy in question was around 3 years of age. If he weighed 15 kgs, then the dosage should have been around 66 mg. If the dosage given was way above this, it could have caused toxicity. Even while injecting a block for the lower teeth, some precautions need to be taken since there are blood vessels around the nerve. Aspirating the needle (pulling the plunger) to check for blood in case of entering a blood vessel inadvertently is an important step that cannot be missed. If this wasn't done, the anaesthetic rapidly enters the blood stream and causes toxicity to the heart ultimately resulting in cardiac arrest.
Also since it was for upper teeth, repeated injections, even infiltrations can prove fatal for the heart.
