How possible is it that the sedation didn't work?

[AimeeM]

The special needs ped's dentist we are using does sedation of the variety that the children shouldn't remember anything that happened. Today Nico had quite a bit of work done, and it didn't go well (if you've seen my post). He is post sedation now by many hours, awake and watching television. He appears to remember EVERYTHING, and is pretty terrified. Enough details, he remembers, that when his brother tried to snatch the special lollipop the dentist gave him, Nico reminded me that they had given me two.

 

Is it possible that the sedation didn't take? If so, is there anyway to remedy that for next time? This is only phase 1 and he has to go back.

[zoobie]

Did they give him Versed? Yikes. :grouphug:

[Cera]

It is certainly possible.  I have a very difficult time being sedated and often the meds won't work at the doses that one would expect them to.  They have to use alternate (less safe) medicines for me to ensure sedation.

 

[AimeeM]

Did they give him Versed? Yikes. :grouphug:

 

I think so. I think I understand why he was so stressed on the table that his heart rate was sky high and his ox levels were dropping... if the sedation wasn't working.

I'm not sure how to approach this with the doctor.

[AimeeM]

They reassured me that him fighting so much was normal and that he wouldn't remember a thing. I feel terrible for him.

[Annie G]

I hope the dentist will listen to your concerns. Poor little guy was already afraid and getting him back there for round two is probably going to require some real effort.  :grouphug:

[AimeeM]

I hope the dentist will listen to your concerns. Poor little guy was already afraid and getting him back there for round two is probably going to require some real effort.  :grouphug:

 

It's going to be a hard call. We really need to keep his levels stable. I don't know what to do. Everything is already paid for, appointments are made. Is there anything the dentist COULD do, outside of hospital sedation? The hospital route is very risky for him, with his risk of secondary infection/other infection, considering it's such a minimal amount of work left to do (may 30 minutes of work left, total). It's hard for me to weigh that.

 

[Robin M]

Yes, it is possible to start to wake during surgery.  They may have given him the amount they expected for his weight class, not taking into account if he had low tolerance or high tolerance for drugs.  I woke up during knee surgery and during my c section. Couldn't move so couldn't let them know. But the doctors were quick to notice increased heart beat, realize I was coming out of it and put me under.  I didn't feel any pain but just being able to hear what was going on was definitely scary. 

 

Definitely talk to the doctor and let him know so he can adjust for the next time. 

[AimeeM]

Yes, it is possible to start to wake during surgery.  They may have given him the amount they expected for his weight class, not taking into account if he had low tolerance or high tolerance for drugs.  I woke up during knee surgery and during my c section. Couldn't move so couldn't let them know. But the doctors were quick to notice increased heart beat, realize I was coming out of it and put me under.  I didn't feel any pain but just being able to hear what was going on was definitely scary. 

 

Definitely talk to the doctor and let him know so he can adjust for the next time. 

 

I don't think he was ever sedated. He appears to remember every single thing.

[melmichigan]

Yes, it is possible that the sedation didn't work.  Versed doesn't work with DH, he becomes combative and remembers everything.  Options would depend on what work they are doing and could include premedication with oral meds, alternative sedation (although that may not be an option without hospitalization), or different approach.  As an example, DH doesn't respond to versed, but goes into a nice twilight with high levels of nitrous.

[AimeeM]

I wonder if they could prescribe some sort of sedative before he comes in.  Something where he'd come in relaxed at least.

 

That would be a good question. He had the oral conscious sedation med, and he had laughing gas. Somehow, all 30 lbs of him appears to have fought it off :(

[Robin M]

I don't think he was ever sedated. He appears to remember every single thing.

 

Was he in pain?  They may have just given him a local.  Dentist once tried laughing gas on my aspie and he just got more agitated. Plus he couldn't stand the smell of the mask so it was a complete bust.

[melmichigan]

That would be a good question. He had the oral conscious sedation med, and he had laughing gas. Somehow, all 30 lbs of him appears to have fought it off :(

Oral is traditionally less reliable than IV.  They may be able to give him something like Valium to relax him and then use nitrous with the approach that he will remember everything, which means they may have to do things a little differently.

[Insertcreativenamehere]

My 2 yo has a terrible time with sedation. He had heart surgery last year and post-op, they could not keep him sedated to prevent him from pulling out his chest tubes. They were giving him enough to level a 150-pound adult and he was still extremely restless, agitated and delirious. He's having another major surgery tomorrow and I'm terrified. He just eats through the stuff so quickly. In his case, he has Down syndrome and I've heard of a lot of kids with DS who have trouble with sedation. 

[Whereneverever]

I would ask about in office iv sedation.

[Spryte]

:grouphug: Oh, poor baby.  Poor mama, too.

 

 

[Katy]

I have a terrible time with dentists too.  They just can't seem to get me numb with the normal drugs.  I've since learned that's a symptom of later having trigeminal nerve issues (TMJ, Trigeminal Neuralgia, or in my case, Cluster Headaches).  I have found one dentist who could get me numb.  He uses some different meds that he said are fairly new to the US but standard in Europe.  I just called to find the name of the drug but their office closed for the day half an hour ago.

 

I urge you to not take him to the dentist again unless it's to someone else with different meds.  I am terrified of the dentist to this day.

[TammyS]

I think so. I think I understand why he was so stressed on the table that his heart rate was sky high and his ox levels were dropping... if the sedation wasn't working.

I'm not sure how to approach this with the doctor.

 

TELL him!  Start by understanding that these things DO happen, even though it's uncommon.  Some people react differently to the drugs than most.  But TELL him.  The DR wants your son to be comfortable under sedation.  If the sedation isn't working the way it's supposed to he WANTS to know can't know if you don't tell him.

[AimeeM]

Was he in pain?  They may have just given him a local.  Dentist once tried laughing gas on my aspie and he just got more agitated. Plus he couldn't stand the smell of the mask so it was a complete bust.

 

Yes, he was in pain. I saw them give him the sedative, and the laughing gas, but it appears neither "took".

[AimeeM]

I have a terrible time with dentists too.  They just can't seem to get me numb with the normal drugs.  I've since learned that's a symptom of later having trigeminal nerve issues (TMJ, Trigeminal Neuralgia, or in my case, Cluster Headaches).  I have found one dentist who could get me numb.  He uses some different meds that he said are fairly new to the US but standard in Europe.  I just called to find the name of the drug but their office closed for the day half an hour ago.

 

I urge you to not take him to the dentist again unless it's to someone else with different meds.  I am terrified of the dentist to this day.

 

I have to have the dental work done. It isn't an option. These aren't issues that can wait, and they are potentially dangerous if we choose to do so. From what I understand, all of the ped's dentists here use the same sedation and meds.

[jewellsmommy]

The special needs ped's dentist we are using does sedation of the variety that the children shouldn't remember anything that happened. Today Nico had quite a bit of work done, and it didn't go well (if you've seen my post). He is post sedation now by many hours, awake and watching television. He appears to remember EVERYTHING, and is pretty terrified. Enough details, he remembers, that when his brother tried to snatch the special lollipop the dentist gave him, Nico reminded me that they had given me two.

 

Is it possible that the sedation didn't take? If so, is there anyway to remedy that for next time? This is only phase 1 and he has to go back.

 

I have the ability to break through the standard twilight drugs. Versed and Ketamine, I think? I woke up during my colonoscopy, endoscopy, tooth extraction, etc. I have memory of the event and can tell doctors what they said during those times.

 

So, yes, it is very possible that the same happened with your son. Mine is like an in and out type of thing. I have often wondered if it is tied to a strong flight or fight reaction. I wake from general anesthesia fighting and trying to get out of the bed. Have you ever noticed a particularly strong flight or fight response in your son?

[AimeeM]

Poor kid.

 

What work does he need done?

 

We aren't sure how it got here, because before his lung and vascular surgery he had a beatiful dental report, but he needs a couple crowns, a couple extractions, and a fixed partial until his perm teeth come in. The best they're able to tell us is that the medication he was on pre-op, during, and post-op (for the congenital defects) may have caused long term damage to his teeth.

[AimeeM]

I might be tempted to heavily bribe him with the prospect of a really cool toy or something.  Whatever works..ya know?

 

He isn't able to be bribed. Unfortunately. Tried it. Lol. He'll go in because one thing he definitely is NOT, is disobedient, but it won't calm him. We need to keep his heart rate and oxygen levels stable.

I would take him on a TRU spree if I thought it would sincerely help him to... chill, lol.

[AimeeM]

I have the ability to break through the standard twilight drugs. Versed and Ketamine, I think? I woke up during my colonoscopy, endoscopy, tooth extraction, etc. I have memory of the event and can tell doctors what they said during those times.

 

So, yes, it is very possible that the same happened with your son. Mine is like an in and out type of thing. I have often wondered if it is tied to a strong flight or fight reaction. I wake from general anesthesia fighting and trying to get out of the bed. Have you ever noticed a particularly strong flight or fight response in your son?

 

Yes, he definitely has a fight or flight response to anything related to pain and doctors. This doesn't really get in our way at regular doctor's and specialists - his endocrinologist and his pulmonary team do any invasive, painful, or scary tests downstairs in the outpatient center, so it is never associated, with Nico, as a painful place to be (the office itself).

 

[melmichigan]

TELL him!  Start by understanding that these things DO happen, even though it's uncommon.  Some people react differently to the drugs than most.  But TELL him.  The DR wants your son to be comfortable under sedation.  If the sedation isn't working the way it's supposed to he WANTS to know can't know if you don't tell him.

Now that the procedure is over you simply call and talk to the doctor.  I'm betting with his HR in the 230+ range they already know there was a problem, but they may not understand the extent of it.  You can't plan for the next procedure without getting the doctors view on what went wrong.  

 

It sounds like it's possible it was more than just the amnesiac, unless he was just that scared.  I hate when medical professionals approach procedures with the impression that the patient can't hear or won't remember, when often times they do.  (Yes, it's my profession too.)  It can cause undue stress.  He might have simply heard what they were saying and it caused further agitation, or he could have been in pain. 

[Caroline]

Is he a redhead? Lots of med work differently in redheads. No really, it's true.

[Katy]

You could try an oral surgeon for whatever work he needs. 

[AimeeM]

You could try an oral surgeon for whatever work he needs. 

 

Huh. I didn't consider that. Do they work with children with medical needs (it's been oddly difficult to find a ped's dentist who will work with him with his weight).

[melmichigan]

You could try an oral surgeon for whatever work he needs. 

Yes, and an oral surgeon will be more likely to been able/willing to give IV meds.

[AimeeM]

Now that the procedure is over you simply call and talk to the doctor.  I'm betting with his HR in the 230+ range they already know there was a problem, but they may not understand the extent of it.  You can't plan for the next procedure without getting the doctors view on what went wrong.  

 

It sounds like it's possible it was more than just the amnesiac, unless he was just that scared.  I hate when medical professionals approach procedures with the impression that the patient can't hear or won't remember, when often times they do.  (Yes, it's my profession too.)  It can cause undue stress.  He might have simply heard what they were saying and it caused further agitation, or he could have been in pain. 

 

He's calling tonight to check on him. Well, I hope it's the main dentist (our dentist) and not the obviously terrified young lady who did the procedure.

 

I don't think he simply overheard. He is able to very vividly recall where it hurt, and what color the instruments were. He is not happy about it either, lol.

[AimeeM]

Yes, and an oral surgeon will be more likely to been able/willing to give IV meds.

 

Do IV meds work better?

[Myeightkiddies]

I've had sedation wear off with skin surgery and my c-section.  I second the comment above about using an oral surgeon.  The oral surgeon should be much better at making sure he is sedated.

[happypamama]

Can an oral surgeon do it under general? One of my boys had to have an extra partial tooth removed, and it was done in the oral surgeon's surgery center under general. Not as problematic as a hospital.

 

Poor little guy -- that sounds really miserable!

[AimeeM]

Hmmm. Now he's saying that he had a great time at the dentist and that the big white thing was fantastic...

:P

[Reefgazer]

I had 4 wisdom teeth pulled about 25 years ago and I remember every detail of what went on in the room during the last few minutes of the surgery.  The doc said impossible, but when I related what he said, where he placed the pulled teeth, etc... he looked pretty taken aback.  I was not in pain and didn't see anything, but I heard everything.  Talk to the doc about other sedation methods.

The special needs ped's dentist we are using does sedation of the variety that the children shouldn't remember anything that happened. Today Nico had quite a bit of work done, and it didn't go well (if you've seen my post). He is post sedation now by many hours, awake and watching television. He appears to remember EVERYTHING, and is pretty terrified. Enough details, he remembers, that when his brother tried to snatch the special lollipop the dentist gave him, Nico reminded me that they had given me two.

 

Is it possible that the sedation didn't take? If so, is there anyway to remedy that for next time? This is only phase 1 and he has to go back.

 

[Excelsior! Academy]

I didn't read the full thread, but I say YES! very possible.  My mom had a surgery where she was sedated, yet remembers everything.  She said she felt helpless and paralyzed during the surgery.  It terrified her.

[kwickimom]

I have woken up in the middle of 2 d&c's and when having my wisdom teeth surgically removed. Its very possibly he was awake and remembers. 

[melmichigan]

Do IV meds work better?

IV meds are more reliable and consistent in their action. Then you also have an access if something comes up and additional meds are needed or there are any complications.  Oral surgeon offices that use IV meds are also more equipped to deal with medical needs than a dentist office.

[Ottakee]

Yes it is certainly possible.  He is the one that I questioned mito or other genetic issues with----and I know you mentioned the same thing. I have one dd that needed enough seizure med that would have killed a typical child just to keep her levels up but then some other meds she was super sensitive to.

 

Can they give him Valium or Ativan before the next appointment (obiviously double check any reactions/interactions/contraindications, etc.) and then use the oral with a local shot for the pain?

 

We just did the dentist today and even at 18 it is not an easy thing with her.

[AimeeM]

Yeah.. the dentist ASKED about genetic syndromes, and I told them that we were waiting on a genetics appointment, but that it was a consideration.

 

I thought that one of the reasons they monitered heart and oxygen levels was to make sure the sedation was working?

 

I'm not sure what they can give him beforehand (he can't swallow pills). Would it even help, though? He wasn't the least bit anxious or upset until they started working and it hurt (and he realized he was strapped down). He was playful and happy in the waiting room and even after the sedation meds. He fell asleep for about 15 minutes after the sedation medication kicked in, but then "woke up" and was freaking out the minute they put him in the straps. They kept insisting this was normal for the sedation... but he remembers it :(

Yes it is certainly possible.  He is the one that I questioned mito or other genetic issues with----and I know you mentioned the same thing. I have one dd that needed enough seizure med that would have killed a typical child just to keep her levels up but then some other meds she was super sensitive to.

 

Can they give him Valium or Ativan before the next appointment (obiviously double check any reactions/interactions/contraindications, etc.) and then use the oral with a local shot for the pain?

 

We just did the dentist today and even at 18 it is not an easy thing with her.

 

[Katy]

If you're in a bigger city some oral surgeons specialize in pediatric oral surgery.  Try and see if you can find one of those. 

[magnificent_baby]

That's a tough one. I am not sure I would want a regular dentist having to monitor heart rate and oxygen levels so closely, and knowing what to do if they became unstable. Did you or someone mention a HR of 230? I know you do not want to go the hospital, but I really think anesthesia would be best to handle his vitals/administer an IV anesthetic or sedative, especially considering his small size, while the dentist did the work. Our pediatric dentists here do procedures all the time at the hospital on special needs kids. Also, many of our hospitals have dedicated outpatient surgery areas, which could help avoid being in areas with sick/contagious patients. If his heart rate was truly that high and sats were dropping, I would not feel comfortable at all with being in a dentist's office or even an oral surgeon (and I love and trust our dentist). A dedicated pediatric hospital would be my first choice.

 

Poor kid! I hope you find an easy solution that takes care of the next step. :grouphug:

[trulycrabby]

Is he a redhead? I know redheads tend to need more opiods than others, but it might apply to cersed as well.

[AimeeM]

Is he a redhead? I know redheads tend to need more opiods than others, but it might apply to cersed as well.

 

Not really. He has some tints, but he's more blond. My eldest is a redhead, and my husband is a redhead, though :P

Funnily, my husband said that morphine does nothing for him, but versed knocks him out cold, lol.

[prairiewindmomma]

Our local children's hospital brings in led dentists and oral surgeons for their SN kids.... We did iv sedation, and even then there was a certain drug combo that caused dd to rage.

[73349]

Little kids can have unpredictable reactions (or lack of reactions) to drugs. Peds had quite a time trying to sedate one of my sisters when she needed some testing as a toddler--they had given her enough that they thought it would knock her out completely, yet she wouldn't even sit down. Tell the dentist; s/he should have some other options for next time now that it's clear that the first choice didn't do what it needed to do.

[AimeeM]

That's a tough one. I am not sure I would want a regular dentist having to monitor heart rate and oxygen levels so closely, and knowing what to do if they became unstable. Did you or someone mention a HR of 230? I know you do not want to go the hospital, but I really think anesthesia would be best to handle his vitals/administer an IV anesthetic or sedative, especially considering his small size, while the dentist did the work. Our pediatric dentists here do procedures all the time at the hospital on special needs kids. Also, many of our hospitals have dedicated outpatient surgery areas, which could help avoid being in areas with sick/contagious patients. If his heart rate was truly that high and sats were dropping, I would not feel comfortable at all with being in a dentist's office or even an oral surgeon (and I love and trust our dentist). A dedicated pediatric hospital would be my first choice.

 

Poor kid! I hope you find an easy solution that takes care of the next step. :grouphug:

 

He's "kind of" a regular dentist. He's a DMD who specializes in children with medical and other special needs.

 

Now, Nico didn't see the specialist today. He saw him the other day when we first went in, but today the office was behind and his new associate did Nico. <----- that's my fault. It was against my better judgement to let another doctor handle him, without really KNOWING his medical background (like the main DMD does), but Nico was already 14 hours out, at that point, with no food or drink, and had already been carsick from it (no way to avoid that - if he rides with an empty stomach, he will be sick)... they were anticipating an even longer wait if we wanted to wait for our regular doctor, but we were told that AFTER he was sedated initially, and already strapped in, terrified - I wasn't going to take him back out only to put him through that after he felt safe in my arms.

I feel that the associate is a good dentist, but I do not feel confident that she is experienced with special needs children, like the main dentist is. Her freaking out did NOT help Nico calm down... as soon as he calmed, his levels stabilized. At one point she was actually yelling over his face, nose to nose with him, saying "Nico! Nico, can you HEAR ME? I AM NOT YELLING AT YOU - BUT YOU NEED TO CALM DOWN SO WE CAN F.I.X Y.O.U.R T.E.E.T.H".

 

Then when we were leaving, the associate dentist was worried about him vomiting and aspirating (a concern for me as well), but the hygienist next to her actually suggested that I put his car seat... in the front seat with me, in my SUV, so that I could watch him. Not only stupid amounts of unsafe, but ILLEGAL.

 

I'm blabbering again. Sorry.

 

So, outpatient. I didn't realize that he could be outpatient. If that's a possibility, we're familiar and comfortable with the pediatric outpatient center - we spend quite a bit of time there as all of his medical specialists are housed there, as well as the imaging and labs. I would be completely okay with outpatient. I am curious if medical insurance would cover that portion. We've already paid in full for the dental treatment and sedation, in office. I know we've met our outpatient deductible already with Nico (or almost met it), but I'm curious if since it's dental, they would even cover just the hospital portion of it (not the dentist himself - our dental already picked up part of that, and we paid the rest).

 

[MooCow]

My 2 yo has a terrible time with sedation. He had heart surgery last year and post-op, they could not keep him sedated to prevent him from pulling out his chest tubes. They were giving him enough to level a 150-pound adult and he was still extremely restless, agitated and delirious. He's having another major surgery tomorrow and I'm terrified. He just eats through the stuff so quickly. In his case, he has Down syndrome and I've heard of a lot of kids with DS who have trouble with sedation.

Praying that your son's surgery goes well, and comfort for you. :hug:

[Katy]

So, outpatient. I didn't realize that he could be outpatient. If that's a possibility, we're familiar and comfortable with the pediatric outpatient center - we spend quite a bit of time there as all of his medical specialists are housed there, as well as the imaging and labs. I would be completely okay with outpatient. I am curious if medical insurance would cover that portion. We've already paid in full for the dental treatment and sedation, in office. I know we've met our outpatient deductible already with Nico (or almost met it), but I'm curious if since it's dental, they would even cover just the hospital portion of it (not the dentist himself - our dental already picked up part of that, and we paid the rest).

 

 

 

It really depends on what your insurance says regarding dental surgeries.  Some cover them, some don't, and some will cover if a physician writes a letter explaining it is medically necessary.

[AimeeM]

It really depends on what your insurance says regarding dental surgeries.  Some cover them, some don't, and some will cover if a physician writes a letter explaining it is medically necessary.

 

And a DMD is considered a medical doctor, right?