Table 3. Death case report.
| First author/publication year | Case number | Age (year) | Sedative drugs (mg/kg, %) | Administered by: / at: | Detailed description | Cause |
|---|---|---|---|---|---|---|
| Grissinger M 2019 [8] | 1, 2 | Unauthorized person | Failure to recognize overdose | Dosing error | ||
| 3 | 13 | CH (6000 mg) | Dentist | Weight-based prescription | Overdose (Respiratory arrest) | |
| 4, 5 | Child | Parents | Pharmacy dispensed 500 mg/5 mL instead of 250 mg/5 mL | Dosing error | ||
| Home | ||||||
| 6 | Child | Parents | Pharmacy prescribed tenfold drug | Dosing error | ||
| Home | ||||||
| 7 | 4M | Strapped onto papoose board without proper head position | Improper patient control during treatment | |||
| 8 | Repeated “5 mL PRN” prescription | Dosing error | ||||
| Nordt SP 2014 [11] | 9 | 4F | CH (70) | Home prior to procedure | Discharge after 1 h, remained somnolent but arousable, ongoing somnolence for 6 h | Resedation after discharge (Respiratory arrest) |
| Dead after PICU | ||||||
| Chicka MC 2012 [14] | 10 | 2M | CH (unknown) | Unknown | Medical history of Russell-Silver syndrome | (Respiratory arrest) |
| Dental office | Dentist noticed respiratory rate slowed CPR, intubation, pronounced dead upon arrival at emergency department | |||||
| Kupiec TC 2011 [16] | 11 | 6M | Meth (2), Hy (1.64), CH (15), N2O-O2 | Dentist | Medical history of asthma | Cocktail (Toxicity of methadone) |
| Dental office | Patient appeared responsive but groggy after | |||||
| procedure, taken home and fell asleep | ||||||
| Dead after few hours of procedure | ||||||
| Engelhart DA 1998 [28] | 12 | 2M | CH (95), N2O-O2 | Unknown | Full arrest during surgical procedure | Combined effect of CH, lidocaine, N2O |
| Not in dental center | Transported to emergency room after 2 h, dead after 2.3 h of administration |
CH, chloral hydrate; Meth, methadone; Hy, hydroxyzine; N2O-O2, nitrous-oxygen inhalation; PRN, pro re nata, as needed; PICU, pediatric intensive care unit