Hyderabad would-be groom’s death after dental procedure: Alleged overdose highlights need for anesthesia awareness

Vinjan Ramulu, the grieving father, has filed a complaint with the Jubilee Hills police, asserting that the administration of an excessive anesthesia dose led to the loss of his son's life.

BySumit Jha

Published Feb 20, 2024 | 11:00 AMUpdatedFeb 20, 2024 | 11:03 AM

Hyderabad would-be groom’s death after dental procedure: Alleged overdose highlights need for anesthesia awareness

Laxmi Narayan Vinjan was excited about his upcoming marriage. He began the preparations in advance, including a dental procedure to enhance his smile.

With a few days remaining to make a new beginning in life, the 28-year-old man breathed his last after undergoing dental treatment at a hospital in Hyderabad’s Jubilee Hills on 16 February.

His family blamed the dentist at FMS International Dental Centre for administering anesthesia in excess, leading to the would-be groom’s premature death.

Laxmi Narayan’s father Vinjan Ramulu complained to the Jubilee Hills police, accusing the hospital of fatal negligence. He urged the authorities to initiate action against the doctors concerned.

The police registered an FIR under Section 304(A) of the Indian Penal Code for culpable homicide not amounting to murder and are investigating.

The family’s allegations contradicted the initial statement of Dr Rama Krishna Reddy, the maxillofacial surgeon, who made no mention of excessive anesthesia.

Dr Reddy stated that Laxmi Narayan had previously undergone root canal treatment, and on 16 February, he visited the clinic for dental procedures.

The initial procedure, involving the examination of natural teeth and a CT scan, did not require anesthesia. Subsequently, local anesthesia, totalling 0.6 ml, through infiltration was administered.

The crown lengthening procedure, necessitating 0.5 ml of anesthesia, proceeded smoothly. Post-procedure, Laxmi Narayan complained of slight pain, a common occurrence after dental interventions.

He was provided a standard painkiller mixed with water. However, he experienced discomfort and seizures. Medical intervention followed, with doctors checking his vital signs, administering a life-saving steroid injection (adrenaline), and performing continuous CPR.

An ambulance transported him to Apollo Hospital’s Emergency Room at Jubilee Hills, where, despite concerted efforts, he did not respond.

Dr Reddy emphasised that the anaesthesia administered was well below the standard dosage for procedures like tooth extraction or root canal treatment, dispelling any possibility of death-causing overdose.

Dr Reddy attested to the patient’s prior exposure to anesthesia during root-canal treatment and highlighted his anxiety, possibly related to upcoming family functions and marriage.

He denied any negligence on the dental centre’s part, emphasising that Laxmi Narayan was coherent, conversing, and checking his phone throughout the procedure.

Also Read: 3-year-old dies in Kerala after root canal treatment

What is local anaesthesia?

Local anesthesia, also known as local anesthetic, is a method of pain management that involves the administration of a one-time injection of medicine to numb a small area of the body.

“It is commonly used for minor out-patient procedures, such as dental surgery, biopsies, and the removal of growths. Unlike general anesthesia, local anesthesia does not cause the patient to lose consciousness,” Dr Md Manzur Ahmed, president of the All India Dental Students’ Association (AIDSA), said.

“Instead, it works by preventing the nerves in the affected area from communicating sensations of pain to the brain. This method is generally considered safe and is often used in situations where the procedure is minor, quick, and does not require the patient to stay overnight,” he told South First.

He added that local anesthesia is typically administered just before the procedure, and the effects are short-lived, wearing off within an hour in most cases. While it can occasionally cause side effects, they are usually minor and rare, especially when administered by a trained professional.

The type and dose of anesthesia used depend on various factors, including the person’s age, weight, allergies, medical conditions, and the site and aim of the procedure.

Also Read: 5-year-old boy dies after treatment for arm fracture

Precautions

Dr Ahmed added that patients preparing for dental procedures involving local anesthesia should inform their dentist about any medical conditions, medications, and allergies, as they could affect the choice of the anesthetic agent.

“The patient should have a light meal a few hours before the procedure, but avoid eating immediately before the appointment, and they should remain calm during the procedure, as it helps the dentist administer the anesthetic easily,” he said.

He pointed out that the doctor should make the patient aware that the local anesthesia would cause temporary numbness, swelling, and discomfort in the treated area.

“Plan to rest for a few hours after the procedure, especially if it involves more extensive work, and also avoid eating until the anesthetic wears off, as advised by the dentist,” Dr Ahmed said.

He also pointed out the patient should communicate to the dentist any concerns or questions before the procedure.

Administering local anesthetic

The dose of local anesthesia required for dental procedures would vary depending on the specific anesthetic agent and the patient’s weight.

For instance, the maximum dose of lidocaine (2% solution) is 4.4 mg/kg, not to exceed 300 mg. A typical dental local anesthetic cartridge contains approximately 1.8 mL, and a 2% solution has a concentration of 20 mg/mL.

To calculate the maximum dose for a patient, multiply their weight by the per kilogram maximum specific to the local anesthetic being used.

In the case of Laxmi Narayan, who weighed approximately 70 kg, the maximum dose of lidocaine (2% solution) would be 308 mg (70 kg × 4.4 mg/kg).

Since each 1.8 ml cartridge contains 36 mg of lidocaine (20 mg/mL × 1.8 mL), a patient of his weight would require approximately 8.5 cartridges (308 mg / 36 mg/cartridge) for a single administration.

However, it is crucial to note that the patient’s response to drug dosage is not always predictable, and individual tolerances may affect the required dose. Dentists and dental hygienists should use the smallest amounts needed to provide effective anesthesia, avoiding excessive doses that could lead to overdose and complications.

Also Read: Bengaluru hospital told to pay ₹1.6 crore to family for death of patient during C-section surgery

Associated risks

The risks associated with local anesthesia in dental procedures include:

1. Common complications: Pain at the injection site, needle fracture, and prolongation of numbness are common local complications associated with local anesthesia.

2. Incidence of complications: The overall incidence of complications associated with the administration of local anesthesia in dentistry is reported to be 4.5%. The most frequently observed complications, such as dizziness, tachycardia, agitation, nausea, and tremor, were transient and did not require treatment. Severe complications such as seizures and bronchospasm occurred in only a small percentage of cases.

3. Adverse effects: It can include various physical reactions during and after administration, such as fist clenching, moaning, sweating, dizziness, agitation, nausea, tremors, syncope, and headache. Additionally, adverse cardiovascular effects, allergic reactions, and paresthesia have been reported.

4. Special precautions: Risks are higher for individuals with certain conditions, such as sleep apnea, seizure disorder, obesity, high blood pressure, heart problems, and chronic obstructive pulmonary disease (COPD).

5. Anesthetic toxicity: Overdose of local anesthetics can lead to toxic reactions, especially in young children, and may result in excitation followed by depression of the central nervous system. Early symptoms include dizziness, anxiety, confusion, and subjective and objective signs of central nervous system and cardiovascular system responses. Local anesthetic toxicity is preventable by following proper injection techniques and being knowledgeable of maximum dosages based on weight.

6. Allergic reactions: Although rare, allergic reactions to injectable amide local anesthetics can occur. Patients may also exhibit allergic reactions to the bisulfite preservative added to anesthetics containing epinephrine. Allergies can manifest in a variety of ways, including urticaria, dermatitis, angioedema, fever, photosensitivity, and anaphylaxis.