Man dies from trip to the dentist
A trip to the dentist turned into an untimely death for a Melbourne man who went into cardiorespiratory arrest after being sedated for a root canal procedure.
A Coroner's Court of Victoria inquest that started on Tuesday is investigating if Michael Anderson's death in the dental chair at the age of 36 was preventable.
Counsel assisting the court, Victoria Police acting sergeant Jeff Dart, said Mr Anderson arrived at Collins Street Specialist Dental Centre on April 18, 2017, and was "seated and reclining in the dental chair" by 8.45am for the root canal.
The procedure involves drilling a hole into a decayed tooth and removing the soft centre to save a badly infected or damaged tooth.
By 9.15am he had stopped breathing and at 10.48am he was declared deceased at Alfred Hospital.
Mr Anderson had been administered Propofol as a sedative by anaesthetist Anthony Singh for the procedure.
Propofol hit headlines in 2009 for being the drug that killed Michael Jackson, along with benzodiazepines.
An autopsy found Mr Anderson's cause of death was cardiorespiratory arrest - meaning his heart stopped and he stopped breathing - complicating Propofol administration.
The court heard the obese man had a "slightly enlarged heart" and "diseased arteries" prior to being administered the sedative.
But expert witness Forbes McGain, anaesthetist and intensive care physician, said there were two "areas of concern" when asked if the death was preventable.
He said there was no record of Mr Anderson's blood pressure being documented before or after he was given Propofol - despite one of its main effects being to lower blood pressure.
"It's an incredibly dangerous drug that needs to be very, very carefully (used) with great attention to detail," he said.
He said it was "almost routine" for anaesthetists to need a second drug, called metaraminol, to increase blood pressure and prevent cardiac arrest - because it was so common for blood pressure to fall after Propofol took effect.
"Propofol will always, if you give enough of it, cause you to stop breathing," he said.
"(It) causes both a respiratory depression and a cardiovascular depression.
"It will eventually stop your heart.
"He walked into a dental office, he received Propofol and then he was dead within an hour."
Dr Singh's lawyer told the court a machine had been automatically monitoring the blood pressure at regular intervals.
But Dr McGain said there was no record of it being written down prior to the procedure as a baseline, or being recorded after each dose of sedative.
He said "close attention" to blood pressure would have been "very important".
"My concern is that blood pressure was not monitored for a drug that we know lowers blood pressure," he said.
Dr McGain did not have any criticism of the dental clinic's efforts to ascertain Mr Anderson's health and medical history before the procedure, nor the resuscitation attempt by the clinic after the cardiorespiratory arrest.
But he said the size and layout of the dental clinic was another area of concern.
Acting sergeant Dart told the court it took paramedics nine minutes from triple-zero being called to arrive at the building.
It took them another eight minutes to reach Mr Anderson due to the clinic being on the eighth floor of a "busy complex".
He said paramedics identified Mr Anderson's "large size and small space available" to be "major obstacles" to administering treatment.
Dr McGill said the Collins Street Specialist Dental Centre could be viewed as inadequate for an emergency situation.
"The problem of having a large man arresting in a dental clinic way up in a multistorey building which the Mobile Intensive Care Ambulance paramedics describe as being cramped and difficult to access …
"I think that also indicates that, yes, this clinic is fine for when things are going well, but really is this adequate for a situation where things don't go well?"
He acknowledged the centre did have a defibrillator present.
"But, to me, what is just as important is, well, how big is the room? What's the arrangement of the trolleys?" he said.
Mr Anderson was administered three 50 milligram doses of Propofol over 10 minutes.
The inquest in front of coroner Audrey Jamieson will resume in February.
Originally published as Man dies from trip to the dentist