Medico-legal autopsy case of an infant suffering anaphylactic shock during dental treatment. Potential hazards in the use of a rubber-dam-sheet for infants

We report a medico-legal autopsy of a 4-year-old girl without any history of allergies, who died following anaphylactic shock due to local anesthesia with lidocaine during dental treatment. The shock symptoms were overlooked due to a rubber-dam-sheet covering her face. The autopsy revealed laryngeal...

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Bibliographic Details
Published inNihon hoigaku zasshi = The Japanese journal of legal medicine Vol. 60; no. 2; p. 120
Main Authors Masuda, Tomoo, Murayama, Takako, Takada, Yuzo, Mukaida, Masahiro
Format Journal Article
LanguageJapanese
Published Japan 01.10.2006
Subjects
Anaphylaxis - chemically induced
Anaphylaxis - pathology
Anesthetics, Local - adverse effects
Autopsy
Child, Preschool
Fatal Outcome
Female
Forensic Pathology
Humans
Lidocaine - adverse effects
Malpractice
Pediatric Dentistry
Respiratory Insufficiency - etiology
Respiratory Insufficiency - pathology
Rubber Dams - adverse effects
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Summary:We report a medico-legal autopsy of a 4-year-old girl without any history of allergies, who died following anaphylactic shock due to local anesthesia with lidocaine during dental treatment. The shock symptoms were overlooked due to a rubber-dam-sheet covering her face. The autopsy revealed laryngeal edema, secretory fluid filling the trachea, severe pulmonary congestion and edema. An immunohistochemical investigation showed numerous mast cells releasing histamine in lungs, and the fluids in the pulmonary alveoli and veins also showed positive staining. In addition, the plasma concentration of histamine in the heart blood showed a high value. From these findings, the cause of death was determined to be respiratory failure due to anaphylactic shock induced by lidocaine. In this case, her death was considered to be due to medical malpractice; adequate life support had not been performed, because anaphylactic shock was overlooked until the rubber-dam-sheet removed. In addition, due to two previous autopsy case reports that described infantile fatalities involved with the misusage of a rubber-dam-sheet for the patients under local anesthesia, we therefore recommend immediate improvements in rubber-dam-sheets and/or better applications of them in pediatric dentistry.
ISSN:0047-1887