NEED TO KNOW
Silvanna Moreno, a 9-year-old California girl, died on March 18, hours after undergoing a three-hour dental procedure
An autopsy report revealed her cause of death was methemoglobinemia in the setting of recent nitrous oxide administration
Additionally, the autopsy shed new light on her final moments
New details offer insight into the final moments of a 9-year-old girl who was put under anesthesia for a dental procedure one morning — then was dead hours later.
Silvanna Moreno died on March 18 hours after undergoing surgery at Dreamtime Dentistry in Vista, Calif., according to a San Diego County Medical Examiner’s Office (SDCME) autopsy report obtained by PEOPLE. Her cause of death was listed as methemoglobinemia in the setting of recent nitrous oxide administration.
Silvanna first complained of tooth pain in October, according to the autopsy report, and was eventually referred for surgery at Dreamtime Dentistry in Vista. After a consultation, the surgery was booked for March.
“The patient was referred to our office for dental treatment under general anesthesia due to her young age and acute situational anxiety,” Dreamtime Dentistry’s Dr. Ryan Watkins said in a statement obtained by PEOPLE.
The morning before the procedure, the Southern California third grader had a 101-degree fever, according to the autopsy report. She took Children’s Tylenol and her symptoms appeared to resolve. The next morning, she “complained of a headache” but did not appear distressed — and around 10 a.m. local time, she was placed under anesthesia for the procedure, which lasted about three hours.
In a statement obtained by PEOPLE on Friday, May 30, a spokesperson for Dreamtime Dentistry claimed they were “not aware of a fever nor any illness” and that Silvanna had a normal temperature the day of the procedure.
“Dreamtime Dentistry’s records show that the patient’s mother completed and signed a pre-operative check-in form indicating ‘NO’ when asked if the patient was sick,” the statement continued. “Dr. Watkins follows standard protocol. Had he been informed of any recent fever or illness, especially within 24 hours of the procedure, it would have been rescheduled until the patient was healthy.
Gofundme
Silvanna Moreno.
In his own statement, Watkins previously described Silvanna as a “healthy nine-year-old with a history of regular medical checkups” and said that she underwent a “thorough review of her medical and dental history” before the procedure. Additionally, Watkins insisted that “all medications were administered according to manufacturer guidelines based on Silvanna’s age and weight.”
Watkins said Silvanna “never exhibited” warning signs of methemoglobinemia, an “extremely rare condition that can occur with nitrous oxide administration,” throughout either the procedure or her recovery.
“In patients experiencing this condition, there is typically a refractory hypoxemia, which means that even when breathing 100% oxygen with no airway obstruction, pulse oximetry readings will show abnormally low levels in the 80s instead of the normal high 90s,” explained Watkins, who said he continuously monitored Silvanna throughout the procedure.
After the procedure, she went to a recovery room. During that time, she was described as being “out of it” and “incomprehensibly mumbling,” according to the autopsy report.
According to Watkins, Silvanna remained under observation “until she was awake with stable vital signs” — and before being released into her mother’s care “awake, alert, and with all protective reflexes intact,” the child was checked for “oxygenation, respiratory stability, consciousness, post operative pain, nausea and vomiting, and gait.”
The girl left the office in a wheelchair, according to the autopsy report, but was reportedly able to stand up and be helped into the backseat of a car.
Never miss a story — sign up for PEOPLE’s free daily newsletter to stay up-to-date on the best of what PEOPLE has to offer, from celebrity news to compelling human interest stories.
On the drive home, she fell asleep and began snoring loudly, according to the autopsy report. When they got home, she remained asleep and was carried inside and put into bed on her side, where she was monitored. She stayed asleep for about an hour and a half before her snoring began “quieting and slowing.”
Moreno’s family used her grandma’s blood pressure cuff to check her vitals — and as she remained “unresponsive,” they called 911 at 4:46 p.m.
A dispatcher instructed her family to move her from the bed to the floor and start chest compressions until first responders arrived.
First responders transported Silvanna to Rady Children’s Hospital in an ambulance and emergency personnel continued chest compressions, supplemental oxygen and other lifesaving measures on the way. She was suffering from asystole, also known as “flat-lining.”
At the hospital, she was “provided additional medications, ongoing chest compressions, and was intubated but her condition did not improve,” per the medical examiner’s report.
Resuscitative efforts ended when heart testing at her bedside showed no cardiac activity. A doctor pronounced her dead at 5:44 p.m. local time.
In addition to her cause of death, the medical examiner listed contributing factors as the “administration of dexamethasone, glycopyrrolate, hydromorphone, isoflurane, ketorolac, midazolam, ondansetron, propofol, and sevoflurane.” According to Dreamtime Dentistry, all of those medications are “standard anesthesia drugs commonly used in pediatric dental sedation procedures” and they claim that “any interactions or negative side effects were not due to dosage but instead due to her rare but undiagnosed/undetected medical condition.”
“While the Medical Examiner has ruled this an accident, we take this outcome with the utmost seriousness. We are conducting a thorough internal review of this case and are consulting with leading experts in dental anesthesia to ensure we continue to provide the safest possible care for our patients,” Watkins said.
Added Watkins, “we extend our deepest condolences to Silvanna’s family and ask for continued respect for their privacy during this time of grief.”
Read the original article on People
