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The death of a 9-year-old girl who was unresponsive after dental surgery in San Diego County has been ruled out as an accident caused by a rare blood disorder, according to an autopsy report from the San Diego County Medical Examiner’s Office.
Silvanna Moreno died during her dental surgery on March 18th from a disorder called metomeglobinemia, which could have been caused by the administration of nitrous oxide and other commonly used anesthetics, the inspector said.
Metoglobinemia is a rare blood disorder that disrupts the way in which hemoglobin iron delivers oxygen to cells and tissues in the body.
It is very rare for a person to be born with a disability. Due to its rarity, there is no exact number of people affected. Experts who studied this condition say it can be developed more generally by the unusual confluence of events involving exposure to drugs that could have occurred in the case of Moreno.
It is not clear whether moreno has a congenital form of methemoglobinemia, meaning it is present at birth, or a form caused by exposure to a particular drug.
Dr. Michael Levine of UCLA Health said the disorder can lead to symptoms such as shortness of breath, fatigue, cyanosis and bluish discoloration of the skin.
“Sometimes people have flaws in their systems, which results in them gaining congenital methymoglobinemians,” Dr. Gentry Wilkerson, an associate professor at the University of Maryland School of Medicine, wrote a study on the conditions and methods for treating it. “I’m very rare. I’d be shocked if I ever saw it in my career.”
San Diego Police’s Child Abuse Unit announced in April that it was investigating the girl’s death, but the department said it stopped investigating on Friday and closed the incident, Lt. Col. Travis Easter said.
Dreamtime Dentistry, Vista, California, facility where Moreno had been surgically operated, responding to a medical inspector’s report, stating that the death was “not due to dose, but rare, but not due to undiagnosed/undetected medical conditions.” The Dental Department also said there were no clear indications that she had this condition prior to the surgery.
“A common cause of exposure that can lead to metomeglobinemia is dental procedures, as benzocaine is one of the medications given to patients with tooth pain,” Wilkerson said.
Benzocaine was not listed in the medical inspector’s report as one of the drugs administered to Moreno.
Wilkerson said dental procedures are generally very safe. But in other cases, “it’s a drug-dependent effect in which a person takes an excess or excess of the drug and then develops methemoglobinemia,” Levine said.
According to an autopsy reviewed by The Times, Moreno was featured in Dream -Time Dentistry after complaining about toothache four months ago.
The dentist accepted the referral as it provided “treatment under general anesthesia due to young age and acute circumstances anxiety.”
One day before the surgery on March 18th, Moreno’s autopsy said she had a fever but her symptoms had resolved after being given the child Tylenol.
A representative from the Dreamtime Dentistry told The Times that she was unaware of her fever, and Moreno’s mother said “we completed and signed a preoperative check-in form indicating “no” when asked if the patient was ill.”
Preoperative assessments included a thorough review of Moreno’s medical and dental history, physical examinations such as vital sign assessments, heart, lung sounds and airway assessments, according to a statement from the Dream-Time Dentistry.
According to the facility’s statement, “All drugs were administered according to manufacturer guidelines based on Moreno’s age and weight.”
Through this procedure, anesthesiologist Dr. Ryan Watkins observed Moreno and noted that there were no complications, the dentist said. Once the procedure was completed, the child was monitored in the facility’s recovery area and woke up with stable vital signs.
According to the San Diego Clinic office, after the procedure she was discharged to care for her mother and sent home.
Moreno fell asleep in the car home and when she arrived home, she was moved to her bed about sleeping, according to the medical examination room. Her family checked her all day and later discovered that she didn’t respond when they called 911.
The first responder transported Moreno to Rady Children’s Hospital, carrying out life-saving measures.
When the child arrived at the hospital, medical staff assumed that she had not taken any life-saving measures and was declared dead, according to the examination room.
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