‘Continuously monitored’
About 10 a.m. that morning, Dr. Ryan Watkins, the dentist and only anesthesiologist listed at the clinic, administered the sedative and completed the procedure without any reported complications.
In a statement to FOX 5 San Diego, Dreamtime said the young girl was “continuously monitored by our dentist anesthesiologist” and displayed no signs of trouble throughout the surgery or during recovery.
“Following the procedure, she was discharged in stable condition – awake, with stable vital signs and protective reflexes intact – into her mother’s care, following our standard post-anesthesia protocols,” the statement continued.
Breathing slowed
After she woke and was discharged, Silvanna – who for the first while was able to open her eyes and stand on her own – travelled home with her family, “out of it” and snoring heavily as she slept, according to reports.
When the child arrived, she was carried inside, where she continued to sleep – snoring loudly – for approximately 90 minutes.
But then her breathing began to slow, and her snoring became quieter.
Her grandmother, concerned by the changes, checked her heart rate twice. After the second check, Silvanna was unresponsive.
Emergency services were called at 4:46 p.m. local time, nearly six hours after she received anesthesia.
Flatlined
The child was transported to Rady Children’s Hospital, where doctors found she was in asystole.
According to the Cleveland Clinic, asystole is when your “heart’s electrical system fails, causing your heart to stop pumping. This is also known as “flat line” or “flat lining” because it causes your heart’s electrical activity to look like a flat line on an electrocardiogram. Without immediate CPR or medical care, this condition is deadly within minutes.”
Despite live saving measures, Silvanna, one of four children, died in hospital.
Fatal combination
Later, the medical examiner determined that Silvanna’s cause of death was “methemoglobinemia in the setting of recent nitrous oxide administration” – meaning it could have been triggered by the anesthetic.
Per the Cleveland Clinic methemoglobinemia (MetHb) is a “very rare blood disorder” that “usually happens when people use certain medications or recreational drugs or exposure to certain chemicals.”
MetHb can be inherited but the site explains it is extremely “rare, with “only a few cases documented worldwide.”
As for Silvanna, NBC News explains that factors contributing to her death included the use of multiple anesthetic drugs during the procedure – a combination that proved fatal for the 9-year-old.
No warning signs
In a follow-up statement to People, Dr. Watkins referenced the rare condition “that can occur with nitrous oxide administration.”
He emphasized that Silvanna “never exhibited” any warning signs of this condition during or after her procedure, and that her oxygen saturation remained within normal range throughout.
In a separate statement to NBC, Watkins said: “If we had observed any indication of methemoglobinemia, we would have immediately discontinued the procedure and transported her to the hospital for emergency treatment.”
Watkins also stressed that the team had taken a thorough review of the child’s medical and dental history and followed standard safety protocols. However, this is not the first time his practices have come under scrutiny.
Dentist investigated in 2016
In a separate article, NBC reports that back in 2016, Watkins was investigated by the Dental Board of California after a 54-year-old male patient nearly died while under his care.
The man was given two drugs for anesthesia, one of which state investigators said should never have been administered to him. The patient’s heart temporarily stopped, and he later filed a lawsuit that was eventually settled. As a result of the investigation, Watkins was placed on professional probation from 2020 to 2023.
As of now, Silvanna’s death has been ruled accidental, and an internal review is underway at Dreamtime Dentistry.
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