Death of woman, 24, in wisdom teeth surgery due to severe reaction from anaesthesia

A dentist removing wisdom teeth. (Getty Images file photo)
A dentist removing wisdom teeth. (Getty Images file photo)

SINGAPORE — Toh Yi Lin, 24, was having a regular procedure while under general anaesthesia to extract all four wisdom teeth in 2019.

But nearing the end of her surgery, she developed a rare case of malignant hyperthermia, a severe reaction to certain drugs used for anaesthesia, and died three hours later despite efforts to resuscitate her.

In findings released on Monday (3 October), a coroner ruled Toh's death as an unfortunate medical misadventure, according to a report by CNA.

Toh was first seen at the National Dental Centre Singapore (NDCS) on 8 August 2018, after being referred there from Ang Mo Kio polyclinic.

She complained of severe pain in the upper and lower right side of her mouth during a review at the NDCS on 23 April 2019. Examinations suggested that the pain could be due to an affected wisdom or necrotic tooth. Three other wisdom tooth were also assessed to be causing her pain.

To remove them, Toh chose to undergo surgery under general anaesthesia, according to the findings.

On 8 May 2019, she was admitted to hospital where a nurse ran through a checklist to assess her general condition, drug allergies and other facets of her medical history.

An anaesthetist for the surgery also went through a pre-anaesthetic assessment with Toh. According to the assessment, she had past medical history of high cholesterol, a high body mass index of 30.5 with a weight of 73.5kg and a condition called hidradenitis suppurativa, which causes small and painful lumps to form under the skin.

Toh had no known drug allergy and had undergone two uneventful surgeries under general anaesthesia previously. She had no family history of malignant hyperthermia.

The anaesthetist took a set of Toh's vital signs before administering the general anaesthesia for the surgery, and they were normal.

While uneventful for the first 90 minutes of the surgery, Toh showed signs of mild hypercapnia, or a rise in the concentration of carbon dioxide. The surgery was completed at 10.20am with the supply of anaesthetic gas discontinued.

Toh was given oxygen ventilation as her mild hypercapnia began increasing in severity and she showed reduced oxygen saturation. She did not wake up at 10.30am despite discontinuation of anaesthetic gas supply and had a fever of 42 degrees Celsius. She died at 1.31pm that same day.

An autopsy certified her cause of death as consistent with malignant hyperthermia, which may manifest at any time during anaesthesia, CNA reported.

No other causes of death were detected and the coroner concluded that there is no basis to suspect foul play.

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