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In a 2019 case of a death resulting from a complication during a wisdom teeth surgery under general anaesthesia, the coroner has ruled it a medical misadventure, Today wrote.

The findings from the coroner's inquiry were made available on Monday (Oct. 3), CNA reported.

An independent medical expert also found that pre-surgical screening was appropriately carried out.

Response to the post-surgery complication was also adequate and in accordance with established protocols.

There was no basis to suspect foul play, the coroner concluded.

Developed 42^oC fever after surgery

24-year-old Toh Yi Lin first visited the National Dental Centre Singapore (NDCS) on Aug. 8, 2018, following a referral from Ang Mo Kio Polyclinic, Today wrote.

She complained of severe, radiating pain in the upper and lower right side of her mouth during a review on Apr. 23, 2019.

Further examinations revealed a total of four impacted wisdom teeth that might be causing the pain and potentially lead to more swelling and infection.

Toh decided to undergo surgery under general anaesthesia to remove the impacted wisdom teeth.

On May 8, 2019, Toh was admitted and a nurse ran through with her a list of allergies to assess her medical condition and history.

The anaesthetist also conducted a pre-anaesthetic assessment with Toh.

Toh entered the operating theatre at 8:20am the same day and general anaesthesia was administered accordingly.

The surgery went on as expected and was uneventful for the first 90 minutes, CNA wrote.

However, between 10am and 10:15am just before the surgery was completed, Toh started showing signs of mild hypercapnia or a rise in carbon dioxide concentration in the body.

The surgery was completed by 10:20am, and the anaesthetic gas was discontinued.

The carbon dioxide concentration in the body continued to increase, and she began to show signs of reduced oxygen saturation.

At 10:30am, Toh did not awake even though the anaesthetic gas had been discontinued.

A fever of 42^oC developed, and Toh was given oxygen ventilation.

Another anaesthetist arrived to help and an ambulance was called for.

Toh was pronounced dead at 1:31pm the same day after resuscitation attempts.

Cause of death was very rare genetic condition

The cause of death was determined as malignant hyperthermia -- a life-threatening reaction caused by certain anaesthetic agents used in general anaesthesia.

Diana Chan, the anaesthetist for Toh's surgery, stated that malignant hyperthermia was a very rare inherited genetic condition that leads to adverse reactions to general anaesthesia.

It can occur after single exposure, and may manifest at any time during anaesthesia.

Effects of the condition include elevated carbon dioxide levels, muscle rigidity, hyperthermia or raised body temperature and tachycardia.

It can also cause widespread muscle breakdown and severe physiological dysfunction, potentially causing the breakdown of heart muscles if it reaches the organ, Today wrote.

No family history of condition

During the inquiry, Jody Hong, the dental officer who attended to Toh, was asked if it was appropriate for Toh to remove all four teeth in one operation instead separately across multiple surgeries.

Hong stated that she presented the option of removing the teeth to Toh and her mother after they were found to have clinical indication for removal, as was standard practice.

Hong explained that if patients choose to remove all four teeth and to do so under general anaesthesia, she would advise them to do so in a single surgery rather than undergo general anaesthesia multiple times in different surgeries.

This was due to the risks associated with general anaesthesia.

Hong had presented Toh the option of local or general anaesthesia, and explained the risks associated with the surgery.

After discussing with her mother, Toh opted to remove all four teeth in one go under general anaesthesia.

Toh mentioned that she has had surgery under general anaesthesia in the past.

Based on her pre-surgery assessments, Toh had a past medical history of high cholesterol, a Body-Mass Index of 30.5 with a weight of 73.5kg, and an existing skin condition.

There was no family history of malignant hyperthermia.

The coroner conveyed its condolences to Toh's family.

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