AN inquiry into the death of a 10-year-old boy in a dentist's chair heard yesterday that the management practices of the anaesthetist in charge at the time were ''dangerous, bizarre, inappropriate, and inept''.

Professor Alan Aitkenhead, consultant anaesthetist at Nottingham University, also described the anaesthetist in charge, Dr John Evans-Appiah, as a ''failed trainee''.

He was giving evidence on the thirteenth day of the fatal accident inquiry into the death of Darren Denholm, of Armadale, West Lothian, who died after going to the Peffermill Dental Clinic in Edinburgh to have a tooth removed last October.

Professor Aitkenhead criticised Dr Evans-Appiah's failure to attach an ECG heart monitor to the boy when putting him to sleep.

He said: ''Whenever Darren lost consciousness, any responsible anaesthetist would have attached the ECG.

''Dr Evans-Appiah's management of the anaesthetics after induction was either frankly dangerous, if we are to believe his account, or bizarre, inappropriate, and inept.''

He also criticised Dr Evans-Appiah's reaction when an ECG monitor was connected to the boy.

He went on: ''I believe that Dr Evans-Appiah misinterpreted the ECG once it was attached and as a result of his misinterpretation the defibrillator was not employed for 10 or 15 minutes.''

Asked by depute-fiscal Robert Shiels whether he regarded that as ''a crucial error, probably the factor which determined the difference between successful resuscitation and death'', he replied: ''Yes.''

He continued: ''That Dr Evans-Appiah was in a state of panic confirms that he failed to lead the resuscitation attempts in the manner of a competent anaesthetist.''

Mr Shiels also asked Professor Aitkenhead about Dr Evans-Appiah's performance on the day of Darren's death.

He answered: ''I believe he made a complete misdiagnosis. I believe it was completely ill-founded and thereafter the treatment he gave was inappropriate.

''I also thought when he was giving his evidence (to the inquiry) he expressed a degree of arrogance to the suggestions from other expert people.''

Professor Aitkenhead told Mrs Anne Smith QC, for the family, that he was critical of ''many things'' that happened at Peffermill. He said: ''On a scale of one to 10 where 10 is very serious I would give it nine. He (Dr Evans-Appiah) made a number of serious errors.''

One of these was leaving the boy's head, which he should have attended to look after the airway, or ensured it was attended at all times, which Professor Aitkenhead described as ''reckless''.

He went on to criticise recruitment procedures at the private Poggo Clinic in Kent, which supplied Dr Evans-Appiah.

He described Poggo's system as ''hopelessly inadequate'' saying that the majority of anaesthetists he knew of there were not accredited specialists and that new employees would have been assessed by such consultants.

He said: ''The level of equipment was inadequate and the standard of the anaesthetic assistance was as inadequate as Peffermill.

''The other clinics that I know of did not even have partially qualified anaesthetic assistants.''

Professor Aitkenhead criticised the lack of a monitoring system for general anaesthesia being given in dental clinics, echoing a previous expert's opinion that it should only be done in hospitals.

He said the situation at Peffermill was such that it was impossible for anaesthetists to have full contact with patients during surgery, adding it was cramped and ''unsafe''.

Anaesthetists, their practices and facilities are inspected at intervals in England, but not in Scotland, he said.

''I think it is a serious flaw in the system.'' he added.

The inquiry continues.