Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
9.16 The choice of the most appropriate anaesthetic approach will be influenced by
the history of the child and family and the results of examination. There is no
“one way” to induce anaesthesia in children.
9.17 A common paediatric induction method is the “mask” induction. During this
type of induction, a mask is gently applied to the childs’ face and increasing
concentrations of an inhalation agent (usually halothane, or more recently
sevoflurane) are added to oxygen with or without nitrous oxide. The
advantage of mask induction is that it can be relatively rapidly instituted and
does not require insertion of intravenous (IV) catheters in awake patients. IVs
can easily be inserted after children are anaesthetised. However, some patients
need their airways to be very rapidly safeguarded against the risk of vomited
or regurgitated stomach contents and mask induction may not be appropriate.
9.18 Such patients, along with others with specific medical conditions, or those
who present to the operating room with an IV in place, are induced with IV
agents. These agents include thiopentone, propofol, ketamine, etomidate, and
occasionally high dose narcotics or benzodiazepines. Even when an IV is not
inserted before induction, it usually is once the patient is anaesthetised in order
to provide a route to give any medicines that might be required for the
continuance of anaesthesia or other purposes.
9.19 Whether an IV line is used to give an anaesthetised child intravenous fluids
depends on a number of circumstances, eg, how long the patient has been
fasting and how long it is before the patient is expected to be able to take
fluids.
9.20 My expert anaesthetist also advised that “comments from Gisborne suggest
that there was a lack of familiarity with the nuances of paediatric anaesthesia”,
and that Dr Lucas failed to communicate his plans and their rationale to staff.
Dr Lucas responded that it was “not for want of trying”, and that he had been
trying to teach that particular technician about such matters for months.
Opinion
9.21 In my opinion, none of Dr Lucas’ acts or omissions in administering
anaesthesia to child patients amounted to a failure to exercise reasonable care
and skill. Nor is there any evidence that Dr Lucas failed to communicate
effectively with child patients and their parents or guardians, whatever may
have been his failings to communicate to colleagues. Accordingly, Dr Lucas
did not breach Right 4(1) or Right 5(1) of the Code.
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