Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
this. The Group Manager had previously discussed this with Dr Lucas
who had logical reasons for preferring this.
The Group Manager does not recall whether the application of ice on
this same patient was also discussed at this time, though it may have
been. Dr Lucas was known to use ice on patients and this had been
investigated at this stage.
After discussing the gynaecology patient above, the staff informed the
Group Manager about the occasion on the preceding weekend involving
the induction of anaesthesia on the child, referred to in [paras 9.5 and
9.6]. Considerable time was spent discussing this.
The matter raised in [para 13.13], also occurred at this same meeting.
Two of the anaesthetic staff and the theatre nurse involved above stated
that they did not want to work with Dr Lucas any more. While the
Group Manager cannot recall his exact choice of words – or those of the
staff – it was noted by those present that there were only a matter of
weeks left before Dr Lucas was to leave. It was also noted that staff
could not refuse to provide a service simply because they disliked
another staff member. However, it was agreed to examine the theatre
roster to see if it might be arranged for those staff who did not want to
work with Dr Lucas might be able to be accommodated in this for the
remaining period. The theatre manager agreed to arrange this, if
possible. This occurred for the nurse, but when this arrangement was
subsequently offered to the anaesthetic technician who worked with him
mostly, she declined the offer and agreed to continue working with him.”
Appropriate standards
13.15 I am advised that there are no directly relevant standards. The depth of
anaesthesia is difficult to define “because anaesthetists have approached the
issue in terms of the drugs available to them rather than the patient’s needs
during surgery. The loss of consciousness is considered a threshold or all-ornone
(quantal) phenomenon. By this definition, there can be no degrees of
anaesthesia or any variable depth of anaesthesia. The definitions of
anaesthesia depth have evolved with the drugs used in clinical practice. The
use of potent inhaled anaesthetics, opioids, and intravenous anaesthetics in
modern clinical practice has precluded simple unifying definitions .…”
(Miller, RD, Miller’s Textbook of Anaesthesia. Churchill Livingston, 5 th ed,
NY, 2000)
Opinion
13.16 My expert anaesthetic advisor noted that there is a difference between: (1)
“wakening” and other signs of lighter anaesthesia, such as coughing, and (2)
“wakefulness” in the context of general anaesthesia and when associated
with regional anaesthesia. The advisor did note that “Dr Lucas seems to have
a slightly extreme view of when to lighten anaesthesia based on a
preoccupation with efficiency”.
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