Cardiac Anaesthetist for Ganglion Removal

PIG Meeting: 8th April 2021

29-year-old lady for elective ganglion excision from her wrist.


  • Netherton syndrome – rare autosomal recessive disorder. Characteristic triad of congenital ichthyosiform erythroderma, a specific hair shaft abnormality termed trichorrhexis invaginata (“bamboo hair”), and an atopic diathesis.
  • 2 syncopal episodes a few years ago thought to be due to acquired long QT
  • Regular cardiology review with recent normal echo and holter.
  • No current evidence of long QT, normal ECG at clinic


  • Patient’s mother is requesting cardiac anaesthetist for procedure as per previous cardiologist
  • Anaesthetist called new Cardiologist with mother in room, advised she does NOT need to have a cardiac anaesthetist
  • Patient’s mother became distressed and left the consultation after extensive discussion that a cardiac anaesthetist wasn’t required for this procedure. She stated that she no longer wanted to proceed with surgery.


  • Difficult situation to navigate
  • Anaesthetic consultant and the patient’s current cardiologist were both involved in the discussions
  • The benefits of regional anaesthesia in peripheral surgery were discussed. This was unfortunately declined due to anxiety.
  • Techniques to manage the expectations of the patient while still working within acceptable limits of time and clinical resources
  • Examples of strategies from pain clinics outlined
  • Elective procedure, option to delay surgery and allow family time to consider options
  • Complex social and medical needs of family were recognised as significant stressors


  • Follow-up nursing phone call with family revealed that patient has decided to proceed with surgery as planned
  • Procedural anaesthetist informed of events