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