The inquest into the death of baby Brian Lankuts in ACT Coroners Court centred yesterday (wed16sept) around a document recording the results of a blood test.
The blood test had been taken early in an operation on Brian, who died aged five months on November 21, 1990, after surgery to correct a skull abnormality which threatened to compress his brain.
Coroner John Burns was told that if the document had been on the medical file at the time it went to an independent expert the expert might have come to a different conclusion about the appropriateness of anaesthetic treatment during the operation.
Anaesthetist Dr Nicholas Gammell-Smith, who gave evidence for most of the day, said the results of the first test had showed there was no significant high acid level in Brian’s blood (acidosis). It showed there had been adequate blood replacement early in the operation, contrary to the conclusion of Dr Donald Sweeney, the independent expert.
In response to Stuart Littlemore (for neurosurgeon Dr Nadana Chandran, maxillary facial and oral surgeon Dr Peter Vickers and plastic and reconstructive surgeon Dr Alan Ferguson), Dr Gammell-Smith said it was not common practice to do blood coagulation tests before such an operation, as suggested by another expert, Dr David David, ÿ(subs correct)@ head of the Australian Cranio-Facial Unit. They were not done at the Prince of Wales Hospital.
Dr Gammell-Smith agreed that the degree of preparation and discussion before this operation was as high as he had ever done.
He said that during the operation Brian’s blood pressure had fallen. It was not accompanied by other indicators of blood loss: pulse up, internal carbon dioxide down and central venous pressure up. He had taken samples for several tests. He had still thought it appropriate to treat the fall in blood pressure as being caused by blood loss so he had increased the transfusion rate and increased the level of stable protein plasma solution (SPPS). He said this could have increased the level of potassium in the blood and caused acidosis. Excess potassium could cause the heart to stop.
The inquest heard earlier that a machine that tested potassium at Royal Canberra Hospital North was not working.
Dr Gammell-Smith said a second blood test had showed an increased acidotic state. He had treated Brian for acidosis and excess potassium with calcium (which protects the heart against potassium) and a bicarbonate solution which lowers the potassium rate.
The bicarbonate had a better result on Brian’s blood pressure than the Calcium.
There was no real risk in over-transfusion.
He said medical knowledge now, but not then, was that some SPPS packs had been associated with low-blood-pressure problems.
Asked about the state of records he said, “”When blood pressure goes down we have problems; the last thing we do is record it,” he said.
Dr Gammell-Smith stayed with Brian until the transfer to intensive care was complete. He then had to attend another operating theatre. He had returned to intensive care and had helped with treatment and resuscitation until Brian had been declared dead.
A biochemistry technician at Woden Valley Hospital, Michael Penkethman, agreed with Paddy Bergin, for Dr Gammell-Smith, that the documentation about the first blood test had not been in the medical file and it had only been produced shortly before the hearing.