Coroner issues anaesthetic warning after death

A coroner has raised concerns about how local anaesthetic is administered after a woman was given too much during an operation and later died.

Rachel Gibson, 47, went into cardiac arrest following hip replacement surgery at Spire Lea Hospital in Cambridge on 12 April 2022.

She sustained irreversible brain damage and died at Addenbrooke’s Hospital three months later.

In a prevention of future deaths report to the Royal College of Anaesthetists (RCOA), coroner Philip Barlow said there was "inconsistency" with the way local anaesthetic was measured, increasing the risk of mistakes.

He said: "The evidence was that the drug was sometimes specified in millilitres and sometimes in milligrams.

"This is of particular concern when the intention is for the drug to be diluted."

In the case of Dr Gibson, an inquest found the intention was for a 2% solution of Ropivacaine to be diluted with normal saline before it was infiltrated.

Evidence suggested it was not done and an excessive amount of the drug was administered by mistake.

Mr Barlow said evidence suggested this type of practice was common nationally.

He added: "The hospital [Spire] has now introduced a system for labelling and countersigning the drug that was given during the operation.

"However, the evidence at the inquest was that, on a national basis, there is wide variation in the way local anaesthetic is prescribed, checked and administered in this type of procedure; and that it is common to use similar practice to that which occurred during this operation".

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Source: BBC News, 3 September 2024