The Pediatric Cardiac Surgery Inquest Report



Pre-operative condition

Vinay was admitted to the Children's Hospital at 1145 hours on Wednesday, March 16, 1994 for surgical correction of his condition. On examination, Vinay was cyanotic with clubbed fingers. Since March 9 he had been treated with an antibiotic for an upper respiratory tract infection. In Vinay's pre-operative assessment, a physiotherapist heard breath sounds present throughout all lung fields, with a slightly harsh sound, especially in the left upper lobe.

At 1600 hours, Dr. H. Grocott, the anaesthesia resident, examined Vinay's chest and determined that his air entry was clear. He noted the child had had a mild upper respiratory-tract infection a week earlier with a runny nose, but no cough or fever. He assigned Vinay an anaesthetic class of ASA IV and noted that he was fit for anaesthesia. Swartz, the attending anaesthetist, also saw Vinay pre-operatively. She reviewed his history and tried to examine him. Both Grocott and Swartz made entries on the chart that the examination was difficult because Vinay was unco-operative. Swartz listed anticipated problems: arrythmias (irregular heart rhythm), coagulopathy and right ventricular failure post-operatively. She also assessed the child as ASA IV.

A chest X-ray taken on March 16 indicated that Vinay's lungs appeared essentially normal. The heart remained slightly enlarged, with evidence of right ventricular hypertrophy.



Current Home - Table of Contents - Chapter 6 - Pre-operative condition
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Previous Consent
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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