Amy Rickhuss suffered a cardiac arrest during cosmetic surgery. Picture: SUPPLIEDA young woman who went into cardiac arrest during cosmetic surgery inSydneyappears likely to have been given anoverdose of local anaesthetic.
Amy Rickhuss was rushed to Westmead Hospital after having surgery for abreast enlargement at The Cosmetic Institute in Parramatta on January 30.
Early reports from The Cosmetic Institute indicated that MsRickhuss”had a reaction to the anaesthetic”.
Fairfax Media understands Ms Rickhuss, 21, was given intralipid, a drug most commonly used to treat an overdose of local anaesthetic.
Phillipa Hore, who chairs the safety and quality committee of the Australian and New Zealand College of Anaesthetists, said intralipid was used to treat “local anaesthetic systemic toxicity”.
Dr Hore said local anaesthetic overdose was preventable and generally occurred when an inappropriate amount was given for the weightand age of the patient.
“Intralipid is used for treatment of an overdose of local anaesthetic,” she said.”It is either an overdose or a smaller dose that has been inadvertently injected into a blood vessel.”
Amy Rickuss is taken from The Cosmetic Institute to Westmead Hospital. Picture: WEBCAM-NT
Incidents of local anaesthetic being injected into a blood vessel are rare.
Dr Erez Ben-Menachem, an anaesthetist at The Cosmetic Institute,told Fairfax Media in January that it was “highly unlikely” the local anaesthetic was injected into a blood vessel, because if that happened, there would have been an immediate reaction.
He said in Ms Rickhuss’case, the reaction was not immediate, but happened towards the end of the procedure.
“The presumed diagnosis at this stage is that she had a reaction to the local anaesthetic,” Dr Ben-Menachem saidin January.
Dr Ben-Menachem was notinvolved in Ms Rickhuss’procedure and was justspeakingon theclinic’s behalf.
Peter Haertsch, an associate professor in plastic and reconstructive surgery at the University of Sydney, said he had never “seen or heard of a reaction to a local anaesthetic”.
“The intralipid is given only when you think you have a toxic problem due to the anaesthetic that you’ve used,” he said.”That’s its specific indication.”
Ms Rickhusssaid she is planning to take legal action against The Cosmetic Institute.
She said that since January, she has been given anaestheticwithout experiencingany adverse reaction.
“I’ve been to a cardiologist andthere is nothing wrong with my heart at all,” she said.
A spokesman forThe Cosmetic Institutesaid thedosage of local anaesthetic given to Ms Rickhusswas within accepted safe dosage limits and the advertised safe range published by its manufacturer.
He said local anaesthetic toxicity in peripheral nerve blocks occurs in onein 1000 patients, according to US anaesthesia authorities.
Asked whether there was any reason other than overdose for Ms Rickhuss’treatment with intralipid, the spokesman said:”We respect the privacy of our patients and do not deal in speculation.
“All of our anaesthetists are specialists of the highest professional standing – fellows of the Australian and New Zealand College of Anaesthetists (FANZCA) – and treat patients according to their qualifications and extensive experience,” the spokesman said.
DavidSegal, who manages The Cosmetic Institute in Bondi and Parramatta, has previously said his clinics haveabout 40 anaesthetists on rotation who alsowork at”Sydney’s most prestigious hospitals”.
Merrilyn Walton, the professor of Medical Education, Patient Safety at the University of Sydney has referred the Rickhuss incident and two others from different clinics to the Health Care Complaints Commission, which she once headed.
One of the three casesinvolving adifferent clinic was treated at St Vincent’s Hospital.
A spokesman forSt Vincent’s Hospitalconfirmedit had recentlyadmitteda cosmetic surgery patientto the hospital’s intensive care unit “due to local anaesthesia toxicity”.
“Owing to patient confidentiality, we are not in a position to go into any more detail,” he said.
Professor Walton and Dr Hore said consumers needto beaware of the risks associated with cosmetic surgery, which is largely unregulated in NSW, and should ask iftheclinics they attendrecord and independently investigate adverse events.
Doctors registered as plastic surgeons undergo at least five years of specialist trainingand arerequired to record adverse events. Cosmetic surgeons are not required to have fullplastic surgery training with the Royal Australasian College of Surgeonsandare not required toreport adverse events.
“The problem for the consumer is it’s an unregulated industry and they have no knowledge of the potential problems that can occur during what they perceive to be a straight-forward procedure,” Dr Horesaid.
NSW Opposition spokesman for Health, Walter Secord, has drafteda private members’ bill to tightenthe definition of “surgeon”.
“Currently, practitioners have free rein to give themselves the title of surgeon, even though they may only have the most basic medical qualification – a Bachelor of Medicine,” MrSecordsaid.
Under Labor’sdraft exposure-consultation bill, only medical practitioners registered in the specialty of surgery after completing extra trainingwouldbe permitted to use the title of “surgeon.”
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