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Case study: No such thing as a small anaesthesia

Even small surgeries might necessitate very complicated anaesthetics - as a South African anaesthesiologist experienced during a routine ear operation on a little girl.
After a successful cochlear implant, Aloshay Arendse (8) is getting a second chance at childhood. With her from left are anaesthetist Dr Nick Meyersfeld, her grandmother Spasina Isaacs, mother Candice Isaacs, father Ashley Arendse and Dr Gary Kroukamp, one of her surgeons, at Life Kingsbury Hospital. Photo: People's Post
Recently anaesthesiologist Dr Nicholas Meyersveld, participated in a pro bono cochlear implant operation with a difference. The patient was a seven-year-old girl with a difficult medical history, which meant she needed complex special care.

Cape Town-based Meyersveld had been involved in quite a few cochlear implant surgeries and usually keeps his pro bono work under wraps. However, he was coaxed into sharing his latest experience in order to highlight the highly complex nature of anaesthesiology, and the vital importance it plays in a successful surgery.

Complicated medical history


“I was contacted directly by Dr Gary Kroukamp, who explained that a seven-year-old girl needed a cochlear implant. Her difficult medical history included the need for a liver transplant in her toddler years, HLH (haemophagocytic lymphohistiocytosis, a rare but potentially fatal condition of the immune system) for which she needed chemotherapy and impaired kidney functioning. I have worked with Gary on cochlear implants before and was very happy to get involved.”

He explains that the little girl had faced and overcome a plethora of medical challenges – more than most adults have had to endure. He added that this can take its toll on families in various ways, including financially; hence his willingness to assist at no cost.

“It was a morning of my time that I was only too happy to give up to help in a small way,” says Meyersveld.

However, this was an unusually challenging case when it came to anaesthesia. “She also had various allergies and was on a plethora of medications that interfere with the body's processes and how anaesthetics work. It was critical to understand her history and current physiology, and cater the anaesthetic to her specific circumstances.”

From day one, Meyersveld set about preparing for the operation. His priority was to ensure a successful and event-free operation.

Vital for patients to understand


“It was critical to have an in-depth understanding of her medical history. This was a priority for me, and I was able to go through her notes and blood results in the weeks leading up to the surgery. The surgeon and I had also consulted and I felt prepared to take on the case,” he says.

Thanks to his thorough research and understanding of the patient, her history and the current case, the surgery and anaesthetic went smoothly. Meyersveld managed the young patient’s post-operative pain and recovery process, leaving her pain free and physiologically well enough to go home that same day.
Meyersveld believes that it is vital that patients understand the fact that there is no such thing as a “small”, “light” or “risk-free” anaesthetic.

“Every anaesthetic poses risks related to every part of the patient's physiology and required surgery. Patients need to be aware of the risks specific to their history and surgery. They need to weigh these up against potential benefits with their doctor. Even small surgeries might necessitate large, complicated anaesthetics,” he says.

Despite handling medically complex situations such as these on a daily basis, Meyersveld still insists that his greatest challenge to date is getting his own toddler to sleep.
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