Finding into death of G A

86y · Female·Bradycardic arrest secondary to relative hypoperfusion while undergoing surgery to the left hand in a patient with subclinical ischaemic heart disease

An 86-year-old woman underwent elective surgery to excise a probable squamous cell carcinoma from her left hand with split-thickness skin grafting under local anaesthesia with intravenous sedation. She suffered an unexpected cardiac arrest intraoperatively secondary to bradycardia and hypotension. Despite appropriate resuscitation, she sustained a hypoxic brain injury and died three days later. The coroner found she had subclinical ischaemic heart disease. While the second dose of anaesthetic drugs (50mg propofol and 50mcg fentanyl) was excessive, the evidence did not establish causation between this and her deterioration. The surgical decision and anaesthetic plan were appropriate. Her death was unpredictable and not preventable given the unknown coronary artery disease.