A 14-month-old infant in Hong Kong might have suffered from “extremely rare” complications that caused his death after a simple eye surgery, doctors said in an inquest on Tuesday.
Dr Ko Tak-chuen, the ophthalmologist who operated on Chiang Shing-fan, described the incident as unprecedented in his medical career, and anaesthesiologist Dr Vivan Yuen Man-ying, who was called in to offer her expert views, said the case was extremely rare.
“This rarely happens and was very unusual,” Yuen said.
Both were testifying at Chiang’s inquest, which began on Monday, as a result of his death on March 17, 2016, two days after he had an operation to release pressure in his eyes from congenital glaucoma.
The inquest heard that while Chiang had gone under the knife on four prior occasions with no complications, on March 15, following a procedure at Pamela Youde Nethersole Eastern Hospital in Chai Wan, his heart rate suddenly fluctuated.
He had to be resuscitated, and two days later, after a transfer to Queen Mary Hospital, Chiang eventually died from multiple organ failure.
“I have never seen cardiopulmonary resuscitation performed [in an eye surgery],” Ko said on Tuesday.
He said such an incident “was basically non-existent” in medical journals.
Yuen suggested Chiang might have suffered from a condition called anaesthesia-induced rhabdomyolysis, a genetic condition that was also raised by other doctors who testified on Tuesday.
She said patients suffering from this rare condition might experience muscle damage after inhaling certain types of anaesthesia. In such cases, a considerable amount of potassium would be present in the patient’s bloodstream – which affects heart rate.
I have never seen cardiopulmonary resuscitation performed [in an eye surgery]
Dr Ko Tak-chuen, ophthalmologist
But a postmortem neither confirmed nor rejected Yuen’s suggestion.
She was testifying a day after Chiang’s father took to the witness box and blasted doctors at Pamela Youde Nethersole Eastern Hospital, whom he accused of proceeding with the surgery even though they knew something had gone wrong with the anaesthetic process.
Yuen, who was called in to offer an independent view, said doctors involved had followed procedures.
She said what happened to the boy was so rare that it would not be deemed necessary for doctors to conduct tests targeting his possible condition before the operation.
Dr Yip Hong, the anaesthesiologist at Chiang’s operation, said the boy’s heart rate might have dropped from 130 to 80 beats per minute during the surgery. But he said they confirmed it was due to a reflex action commonly observed when a patient’s eye muscle was being pulled.
He said all of Chiang’s vital signs were stable until after the operation, when his heart rate suddenly plunged to 60 beats per minute and flatlined. It also registered very rapid patterns at one point, he said.
Yip also said the cardiography at the time suggested that Chiang’s blood was overloaded with potassium.
The inquest continues before Coroner Stephanie Tsui May-har on Wednesday.