Anesthesia Consent

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Intrathecal

Intrathecal

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So what do you tell the patient when you are obtaining consent for general anesthesia? Here are the things that I tell my patients, but on our pre-printed consent forms, they list things like, brain damage, awareness, DEATH!!!...

I tell my patients:

You may have damage to your lips, tongue, gums, teeth, etc from the breathing tube, but we are very careful when we put it in so it seldom happens....

You may have an allergic reaction to the meds that we give you

You may have a heart attack or stroke under anesthesia.

I don't tell them that there is a risk of death unless I am doing a big CPB case or vascular case.... is that wrong???

THe patients are anxious enough as they are without me telling them that they may die under anesthesia, although it's always a possibility.

Do guys in private practice even do a separate anesthesia consent? In the past if patients consent to surgery it automatically meant they consent to anesthesia as well. Please enlighten me.
 
Intrathecal said:
So what do you tell the patient when you are obtaining consent for general anesthesia? Here are the things that I tell my patients, but on our pre-printed consent forms, they list things like, brain damage, awareness, DEATH!!!...

I tell my patients:

You may have damage to your lips, tongue, gums, teeth, etc from the breathing tube, but we are very careful when we put it in so it seldom happens....

You may have an allergic reaction to the meds that we give you

You may have a heart attack or stroke under anesthesia.

I don't tell them that there is a risk of death unless I am doing a big CPB case or vascular case.... is that wrong???

THe patients are anxious enough as they are without me telling them that they may die under anesthesia, although it's always a possibility.

Do guys in private practice even do a separate anesthesia consent? In the past if patients consent to surgery it automatically meant they consent to anesthesia as well. Please enlighten me.
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About ten tears ago we did not have a separate consent for Anesthesia.
Our legal department determined that was not wise and the vast majority of hospitals across the USA do have a separate consent.

In fact, these days I am not aware of a single MAJOR hospital that does not have a separate Anesthesia consent form (military excluded as I have no idea what they do).

If a complication or risk is less than 1% for a particular procedure or intervention you don't need to mention it. That is why an Inguinal hernia repair or knee arthroscopy doesn't need a "death speech." A double re-do Valve CABG is a different story.

What you do want to mention are the basics: potential tooth damage, sore throat and risk of N/V post-op. These things occur the most frequently and should be mentioned depending on the case/provider. For Regional the basics include headache, paresthesia and the small chance of nerve injury/damage.

Blade
 
I don't tell them anything.

"Your are going to sleep. Once you are asleep you'll get a tube in the throat, which will be removed when you are waking up. If you have pain or nausea we have medication. Just ask for it.


If they have really bad teeth I say " I might knock a few out"


Do airlines tell you you might die before you board the plane? NO, because its understood. Same with anesthesia.
 
Our patients usually come with consent done in preop clinic ahead of time, but when I do it myself I always mention a cut on the lip or chip on tooth, sore throat, bleeding/infection (from lines or blocks), and then I specifically mention things that are far less common going all the way out to death including awareness and brain damage. I mention that we warn everybody about these possibilities and will do our best to take good care of them.

Nobody has batted an eye at signing the consent yet. I did consent one OB lady who's husband was a lawyer. After going through it with her she took it and was looking it over and his quote was "you're consenting to death, why quibble over details". I couldn't help but laugh.

Oh, I also mention blood transfusions if they need it to keep them alive just in case there are in JWs that have slipped through the screening.
 
A friend of mine was sued for a spinal headache after a wet epidural tap. This was a known complication and therefore they went after him on informed consent. The patient was never informed of the risk of headache but did admit that the anesthesiologist and the consent referred to death as a possible consequence of anesthesia. Using a reasonable person standard implied that anyone consenting to a procedure and accepting death as a risk most certainly would have proceded if the risk of headache was disclosed. He won the case!
I handle informed consent in anesthesia for ASA1-3 patients undergoing low risk procedures by comparing it to the trip into the hospital by car. Any type of injury and morbidity is possible from driving (including death etc) but anesthesia for your procedure will be safer than the drive in. However just like a car ride no one can guarantee any outcome. Nervous types understand that the trip to and from the hospital will statisically be the riskiest thing they do today.
 
BLADEMDA said:
About ten tears ago we did not have a separate consent for Anesthesia.
Our legal department determined that was not wise and the vast majority of hospitals across the USA do have a separate consent.

In fact, these days I am not aware of a single MAJOR hospital that does not have a separate Anesthesia consent form (military excluded as I have no idea what they do).

If a complication or risk is less than 1% for a particular procedure or intervention you don't need to mention it. That is why an Inguinal hernia repair or knee arthroscopy doesn't need a "death speech." A double re-do Valve CABG is a different story.

What you do want to mention are the basics: potential tooth damage, sore throat and risk of N/V post-op. These things occur the most frequently and should be mentioned depending on the case/provider. For Regional the basics include headache, paresthesia and the small chance of nerve injury/damage.

Blade
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The University of Chicago Medical Center is a major hospital that does not have a separate consent for anesthesia. We do obtain written consent for pediatric epidurals. There is a rumbling among some attendings that we should have a separate consent, but it seems like this is a long way off.
 
When I was a CA-1, I was telling a patient about the risks of anesthesia. I was telling him the usual spiel: sore throats, N/V, allergic reactions, MI, stroke, death. But before I could finish, my attending shushed me and said, "don't listen to him. General anesthesia is perfectly safe. There are no risks." And then we whisked the patient to the OR.

After the patient was asleep, I asked him why he said anesthesia had no risks. And he told me, do you think that just because you have told him the risks you have exempted yourself from any lawsuits?

I don't necessarily agree with that line of thinking, but I have to admit, he's right.
 
TIVA said:
When I was a CA-1, I was telling a patient about the risks of anesthesia. I was telling him the usual spiel: sore throats, N/V, allergic reactions, MI, stroke, death. But before I could finish, my attending shushed me and said, "don't listen to him. General anesthesia is perfectly safe. There are no risks." And then we whisked the patient to the OR.

After the patient was asleep, I asked him why he said anesthesia had no risks. And he told me, do you think that just because you have told him the risks you have exempted yourself from any lawsuits?

I don't necessarily agree with that line of thinking, but I have to admit, he's right.
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Lets say you dont tell the patient that there is a risk of stroke. He goes in, you do everything right (ie, adhere to the standard of care), but due to a weak blood vessel, whatever, he stokes and is paralyzed.

You dont think that not telling him gives you liability?
 
Noyac said:
So you are saying that I don't even need to mention postdural puncture headaches to my pts?
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I don't.

I'm a minimalist when it comes to going over risk, since as stated by above posters, explaining stuff that may happen doesnt protect you from liability.

They sign the consent, which the patient has every right to read. In eleven years of pp I can count on one hand how many patients read it.

Other than the usual sore throat/nausea/teeth speech....thats the only stuff I cover....and thats only if they ask.

This is what I say about ten times a day...

Operating Room:

"OK! We're gonna bring you back into the operating room, put some monitors on, have you breathe a little fresh Louisiana oxygen thru a mask, and put you to sleep with medicine thru your IV. When its over we'll wake you up, bring you to the recovery room, and monitor you there for a period of time."

Labor & delivery:

"OK, Jane. Time for your epidural, huh? Great! Boy or girl?" (blah blah blah)
"We're gonna have you sit on the side of the bed like you're sitting on the side of a bridge. Jennifer the nurse will help you with positioning. The only part that stings is the numbing medicine, which will sting for about five seconds. After that you'll only feel pressure. You're gonna feel like a new woman in less than five minutes!""
 
jetproppilot said:
I don't.


Labor & delivery:

"OK, Jane. Time for your epidural, huh? Great! Boy or girl?" (blah blah blah)
"We're gonna have you sit on the side of the bed like you're sitting on the side of a bridge. Jennifer the nurse will help you with positioning. The only part that stings is the numbing medicine, which will sting for about five seconds. After that you'll only feel pressure. You're gonna feel like a new woman in less than five minutes!""
Click to expand...


1. My OB instructor (who was an MD/JD/RPh all rolled into one) said a consent only truly protects you from an accusation of battery.

2. Do you think a pt has to have clear mentation to be consentable? Every time I obtain an OB epidural consent from someone writhing like a jumping bean from the pitocin I wonder just how legitimate the consent is...... especially when they scream, "just give me the damned clipboard, I'll sign anything, OOOOWWWWWWWWWWWW." Our L+D nurses can't obtain epidural consent for us, and usually we're not notified about an impending epidural (to consent before the pain really kicks in).
 
The whole point of the consent is to list all those things which don't happen very often. You need to reasure the patient and not scare him/her.
Legally, I was told by a malpractice attorney that complications which occur less than 1% of the time don't need to be specifically mentioned. Most Anesthesia consent forms list all those things anyway like death, stroke, paralysis, etc. Why should you actually mention the RARE stuff? It serves no purpose whatsoever.

Now, if you believe a particular complication has a real chance of occuring then discussing it seems prudent. For example, those of you using a 20 gauge Q needle for spinals should discuss the risk of headache with patients under the age of 65. Those using a whitacre needle on that same Group may want to skip this same discussion.

Blade
 
The standard for informed consent are risks that are possible/probable >1% should be disclosed. Significant risks with profound iimplications (death, paralysis etc) must be disclosed even if they are rare.

Informed consent is a hallmark of professionalism and ethical treatment of patients. I would fail a resident who felt so God-like that he could decide for the patient what risks if any need to be discussed. This is key to patient autonomy and should be of interest to all physicians.
 
The lawyers would tell you that in order to meet informed consent requirements, you need to tell pts things that "the reasonable person would consider "material" to making a health care decision". Most people here(and the ASA closed claims speakers I have heard agree) feel that means anything that happens more often than 1/10,000 and the really big ones. This includes PDPH, tooth damage, nerve damage from periph nerve blocks and the like. Then they say that we are obligated to mention the "big" things like coma, death, paralysis, awareness. I mention all of these to every pt I meet, but I admit, I am an outlier in my department. I would consider coma, death, paralysis, and awareness as very "material" to me if I was deciding about a procedure.
By the way, we do not have a written consent form for anything. The legal department obviously considers it not worth having. A note is placed in the chart from the surgeon/proceduralist for the surgery and a note is placed in the anesthesia record by us that states that risks, benefits and alternatives were discussed.
 
atrxnasd said:
The standard for informed consent are risks that are possible/probable >1% should be disclosed. Significant risks with profound iimplications (death, paralysis etc) must be disclosed even if they are rare.

Informed consent is a hallmark of professionalism and ethical treatment of patients. I would fail a resident who felt so God-like that he could decide for the patient what risks if any need to be discussed. This is key to patient autonomy and should be of interest to all physicians.
Click to expand...


That sounds very noble.

And I respect your viewpoint. But I dont agree with it.

From a patients viewpoint, at least the ones I've dealt with over the last 11 years, wanna get their surgery over with.

They don't want to be reminded that they could die during the 20 minute knee scope....

so you encourage your residents to mention death as a risk for even minor procedures? Knee scope? Boob job? FESS?

If the patient dies, do you think they're gonna care (in the afterlife) about the consent? Will you feel better if the patient dies that you informed them they may die??.......

.........None of the above makes sense to me. And going over remote "risks" does nothing in my opinion except freak out an already-nervous patient.

I'm there to take care of them. Not remind them of death, stroke, blah blah blah.

again, in eleven years, I can count on one hand how many patients were inquisitive about risk.....with these people I'm very patient, and make sure all their questions are answered.....but again, 3 or 4 in eleven years.

Additionally, by asking the patient to sign the consent after they review it, and they sign it, their signature is testifying that they were aware of the risks inherent with surgery and anesthesia......but even this can be dissected...so like I said before, I'm a minimalist. Since it doesnt really matter. If a patient wants to sue you, they're gonna sue you.

A consent is not gonna save you from a lawsuit. Like Trinity said, it protects you from pretty much one allegation: battery.

So save your residents alotta trouble, and your patients alotta anxiety.

Tell them there are risks with anesthesia, but risk is very minimal and that you'll take good care of them.

Then have'em "SIGN RIGHT HERE, NEXT TO THE X..."

You think your residents consider themselves god-like, and you'll fail them if they dont mention death/cva/zebra/zebra etc?

Get off your high horse, Slim.

And teach your residents.

Don't preach to them.

Do you feel that strongly about this subject?

Great.

Instill your passion about your viewpoint without being a dickhole.

They'll remember it a lot longer......maybe they wont agree with you, but they'll remember.
 
BLADEMDA said:
About ten tears ago we did not have a separate consent for Anesthesia.
Our legal department determined that was not wise and the vast majority of hospitals across the USA do have a separate consent.

In fact, these days I am not aware of a single MAJOR hospital that does not have a separate Anesthesia consent form (military excluded as I have no idea what they do).

If a complication or risk is less than 1% for a particular procedure or intervention you don't need to mention it. That is why an Inguinal hernia repair or knee arthroscopy doesn't need a "death speech." A double re-do Valve CABG is a different story.

What you do want to mention are the basics: potential tooth damage, sore throat and risk of N/V post-op. These things occur the most frequently and should be mentioned depending on the case/provider. For Regional the basics include headache, paresthesia and the small chance of nerve injury/damage.

Blade
Click to expand...

Just for info, the Army has a separate consent for Anesthesia.
 
so you encourage your residents to mention death as a risk for even minor procedures? Knee scope? Boob job? FESS?

If your a cop you must tell everyone of their Miranda rights. If your a doctor you must get informed consent. Don't do it and proceed at your own risk.

By the way I have reviewed charts of deaths occuring during FESS. If you think it is impossible you are in the wrong field!
As I wrote earlier one doesn't have to say "You could die during this procedure" but that possibility must be conveyed. I equate anesthesia risk as lower than the risk of driving (ASA1-2) Anything is possible.

It must eb a wonderful feeling to know with certainity that you can do simple anesthestics with no significant risks. I am in awe of your greatness and impressed by your humble attempt to protect your patients from truths that might bother them.
 
atrxnasd said:
so you encourage your residents to mention death as a risk for even minor procedures? Knee scope? Boob job? FESS?

If your a cop you must tell everyone of their Miranda rights. If your a doctor you must get informed consent. Don't do it and proceed at your own risk.

By the way I have reviewed charts of deaths occuring during FESS. If you think it is impossible you are in the wrong field!
As I wrote earlier one doesn't have to say "You could die during this procedure" but that possibility must be conveyed. I equate anesthesia risk as lower than the risk of driving (ASA1-2) Anything is possible.

It must eb a wonderful feeling to know with certainity that you can do simple anesthestics with no significant risks. I am in awe of your greatness and impressed by your humble attempt to protect your patients from truths that might bother them.
Click to expand...

You have misread me.

I have no God complex in our profession, believe me.

I'm more concerned about my upcoming World Series of Poker Tournament, to tell you the truth.

I know, and you know, that even simple anesthetics carry risks. I choose to take a different road than you when it comes to zebra risks of anesthesia.

Your sarcastic, demeaning response towards me is acknowledged.

I choose not to respond, other than the above.
 
No disrespect intended here. But, in my world I use the ANESTHESIA CONSENT FORM to list all the RARE BAD STUFF that can happen to the patient. When I talk with the patient it is my job to REASSURE him/her and not dive into zebra land about rare complications.

My partners and I stick with the meat and potatoes about Anesthesia.
This is the way I want it done for my family and me. This is the way it is done in most private hospitals.

Blade
 
How many of you tell your pts "we might be chopping your arm off if this goes bad" before putting an A-line? If you say that to me I wouldn't let you do it.
​
 
Does anyone here discuss the risk of blindness after surgery(ION), specifically spine surgery or CABG? While it does not meet the >1% rule, it definitely fits in the "bad" or life changing category.
 
Gern Blansten said:
Does anyone here discuss the risk of blindness after surgery(ION), specifically spine surgery or CABG? While it does not meet the >1% rule, it definitely fits in the "bad" or life changing category.
Click to expand...

That's something that should be discussed by the surgeon in his office before scheduling surgery. It is really out of our control, since it is mostly related to the nature of the surgery. I doubt it is wise to tell the pt 10 min before surgery that they might end up blind.
 
urgewrx said:
That's something that should be discussed by the surgeon in his office before scheduling surgery. It is really out of our control, since it is mostly related to the nature of the surgery. I doubt it is wise to tell the pt 10 min before surgery that they might end up blind.
Click to expand...

I don't really see it as a surgeon only problem and isn't really related to the nature of the surgery alone. The surgeon is not the one responsible for maintaining an adequate ocular perfusion pressure or checking the hemoglobin intraoperatively. I am specifically speaking of Ischemic Optic Neuropathy in case I wasn't clear about that before.
 
Gern Blansten said:
I don't really see it as a surgeon only problem and isn't really related to the nature of the surgery alone. The surgeon is not the one responsible for maintaining an adequate ocular perfusion pressure or checking the hemoglobin intraoperatively. I am specifically speaking of Ischemic Optic Neuropathy in case I wasn't clear about that before.
Click to expand...


If you think those are related to ION you are in for a big surprise. Keep reading.
 
urgewrx said:
Do airlines tell you you might die before you board the plane? NO, because its understood. Same with anesthesia.
Click to expand...

I don't think that analogy holds up. Most people have a rudimentary understanding of flying machines and potential risks when you board a plane. Flight attendants also go over escape routes and emergency instructions in the event of a crash, a water landing(even if you are flying over a desert) or if the cabin loses air pressure. The cavity searches at security entrances are a subtle tip-off of the risk of terrorist attacks or hijackings. So, basically, you are being told what some of the potential risks through these processes, even though most people already know these things.
Most people that I interview have no idea about risks of anesthesia. When I finish interviewing them, I always ask if they have any questions. The most common response: "I don't know enough about anesthesia to even ask a question."
Also, to say that death is an understood risk of anesthesia is not my experience at all. Maybe 20 years ago, it was. It has gotten so safe that a large portion of society believes that it is no big deal (ie the rise of the mid level provider). I have seen many very high risk patients that had no grasp of the nature of their illness or the potential risk of surgical and anesthetic interventions.
Is this how you have always gotten "informed consent" or is this something that you have gradually developed over many years? Is it your impression that they "won't understand it anyway, so why bother telling them?"
 
urgewrx said:
If you think those are related to ION you are in for a big surprise. Keep reading.
Click to expand...

Well, he had 2 days to respond before he messed around and got banned. He failed to produce any shred of evidence that he new what the factors related to ION were. I will assume that means he was just being his usual antagonistic self.

For those who care:

ION is not completely understood. It can be arteritic (Giant Cell arteritis etc) or non-arteritic (the kind we usually see with post op vision loss or associated with the use of sildenafil and the other similar ).

It can further be divided into anterior and posterior ION. Risks appear to be similar for both with the exception of anterior ION having a further risk factor of being more common in people with a congenitally small cup to disk ratio (or in simpler terms, crowding of the optic nerve as it passes through a smaller than usual bony structure as it leaves the globe). An ophth exam can show if a person has this congenital problem but it would be terribly expensive to screen everyone who was going to have surgery or who was going to be prescribed viagra.

The generally accepted risk factors seem to be anemia and hypotension. Other associated factors include prone cases, CPB cases, long duration cases, coexisting diseases such as vascular disease and diabetes seem to be somewhat related. The disease is not completely understood because there have been case of ION that occurred in young, healthy patients with trivial loss as well as in cases of very short duration. Pressure on the eyes does not seem to be a critical factor for ION(although it probably is for central retinal artery occlusion) since there are many cases in the database where Mayfield tongs were used and there was absolutely no pressure on the face. Some investigators are speculating that overuse of crystalloid may play a role. Most agree that the prone position is associated with sharp rises in Intraocular pressure after several hours. Ocular perfusion pressure is measured by MAP-IOP, therefore, what was an adequate ocular perfusion pressure at the beginning of the case may not be adequate several hours later as the IOP has risen steeply.

This is a complex topic(the above is only the tip of the iceberg) and one that is evolving as new information is discovered. I had hoped that urge would have shared his knowledge with us. I thought maybe he was being serious and that he knew something different. The fact that he chose to ignore any requests to elaborate makes me think he was just blowing smoke. Since I have never had any previous interactions with him on this board, I am at a loss to figure out what his motivation is. Oh well. If anyone else has any additional info to add, I would love to hear it.
 
trinityalumnus said:
1. My OB instructor (who was an MD/JD/RPh all rolled into one) said a consent only truly protects you from an accusation of battery.
Click to expand...
While the law is state-dependant, the above is not true where I am. The standard to sue for an informed consent breach is rather hi (a reasonable person would not have proceded had they known of the risk), if a jury decides that it is meant, your screwed. The elements are as below, for ohio:

"The tort of lack of informed consent is established when:

"(a) The physician fails to disclose to the patient and discuss the material risks and dangers inherently and potentially involved with respect to the proposed therapy, if any;

"(b) the unrevealed risks and dangers which should have been disclosed by the physician actually materialize and are the proximate cause of the injury to the patient; and

"(c) a reasonable person in the position of the patient would have decided against the therapy had the material risks and dangers inherent and incidental to treatment been disclosed to him or her prior to the therapy."
Click to expand...
SEE: Nickell v. Gonzalez (1985), 17 Ohio St.3d 136, 17 OBR 281, 477 N.E.2d 1145
 
This is an interesting thread. There are a lot of different opinions. I've heard the <1% of the time don't need to be mentioned from a lot of different sources. But how many of us have even knocked out a tooth? I'm pretty certain I've delivered > 100 anesthetics, and I've never had any dental trauma, so do I need to mention it. All we would really have to mention to patients is the risk of sore throat if we want to play that <1% of the time card. I think that this is probably a little too lax, but I think that some of the statements (e.g. allergic reactions) are a little overboard. I've seen some of my partners do that crap, and I've seen their patients overwhelmingly get either totally freaked out or watch the glazed-over "what are you a doctor or a lawyer" look come over the patient's face.

Here's what I tell the patient, in a very reassuring manner:

The biggest risks to you from this anesthetic are a sore throat and some postoperative nausea, which we can treat in the recovery room. There is a small risk of dental trauma or small abrasions on your lips or tongue; forunately, I've never had an issue with that, and I assure you that I will be as careful as possible when I insert the breathing tube. Rest assured that when you are asleep, I will be watching over all of your organ systems, and will take good care of you in the event of any event which risks your life or your immediate health.

I think that that is sufficient. It puts the patient at ease and also reiterates their code status.

I consent for blood on appropriate cases (despite them already signing a consent), and sometimes if they look really scared, I shake my weiner at them a few times. Only on Tuesdays though.

My $0.02
 
I've read a lot of your posts in the past, and I've found a lot of good material.

How come you always have to be so damned condescending to people? It's a real turn-off, Slim. Oops! Did it myself!
 
Unfortunately, I was involved in a lengthy, prone position spinal surgery that had an outcome including posterior ischemic optic neuropathy resulting in total, bilateral vison loss. The patient was not advised of his potential complication by either the surgeon or the anesthesiologist, in part because of the uncommon nature of PION, and the frequency of this condition stated by the literature to be +- 1%. This experience has forced me to consider my position regarding informed consent.

First, I believe that it is incumbant to consider the surgical procedure. The literature indicates a low frequency of occurance for "spinal surgeries"; but I personally feel that frequency is substantially higher in "complex, prone position surgeries" involving significant blood loss, and instrumentation. My personal lesson is to carefully the specific procedure with an eye toward questioning "general comments of frequency" and consider my specific procedure. Obviously rather simple cosmetic surgeries should be examined differently from lengthy, complex procedures.

Second, I believe there is an obligation to consider the seriousness of the potential outcome. I too have never knocked a tooth out; but then again I have never had a PION outcome. We all would certainly theoretically agree that if the frequency of both of these complications are the same, that we would be well advised to think about blindness consent when we might dismiss one less tooth.

Third, it has been suggested that these consent issues are primarily the concern of the neurosurgeon. I do not think I agree. The anesthesiologist team is charged with monitoring overall pt condition, including EBL. CVP, hematocrit, etc. all of which contribute to organ perfusion and the possible loss of the optic nerve. The anesthesiology team is charged with taking corrective action when any of these get out of line.

I have come to the conclusion after this painful event, that it I would rather thoughtfully err on the side of "over-advising" the patient; rather than have a rude awakening the the patient AND me.

Finally, I view two other considerations to informed consent. Certainly the limitation of liability is of significant importance, but one is always in a better position of consent was provided by an informed pt. However, I believe that we have a supreme obligation to the pt. who may wake up with a completely unanticipated, not understood and catastrophic outcome.

Regarding the specific PION condition described in an earlier post by Gern, your information conforms to my studying this subject over the last few months. One other condition that bears perioperative monitoring is facial edema for obvious reasons.
 
Last edited:
Unfortunately, I was involved in a lengthy, prone position spinal surgery that had an outcome including posterior ischemic optic neuropathy resulting in total, bilateral vison loss. The patient was not advised of his potential complication by either the surgeon or the anesthesiologist, in part because of the uncommon nature of PION, and the frequency of this condition stated by the literature to be +- 15. This experience has forced me to consider my position regarding informed consent.

First, I believe that it is incumbant to consider the surgical procedure. The literature indicates a low frequency of occurance for "spinal surgeries"; but I personally feel that frequency is substantially higher in "complex, prone position surgeries" involving significant blood loss, and instrumentation. My personal lesson is to carefully the specific procedure with an eye toward questioning "general comments of frequency" and consider my specific procedure.

Second, I believe there is an obligation to consider the seriousness of the potential outcome. I too have never knocked a tooth out; but then again I have never had a PION outcome. We all would certainly theoretically agree that if the frequency of both of these complications are the same, that we would be well advised to think about blindness consent when we might dismiss one less tooth.

Third, it has been suggested that these consent issues are primarily the concern of the neurosurgeon. I do not think I agree. The anesthesiologist team, in my case, is charged with monitoring overall pt condition, including EBL. CVP, hematocrit, etc. all of which contribute to organ perfusion and the possible loss of the optic nerve. The anesthesiology team is charged with taking corrective action when any of these get out of line.

I have come to the conclusion after this painful event, that it I would rather thoughtfully err on the side of "over-advising" the patient; rather than have a rude awakening the the patient AND me.
 
BLADEMDA said:
In fact, these days I am not aware of a single MAJOR hospital that does not have a separate Anesthesia consent form (military excluded as I have no idea what they do).
Click to expand...

We don't have one for procedures/operations, as the patient signs a consent for the procedure. I did learn, however, that we have one for situations where the patient doesn't sign a consent, like MRI.
 
IlDestriero said:
I consent for my spinals/epidurals, including the risk of permanent pain or nerve damage, need for urgent/emergent surgery and paralysis. Why, because a PCA could almost always be used instead of an epidural or ITN. The parents need to know the risks.
Maybe I am paranoid, but the parents cannot say that they were not informed of the risks before the operation. They can sue me, but they cannot claim that they did not have an informed consent. That fact alone MAY keep some of the wolves at bay, especially with respect to pseudo-frivolous lawsuits looking for a quick settlement.
Click to expand...

Do you have an encyclopedic pre-printed consent form (listing possible alternatives) for the pt to sign? If not, do you take the time for carefully chart the exact conversation you had with the pt? Just curious, due to the adage that if it isn't charted, it didn't happen.
 
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