Awareness and Informed Consent

[drrosenrosen]

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The awareness post below, and the responses that mentioned patient expectations of anesthesia, got me thinking about this. How many of you have had patients who were poorly prepared by their surgeon for anesthesia, who freak out when they find that they're getting regional/MAC? "You mean I'm not going to be asleep!?" And once you've stepped on that landmine, it can be very difficult to regain rapport and trust, and to assure them that MAC is not equivalent to "being awake during surgery." They become distrustful of you and scared about the whole thing, and sometimes no amount of explaining in lay terms the difference between sedation and GA will bring them back. This seems to be a very important dynamic in the dr-pt relationship vis-a-vis the pt's expectation of what anesthesia is going to be, and will color their perception of "awareness." Anybody care to weigh in on this, and/or offer advice for how you deal with this issue when it comes up. (Besides telling your surgeon to mention to the patient that they won't get a GA for their carpal tunnel)

 

[VolatileAgent]

deep sedation/MAC has to be carefully selected for patients who are cooperative and willing to undergo the technique.

as i've said before (and will say again), taylor your anesthetic to the patient. always. it's amazing how many people are only comfortable giving "cookie cutter" anesthesia. that's the point of residency. to learn as many different techniques as possible so you have a big toolbox from which to draw upon. 'cuz when the only tool you have is a hammer, every problem looks like a nail.

 

[milrisome]

Don't rely on the surgeon to prepare the patient, except in a few rare exceptions. And don't come right out and tell them they won't be asleep. You need to break it to them more gently than that. First, say that "we'll be giving you lots of good meds to make you comfortable and sedated." And make sure they understand that the surgeon will be injecting local. And tell them that you'll be there with them the whole time, and they will be able to communicate with you (This helps for those people worried about awareness). And if they are uncomfortable, you will help them out with it, by giving more sedation, pain meds, or local. If that's not working you can have them go to sleep as a back-up plan. This way they understand that you're there for them and they're not just going to be thrown to the wolves.

 

[milrisome]

Don't forget to mention to them the benefits: Less post op sedation, less risk of PONV, faster discharge, no intubation, etc.

 

[coprolalia]

If you do a good MAC, the patient won't remember a thing.

copro, CA-2