Less neuraxials safer?

[nitroglycerine]

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I am looking for opinions.
Does anibody out there think that the benefits of neuraxial blocks ( perhaps except spinals for the C/Ss) are over-emphasized while the risks are under-emphasized?

 

[periopdoc]

I think that the neuraxial block with the most over-emphasized benefit is in fact the SAB for c-section.

I agree that the benefits of regional tend to be overemphasized, although I do not think that the risks are underemphasized. There are some specific situations where the benefits are clear and compelling.

- pod

 

[pgg]

I think that the neuraxial block with the most over-emphasized benefit is in fact the SAB for c-section.

Yeah, if you take away
1) overblown airway fears in pregnant women
2) desire to be awake for the birth, with dad/whoever present
it doesn't make a lot of sense to give a spinal for intraabdominal surgery + a sympathectomy to someone who's about to bleed a lot. But (2) is a big deal.


I don't think neuraxial risks are underemphasized or underappreciated in general though.

 

[seinfeld]

I agree that Spinals for Csections are over emphasized. I remember as a resident a OB fellowship trained attending saying " i would never induce a pregnant women by myself". In the first 6 months of being an attending i had done 3 GA's for emergent Csections, all alone. I am glad they trained me well in residency to do them 😀

 

[Idiopathic]

why dont you tell me what you believe the risks are first.

 

[dhb]

I am looking for opinions.

Or are you looking for advice?

 

[nitroglycerine]

why dont you tell me what you believe the risks are first.

Nerve roots damage, spinal cord damage including conus medullaris, epidural abscess, meningitis, epidural hematoma, TNS, paraplegia, cardiac arrest.

 

[nitroglycerine]

Or are you looking for advice?

That too if you have one.

 

[nitroglycerine]

I think that the neuraxial block with the most over-emphasized benefit is in fact the SAB for c-section.
There are some specific situations where the benefits are clear and compelling.


- pod

What about "maternal death decreased 17 times" ? Do you believe that if we all started doing GAs for all C/Ss mothers will start dying 17 times more often? I personally do spinals for C/S because of the "17 times " thing and trying to avoid awake intubation in an occasional mother with difficult looking airway. I have to admit that I do not recall a situation when I had an expected difficult looking airway in OB. My only failed intubation in OB did not look difficult ( did the rest of the case with oral airway, mask and gentle cricoid pressure). About benefits in non-OB: Upper abdominal incision, open nephrectomy.Thoracotomy when surgical under direct vision paravertebral catheter is not an option. What other serious benefits do you think of?
Thanks.

 

[Idiopathic]

Nerve roots damage, spinal cord damage including conus medullaris, epidural abscess, meningitis, epidural hematoma, TNS, paraplegia, cardiac arrest.

these are, at worst, on the order of 1/2,000 and most are at least 1/10,000, with some that are merely anecdotal. the only cases that i consider absolute indications for neuraxial blockade are

1. elective/non-emergent CS (sometimes even in those)
2. open thoracotomy
3. labor analgesia, if requested

i will assume a 1/2,000 risk of possible complication, most of which will resolve, to avoid the 1/50 chance that i cant get the COPDer off the vent after her TKA or to try and prevent post-op pneumonia after a Whipple

 

[Idiopathic]

blunting of surgical stress response, less opioid requirements, quicker return of bowel function,

paravertebral catheters in mastectomy may affect breast CA recurrence
spinals/epidurals for TKA may affect long term pain

 

[pgg]

to avoid the 1/50 chance that i cant get the COPDer off the vent after her TKA

Do you really think it's that high?

After all, we're not intubating them for respiratory failure. I'm a youngin' yet but I have yet to be unable to wean a COPDer who was electively intubated (for a procedure I'd normally extubate postop in the OR).

 

[Idiopathic]

probably not but we have some pretty bad lungers show up for elective surgery, and more than one of them spends the night on a vent. one night can easily turn into one week, and the complications associated with that are way less palatable than a 1/10,000 chance of transient nerve root injury.

im just saying, if we are speaking in terms of hypothetical complications, then lets not leave out the actual somewhat likely ones

 

[nitroglycerine]

Yeah, if you take away
1) overblown airway fears in pregnant women
2) desire to be awake for the birth, with dad/whoever present
it doesn't make a lot of sense to give a spinal for intraabdominal surgery + a sympathectomy to someone who's about to bleed a lot. But (2) is a big deal.


I don't think neuraxial risks are underemphasized or underappreciated in general though.

1) Agree
2) my wife did not have such a desire
3) cannot agree more
We know the risks and benefits. Frequently I see the approach like " I really want to give you this thoracic epidural for your hysterectomy, it is great and it is safe, PDPH is rare, nerve damage and hematoma are almost unheard of,OK?-let's go!" . I can make an informed decision if I have a surgery, but how many patients can? How many of us even use the words "paralysis" and "wheelchair" which are the lay terms for "permanent neurological damage"? Are our informed consent discussions adequate? Are we trying subconsciously to coerce patients to accept procedures they do not understand?

 

[Idiopathic]

do you tell your ASA2 patients that they may die during surgery? we all cloud over that but i think its probably as likely as someone ending up "in a wheelchair". do you tell your patients in whom you are going to place arterial lines that they may have permanent damage to their hands or your patients in whom you place central lines that there may be inadvertent arterial puncture/insertion and they may need emergency vascular surgery?

i know what i tell people, and im comfortable with my consent as being informed.

 

[nitroglycerine]

these are, at worst, on the order of 1/2,000 and most are at least 1/10,000, with some that are merely anecdotal. the only cases that i consider absolute indications for neuraxial blockade are

1. elective/non-emergent CS (sometimes even in those)
2. open thoracotomy
3. labor analgesia, if requested

i will assume a 1/2,000 risk of possible complication, most of which will resolve, to avoid the 1/50 chance that i cant get the COPDer off the vent after her TKA or to try and prevent post-op pneumonia after a Whipple

Thanks. All the points are really hard to argue against. What is your usual line when you explain risks to patients? Does it change when you communicate via an interpretor? Is it different for a healthy hysterectomy vs. Whipple? By the way, we switched from thoracic epidurals for open thoracotomies to surgical PV catheters (easier, safer, as good for pain and lung function). One of my former attendings was sued for an epidural complication. I must say that his risk explanation to a patient was the most thorough off all I have seen.

 

[dhb]

That too if you have one.

Read a book

 

[nitroglycerine]

Read a book

What book?

 

[Sergio99]

do you tell your ASA2 patients that they may die during surgery? we all cloud over that but i think its probably as likely as someone ending up "in a wheelchair". do you tell your patients in whom you are going to place arterial lines that they may have permanent damage to their hands or your patients in whom you place central lines that there may be inadvertent arterial puncture/insertion and they may need emergency vascular surgery?

i know what i tell people, and im comfortable with my consent as being informed.

Absolutely all my patients of all ages, from ASA1 to ASA5 hear the spiel about death, even children. In pediatric cases I make sure parents and children hear it.

My formula is, "Anesthetics, like everything in medicine, have risks and complications, which may be very minor or very major, including death. However, they are extremely rare and we take lots of precautions. Is there anything you want me to explain in more detail?"

Some people ask questions, but the majority don't. They say, "You already told me more than I want to know."

Some people respond, "I don't like the one about death," to which I counter, "I don't either, please don't do that on my watch," and go on to compare it to a car accident, where you know you can die or become paralyzed from it any time you are in a car, but still drive and take passengers with you.

Very few people have objected, "Nobody ever told me this much; why do you scare me like that? Am I a greater risk than usual?" If they are a greater risk than usual, I explain why they are a greater risk, and if not, I go back to the car analogy. In the end they are all satisfied.

I started doing this many years ago, after a lawyer lecturing at a pediatric meeting told us, "Please do yourself and us a favor and tell all the parents that their child may die."

 

[Idiopathic]

yeah we all do that to some degree, but my point was that if this individual wants to specifically argue that his patient could end up "in a wheelchair" after an epidural, he should be equally graphic when describing the catastrophic fatal and nonfatal outcomes associated with the delivery of anesthesia, and should probably be writing posts such as "do you feel like we are forcing anesthesia on our patients because we dont tell them they could end up a vegetable from prolonged hypoxia if we cant get a breathing tube in quick enough"

 

[Idiopathic]

Absolutely all my patients of all ages, from ASA1 to ASA5 hear the spiel about death, even children. In pediatric cases I make sure parents and children hear it.

My formula is, "Anesthetics, like everything in medicine, have risks and complications, which may be very minor or very major, including death. However, they are extremely rare and we take lots of precautions. Is there anything you want me to explain in more detail?"

Some people ask questions, but the majority don't. They say, "You already told me more than I want to know."

Some people respond, "I don't like the one about death," to which I counter, "I don't either, please don't do that on my watch," and go on to compare it to a car accident, where you know you can die or become paralyzed from it any time you are in a car, but still drive and take passengers with you.

Very few people have objected, "Nobody ever told me this much; why do you scare me like that? Am I a greater risk than usual?" If they are a greater risk than usual, I explain why they are a greater risk, and if not, I go back to the car analogy. In the end they are all satisfied.

I started doing this many years ago, after a lawyer lecturing at a pediatric meeting told us, "Please do yourself and us a favor and tell all the parents that their child may die."

so long as we will all agree that this is not a protection against malpractice claims

and if you are explicitly telling children that they may die during surgery, then im concerned about you

 

[Sergio99]

so long as we will all agree that this is not a protection against malpractice claims

and if you are explicitly telling children that they may die during surgery, then im concerned about you

Everything depends on how you tell it. You may be the monster that scares everybody away, or you may be the caring, loving person that protects them.

As I said earlier, every one of my patients ends up happy that I am taking good care of them.

And as much as you may want to deny it, children are afraid of dying when they are going to have surgery. Somebody is going to cut them open and they are not going to fear? Impossible. You have to accept that they are afraid, let them know that you understand their fears, not dismiss them as if they were the delusions of a crazy or ignorant person, recognize that the danger is real and reassure them that you will take good care of them and they are going to be better than they are now.

If you think children don't know what is going on and lie to them, they are never going to trust you again. Don't lie to them about dangers, don't lie to them about pain, don't lie to them about the smell of the mask, don't lie to them about what you are going to do to them, don't lie to them about anything. They are people: they deserve the same respect as the adults.

 

[seinfeld]

Rarely does one get sued over consent. You get sued for assault, and failure to provide standard of care. Telling a patient that they can die under anesthesia does nothing to prevent a lawsuit if they do die, and honestly if u told my child they could die I would fire you from my kids surgery and register a complaint with the hospital for unnecessarily scaring a child. Once on trial what will matter is whether you acted within reasonable standard practice.

I tell my patients they can be permanent neuro injury with regional but explain what is normal practice and what the realistic benefits could be. I also explain the risks associated with a pure opiod based pain regime, which includes respiratory failure. There is big difference between epidurals for thoracic and lower abdominal surgery.

 

[Idiopathic]

you also dont have to paint the most dire of pictures so that you come out the hero when what usually happens, happens, but i understand your point. i think we get to the same end with slightly different approaches, and i would agree that mentioning bad outcomes is important to show that you are both aware and concerned about the possibility. i just question the utility of talking about death with a 5 year old, they take a lot of things home with them after surgery.

 

[Idiopathic]

Rarely does one get sued over consent. You get sued for assault, and failure to provide standard of care. Telling a patient that they can die under anesthesia does nothing to prevent a lawsuit if they do die, and honestly if u told my child they could die I would fire you from my kids surgery and register a complaint with the hospital for unnecessarily scaring a child. Once on trial what will matter is whether you acted within reasonable standard practice.

I tell my patients they can be permanent neuro injury with regional but explain what is normal practice and what the realistic benefits could be. I also explain the risks associated with a pure opiod based pain regime, which includes respiratory failure. There is big difference between epidurals for thoracic and lower abdominal surgery.

specifically regarding epidurals/spinals, since that is what the OP asked, there is an much greater risk of permanent nerve injury due to positioning (and possibly IV access) than to an epidural, so while i mention the possibility of "nerve injury" with any regional/neuraxial procedure I also stress that it "almost always" is self-limiting, and promise to follow the patients progress

 

[Sergio99]

i just question the utility of talking about death with a 5 year old, they take a lot of things home with them after surgery.

Of course I don't talk about death to a 5 year old! The risks and complications talk is with the parents. The only time I specifically address the child in that talk is when the child has specific fears and questions. That happens often when it is an older child or a teenager, but never with a 5 year old.

And Seinfeld, it is not "unnecessarily scaring the child," but exactly the opposite: sensing if the child has any specific fears and addressing them in order to reassure him. The image you all got from my post is that I go and tell children they are going to die. I may have expressed myself wrong. I was 22 years at a hospital where 60% of our practice was pediatric with lots of repeat customers: all children, parents and surgeons were very happy with how I treated them. I would not have lasted that long there if I did what you thought I was doing. Even now, at my new hospital, when patients come back they are happy to see me again. That would not be the case if I kept scaring them.

 

[sevoflurane]

Unless I have a reason to say so, I don't bring up death with the parents of children... i.e. T&A's, appy's etc. It is written in our consent and I feel that parents may be unnecessarily distressed. It's the truly sick patients who have a real chance of dying that I speak about the possibility of death.

I have never brought a healthy child into my OR (residency or PP) and lost one. That being said, a residency colleague had a terrible experience. 5 y/o was dropped off in the PACU after T&A, subsequently laryngospasmed which resulted in NPPE. The kid became bradycardic and then quickly became asystolic. Post resuscitation he ended up with a hypoxic brain injury. I hope that never happens to me, but I know it does happen.

Unless there is a reason, I don't talk about death to someone who is undergoing a routine case. Maybe I should, but I guess I'm not that type of guy.

 

[sevoflurane]

I do mention that complications occur during surgery and that our anesthesia consent allows us/me to do whatever is necessary in order for the patient to arrive to the pacu safely.

 

[seinfeld]

Of course I don't talk about death to a 5 year old! The risks and complications talk is with the parents. The only time I specifically address the child in that talk is when the child has specific fears and questions. That happens often when it is an older child or a teenager, but never with a 5 year old.

And Seinfeld, it is not "unnecessarily scaring the child," but exactly the opposite: sensing if the child has any specific fears and addressing them in order to reassure him. The image you all got from my post is that I go and tell children they are going to die. I may have expressed myself wrong. I was 22 years at a hospital where 60% of our practice was pediatric with lots of repeat customers: all children, parents and surgeons were very happy with how I treated them. I would not have lasted that long there if I did what you thought I was doing. Even now, at my new hospital, when patients come back they are happy to see me again. That would not be the case if I kept scaring them.

my apologies for misinterpreting your post

 

[Sergio99]

No problem, Seinfeld. I am used to being misinterpreted sometimes because I generalize too much my statements, thinking that the listener has the same set of presuppositions and we are in the same context, but not always happens.

Going back to the OP question, I think we should remember that in good hands, all complications are very rare and probably there are few differences in risk whether we use general or regional, and our choices are more influenced by what article we read last and what new theory we fell in love with. You can dispute this, but it is a fact of life in everything: medicine, physics, politics, child rearing, you name it.

A second consideration is that sometimes surgeons are more comfortable with one technique tan with the other. It seems a very servile attitude, but whenever possible and not contraindicated, it is not a bad idea to play along with their preference. Of course, when it is not a good idea we have to tell them so. For example, we used to put in epidurals for some big cases because the surgeons requested them and convinced the patients to request them as well, but when we saw that they were really a problem and had an increased risk for complications, because those were very sick patients who often ended up with sepsis, DIC, ventilator associated pneumonia and everything else in the book, we stopped doing it, in spite of their insistence.

So, yes, there are complications with neuraxial anesthesia, but the incidence is very low, just as the incidence of complications is very low with general anesthesia. For that reason, when a regional anesthetic is a possibility and the surgeon or the patient requests it, I usually explain it to the patient, point out the main issues to consider and let them decide what they want. Since I am not very much in favor of either one versus the other, unless there is a good reason for choosing one versus the other, I try to be very neutral and not influence their decision.

Remember, when I say those complications are very rare, they are indeed very rare: probably nobody here in the forum has seen in his whole life one of the complications mentioned by Nitroglycerine; we have only read about them. That is another thing I tell my patients if they ask me, "I have read about these complications but never seen one in all the years I have practiced, and never seen one among my colleagues' cases. They are extremely rare."

 

[nitroglycerine]

blunting of surgical stress response, less opioid requirements, quicker return of bowel function,

paravertebral catheters in mastectomy may affect breast CA recurrence
spinals/epidurals for TKA may affect long term pain

There is certainly the studies supporting this (bowel surgery, I mean) and I do give it to patients as an option along with PCA. One of our general surgeons had a bowel resection( right hemicolectomy) and opted for Morphine PCA and Toradol PRN. She said that she had a great pain control and used little morphine. I didn't know about PV catheters and mastectomies. TKA: Our Orthos use Fondaparinux so we only do single shot spinals for those. They all except a coupple who worry about infections use "PAIN-BUSTERS" with ropivacaine infusion into the surgical field so we stopped doing even the femotal blocks. No PCAs, just celebrex, gabapentin,tylenol, sc rescue morphine. They claim it works great and patients get discharged fast. I am a little skeptical but that's how they want to do it. I was called once to ward to do a postop femoral block though. What do you think about local wound infusion of Ropivacaine (same "Pain buster" idea and bilateral TAP blocks plus postop Morphine PCA? I am also thinking about some new anticoagulants that are coming and perhaps these approaches will be safer than relatively blind needle manipulation close to spinal cord?

 

[nitroglycerine]

Rarely does one get sued over consent. You get sued for assault, and failure to provide standard of care. Telling a patient that they can die under anesthesia does nothing to prevent a lawsuit if they do die, and honestly if u told my child they could die I would fire you from my kids surgery and register a complaint with the hospital for unnecessarily scaring a child. Once on trial what will matter is whether you acted within reasonable standard practice.

I tell my patients they can be permanent neuro injury with regional but explain what is normal practice and what the realistic benefits could be. I also explain the risks associated with a pure opiod based pain regime, which includes respiratory failure. There is big difference between epidurals for thoracic and lower abdominal surgery.

All good points but why would you fire smbd who does exactly what a concept of informed consent implies? Your point is taken but still... There is another thing that I worry about with epidural catheters and it is a catheter displacement while the patient is receiving anticoagulants postop (I read smth like 9% rate). No argument about thoracic vs. lower abdomen but even for thoracotomy there is an alternative. May be a big upper abdominal surgery is about the only surgical indication for a thoracic epidural catheter that is worth the risks?

 

[nitroglycerine]

"I have read about these complications but never seen one in all the years I have practiced, and never seen one among my colleagues' cases. They are extremely rare."

This is almost exactly my line. And I so often add that inanesthesia something thet is best for pain is usually the most invasive. And because the epidural has the best potential for excellent pain control I do give this option to a patient even if I think the PCA is better in terms of risks vs. side effects. I also respect the saying "the better is the enemy of good". Althoug many of us did not see but only read about paraplegics etc. wouldn't it be wise to do everything possible to avoid this devastating once-in-smbd's-career's-time complication by limiting this technique to cases and patients with benefits that have been proven beyond doubt and evidence based?

 

[dhb]

I think the PCA is better in terms of risks vs. side effects.

Can you show us some evidence for this?

 

[periopdoc]

That is another thing I tell my patients if they ask me, "I have read about these complications but never seen one in all the years I have practiced, and never seen one among my colleagues' cases. They are extremely rare."

This is almost exactly my line.

The problem is, the longer you do this, the less frequently you can use this line. It is especially hard to use, honestly, if you come from a big residency program.

"Hmm, really... I guess I have another thing to scratch off of the list of things that I have read about but never seen."

- pod

 

[Idiopathic]

im not sure what to make of the OP, but it hurts my head to read his posts.

 

[Sergio99]

I am sorry, Nitroglycerine, but I think you are going too far. Those "devastating once-in-smbd's-career's-time complications" can happen with absolutely everything we do in medicine and life in general. That is exactly the point, that we cannot avoid 100% of risks 100% of the time. If you cannot take that once in a million chance of something going wrong, you shouldn't drive, walk or even eat, because all of these have their own risks of a devastating complication. That doesn't mean that you should be careless and cavalier about it, but the chance of a devastating complication with a regional anesthetic is no different from that of a general anesthetic. If you are afraid of that, you shouldn't give general anesthetics either.

I am not trying to be rude; I am just showing a perspective from another point of view.

 

[Sergio99]

The problem is, the longer you do this, the less frequently you can use this line. It is especially hard to use, honestly, if you come from a big residency program.

"Hmm, really... I guess I have another thing to scratch off of the list of things that I have read about but never seen."

- pod

Maybe everybody has been sending all those complications to your hospital. You found us out!

At least now we can say, "If you have this complication, we'll send you to Periopdoc, who has more experience with it."

 

[periopdoc]

👍👍👍

- pod

 

[nitroglycerine]

Can you show us some evidence for this?

I am sorry, I ment to say risks vs. benefits. In this particular line I was thinking of mainly lower abdominal surgeries where there is no need for "perfect " pain control in order to do well and have good patient's satisfaction. Like you get a wet tap, then blood patch etc. and did not really gain anything.

 

[nitroglycerine]

I am sorry, Nitroglycerine, but I think you are going too far. Those "devastating once-in-smbd's-career's-time complications" can happen with absolutely everything we do in medicine and life in general. That is exactly the point, that we cannot avoid 100% of risks 100% of the time. If you cannot take that once in a million chance of something going wrong, you shouldn't drive, walk or even eat, because all of these have their own risks of a devastating complication. That doesn't mean that you should be careless and cavalier about it, but the chance of a devastating complication with a regional anesthetic is no different from that of a general anesthetic. If you are afraid of that, you shouldn't give general anesthetics either.

I am not trying to be rude; I am just showing a perspective from another point of view.

That is fine, Sergio. Points of view are exactly what I was looking for and you are not rude.

 

[nitroglycerine]

im not sure what to make of the OP, but it hurts my head to read his posts.

Who is this OP?

 

[clubcantholdme]

you know fewer surgeries would make people even safer🙂

 

[Bertelman]

Who is this OP?

Ummmm, that would be you, Original Poster.

 

[Idiopathic]

I am sorry, I ment to say risks vs. benefits. In this particular line I was thinking of mainly lower abdominal surgeries where there is no need for "perfect " pain control in order to do well and have good patient's satisfaction. Like you get a wet tap, then blood patch etc. and did not really gain anything.

your point here, that the risk of the not-rare complication outweighs the benefit is worth discussing. certainly every laparotomy does not need an epidural, but plenty do, and it does the patient a disservice to not consider it and not offer it if its indicated. you can always take the easy way out and not do this, but i think you will be selling certain patients short, and some of us fell it is important to optimize a patients pain regimen, just as we would optimize their preoperative status and intraoperative factors...in certain cases, that means epidural.

so no, its not worth it to place one in every laparotomy, but: Chevron incisions, ventral hernia repairs, patients with difficult to manage chronic pain...all can benefit.

 

[nitroglycerine]

your point here, that the risk of the not-rare complication outweighs the benefit is worth discussing. certainly every laparotomy does not need an epidural, but plenty do, and it does the patient a disservice to not consider it and not offer it if its indicated. you can always take the easy way out and not do this, but i think you will be selling certain patients short, and some of us fell it is important to optimize a patients pain regimen, just as we would optimize their preoperative status and intraoperative factors...in certain cases, that means epidural.

so no, its not worth it to place one in every laparotomy, but: Chevron incisions, ventral hernia repairs, patients with difficult to manage chronic pain...all can benefit.

Thank you and sorry for your headache.

 

[imfrankie]

1) Agree
2) my wife did not have such a desire
3) cannot agree more
We know the risks and benefits. Frequently I see the approach like " I really want to give you this thoracic epidural for your hysterectomy, it is great and it is safe, PDPH is rare, nerve damage and hematoma are almost unheard of,OK?-let's go!" . I can make an informed decision if I have a surgery, but how many patients can? How many of us even use the words "paralysis" and "wheelchair" which are the lay terms for "permanent neurological damage"? Are our informed consent discussions adequate? Are we trying subconsciously to coerce patients to accept procedures they do not understand?

The temptation is there when a $1500 day can become a $3000 day

 

[jetproppilot]

, "Please do yourself and us a favor and tell all the parents that their child may die."

ARE YOU KIDDING ME?

Congratulations, Doctor.

You have taken some of the joy out of your practice because of a LAWYER.

Do you really think telling already anxious parents that their child may die is gonna protect you more than the consent?

HAHAHAHAHAHAHAHAHAHAHAHA

Dude.

You are needlessly torturing yourself, and more importantly, the parents of your patients.

There is no need to bring that up!

Death is such a statistically small endpoint!

Why torture parents with that thought?

Bringing it up preoperatively will not protect you if the unbelievable happens.

If something bad happens you will be sued regardless of your pre-operative speech!

I.E.....tonsillectomy....kid dies...do you think that you telling the kid's parents preoperatively that "your child may die" is gonna help the defense?

HAHAHAHAHAHAHAHAHAHAH

Lemme give you some advice.

If the consent is signed, you are covered as much as you can be covered.

Trudging on to the parents about the potential rare sequelae is only stressing you out, and stressing them out.

The consent is signed.

Do your job.

You will do it well, to the best of your ability, to the standard of care.

If something happens, that one in a million, well it happens.

You did your best.

Thats why we have malpractice insurance.

No need to stress everyone out preoperatively with

YOU MAY DIE.👎

Aint gonna make a difference, so why do it?

 

[imfrankie]

ARE YOU KIDDING ME?

Congratulations, Doctor.

You have taken some of the joy out of your practice because of a LAWYER.

Do you really think telling already anxious parents that their child may die is gonna protect you more than the consent?

HAHAHAHAHAHAHAHAHAHAHAHA

Dude.

You are needlessly torturing yourself, and more importantly, the parents of your patients.

There is no need to bring that up!

Death is such a statistically small endpoint!

Why torture parents with that thought?

Bringing it up preoperatively will not protect you if the unbelievable happens.

If something bad happens you will be sued regardless of your pre-operative speech!

I.E.....tonsillectomy....kid dies...do you think that you telling the kid's parents preoperatively that "your child may die" is gonna help the defense?

HAHAHAHAHAHAHAHAHAHAH

Lemme give you some advice.

If the consent is signed, you are covered as much as you can be covered.

Trudging on to the parents about the potential rare sequelae is only stressing you out, and stressing them out.

The consent is signed.

Do your job.

You will do it well, to the best of your ability, to the standard of care.

If something happens, that one in a million, well it happens.

You did your best.

Thats why we have malpractice insurance.

No need to stress everyone out preoperatively with

YOU MAY DIE.👎

Aint gonna make a difference, so why do it?

I agree with the above completely.

Good grief...Let's just tell patients they might have a stroke, their kid could become a vegetable, they could get burned by the bovie, they might have a reaction that delights the trial lawyers, etc.

I have yet to observe a patient say, "hmm, I didn't know I might die with anesthesia, I guess I won't have this operation after all."

"Hello passengers, welcome to flight 1234. Please be advised this plane could fail to deliver you to your destination, in fact, it could explode in the air and not just kill you, you may in fact survive and be an invalid and horrendously scared burn victim. Please sign the consent form before we depart. Thanks for flying with We Cover Our Butts Airlines"

 

[sevoflurane]

I agree with the above completely.

Good grief...Let's just tell patients they might have a stroke, their kid could become a vegetable, they could get burned by the bovie, they might have a reaction that delights the trial lawyers, etc.

I have yet to observe a patient say, "hmm, I didn't know I might die with anesthesia, I guess I won't have this operation after all."

"Hello passengers, welcome to flight 1234. Please be advised this plane could fail to deliver you to your destination, in fact, it could explode in the air and not just kill you, you may in fact survive and be an invalid and horrendously scared burn victim. Please sign the consent form before we depart. Thanks for flying with We Cover Our Butts Airlines"