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Huynh KN, Rouse-Watson S, Chu J, Lane AS, Cyna AM. Unheard and unseen: The hidden impact of nocebo communication in the Intensive Care Unit. J Intensive Care Soc 2024; 25:128-130. [PMID: 38737306 PMCID: PMC11086720 DOI: 10.1177/17511437231214148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Affiliation(s)
- Kerrianne N Huynh
- Department of Intensive Care, Monash Medical Centre, Clayton, Melbourne, VIC, Australia
| | - Sian Rouse-Watson
- Department of Intensive Care, Sunshine Hospital, St Albans, Melbourne, VIC, Australia
| | - James Chu
- Department of Intensive Care, Ballarat Base Hospital, Ballarat, VIC, Australia
| | - Andrew S Lane
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Nepean Hospital, Penrith, NSW, Australia
| | - Allan M Cyna
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide SA, Australia
- Department of Women’s Anaesthesia, Women’s and Children’s Hospital, North Adelaide, SA, Australia
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2
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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3
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Marsman M, van den Beuken WM, van Klei WA, Kappen TH. Autonomous patient consent for anaesthesia without preoperative consultation: a qualitative feasibility study including low-risk procedures. BJA OPEN 2022; 3:100022. [PMID: 37588577 PMCID: PMC10430827 DOI: 10.1016/j.bjao.2022.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/10/2022] [Indexed: 08/18/2023]
Abstract
Background Informed consent for anaesthesia is mandatory and requires provision of information and subsequent consent during consultation between anaesthesiologist and patient. Although information can be provided in an electronic format, it is unknown whether this a valid substitute for a consultation. We explored whether provision of digital information is equivalent to oral consultation and whether it enables patients to give electronic informed consent (e-consent) for anaesthesia. Methods Qualitative feasibility study using semi-structured interviews in 20 low-risk adults scheduled for minor surgery under general anaesthesia or procedural sedation at a university hospital. Data were analysed using a thematic content analysis approach. During the interviews, patients followed an application that provides information and subsequent e-consenting. Results The mean age was 50 yr and patients had good digital skills. Fifteen patients (75%) had previous experience of anaesthesia. The digital application provided enough information for all patients, but eight (40%) preferred consultation with an anaesthesiologist, mainly for personal contact. Patients had different information needs, with previous experiences leading to lower information needs. Nineteen patients had sufficient information to consent autonomously. Most patients considered separate anaesthesia consent superfluous to the surgical consent. Conclusion The digital application provided sufficient information and patients valued the information offered and the advantage of processing information at their own pace. This information made patients feel empowered to autonomously consent to anaesthesia without consultation. Remarkably, consent for anaesthesia was considered unimportant, because patients felt they had 'no choice' if they wanted to undergo surgery.
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Affiliation(s)
- Marije Marsman
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Wilton A. van Klei
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - Teus H. Kappen
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Information Technology, University Medical Center Utrecht, Utrecht, the Netherlands
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Arrow K, Burgoyne LL, Cyna AM. Implications of nocebo in anaesthesia care. Anaesthesia 2022; 77 Suppl 1:11-20. [DOI: 10.1111/anae.15601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/20/2022]
Affiliation(s)
- K. Arrow
- Women’s and Children’s Hospital North Adelaide SA Australia
| | - L. L. Burgoyne
- Women’s and Children’s Hospital North Adelaide SA Australia
| | - A. M. Cyna
- Women’s and Children’s Hospital North Adelaide SA Australia
- Discipline of Acute Care Medicine University of Adelaide Adelaide SA Australia
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5
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Williams S, Kwanten LE. Can an Aide Memoire Be Useful to Facilitate Anesthetic Consent for Cardiothoracic Surgery or Does it Hinder Patient-Specific Discussions? J Cardiothorac Vasc Anesth 2021; 35:3146-3147. [PMID: 33663976 DOI: 10.1053/j.jvca.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Siobhan Williams
- Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, England
| | - Lloyd Edward Kwanten
- Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, England
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McCombe K, Bogod D. Regional anaesthesia: risk, consent and complications. Anaesthesia 2021; 76 Suppl 1:18-26. [PMID: 33426664 DOI: 10.1111/anae.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
The risks of regional anaesthesia relate primarily to the technical nature of the procedure, chief among them being neurological. While rare, the direct relationship between nerve damage and the procedure itself means that patients need to be aware of this complication when consent is sought. In order to give valid consent, a patient must be informed. The extent of the information required has been defined by a 2015 legal ruling which established that the standard is the expectation of a reasonable patient, rather than the information deemed consequential by a reasonable doctor. The implications of this for clinicians are profound, and mean that the process of consent must, for example, include alternatives to the proposed treatment. Additionally, patients must have capacity and give their consent without coercion. Effective communication of risk can be challenging. As well as the barriers to comprehension that can result from language, literacy and numeracy, clinicians need to be aware of their own biases, often in favour of a regional anaesthetic approach. Patients also have biases, and doctors must be aware of these in order to best target their provision of information. Careful use of language and employing adjuncts such as information leaflets and visual aids can help to maximise the individual's autonomy. Particular care must be taken in special situations such as where patients have capacity issues or time is limited by the emergency nature of the intervention.
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Affiliation(s)
- K McCombe
- Department of Anaesthesia, Mediclinic City Hospital, Dubai Healthcare City, Dubai, UAE
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, London, UK
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Li Ching Ng A, McRobb LS, White SJ, Cartmill JA, Cyna AM, Seex K. Consent for spine surgery: an observational study. ANZ J Surg 2020; 91:1220-1225. [PMID: 33021031 DOI: 10.1111/ans.16348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The tension between the ideal of informed consent and the reality of the process is under-investigated in spine surgery. Guidelines around consent imply a logical, plain-speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable and patient understanding remains poor. To obtain a more authentic reflection of practice, spine surgeons obtaining 'informed consent' for non-instrumented spine surgery were studied via video recording and risk/benefit discussions were analysed. METHODS A prospective observational study was conducted at a single neurosurgical institution. Twelve video recordings involving six surgeons obtaining an informed consent for non-instrumented spine surgery were transcribed verbatim and blindly analysed using descriptive quantification and linguistic ethnography. RESULTS Ten (83%) consultations discussed surgical benefit but less than half (41%) quantified the likelihood of benefit from surgery. The most discussed risks were nerve damage or paralysis (92%), bleeding (92%), infection (92%), cerebrospinal fluid leak (83%) and bowel and bladder dysfunction (75%). Surgeons commonly used a quantitative statement of risk (58%) but only half of the risks were explained in words patients were likely to understand. CONCLUSIONS This study highlights inconsistencies in the way spine surgeons explain risks and obtain informed consent for 'simple' spine procedures in a real-world setting. There are wide disparities in the provision of informed consent, which may be encountered in other surgical fields. Direct observation and qualitative analysis can provide insights into the limitations of current informed consent practice and help guide future practice.
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Affiliation(s)
- Angela Li Ching Ng
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
| | - Lucinda S McRobb
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah J White
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John A Cartmill
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Allan M Cyna
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kevin Seex
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
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Jovaisa T, Norkiene I, Karjagin J, Golubovska I, Gambickas L, Kalinauskaite M, Kauzonas E, Wijayatilake D. Are We Meeting the Current Standards of Consent for Anesthesia? An International Survey of Clinical Practice. Med Sci Monit 2020; 26:e925905. [PMID: 33012779 PMCID: PMC7545782 DOI: 10.12659/msm.925905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background International application of existing guidelines and recommendations on anesthesia-specific informed consent is limited by differences in healthcare and legal systems. Understanding national and regional variations is necessary to determine future guidelines. Material/Methods Anonymous paper surveys on their practices regarding anesthesia-specific patient informed consent were sent to anesthesiologists in Estonia, Latvia, and Lithuania. Results A total of 233 responses were received, representing 36%, 26%, and 24% of the practicing anesthesiologists in Lithuania, Latvia, and Estonia, respectively. Although 85% of responders in Lithuania reported using separate forms to secure patient informed consent for anesthesia, 54.5% of responders in Estonia and 50% in Latvia reported using joint forms to secure patient informed consent for surgery and anesthesia. Incident rates were understated by 14.2% of responders and overstated by 66.4% (P<0.001), with the latter frequently quoting incident rates that are several to tens of times higher than those published internationally. Physicians obtaining consent in the outpatient setting were more satisfied with the process than those obtaining consent on the day of surgery, with 62.5% and 42.6%, respectively, agreeing that the informed consent forms provided a satisfactory description of complications (P=0.03). Patients were significantly less likely to read consent information when signing forms on the day of surgery than at earlier times (8.5% vs. 67.5%, P<0.001). Only 46.2% of respondents felt legally protected by the current consent process. Conclusions Anesthesia-specific informed patient consent practices differ significantly in the 3 Baltic states, with these practices often falling short of legal requirements. Efforts should be made to improving information accuracy, patient autonomy, and compliance with existing legal standards.
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Affiliation(s)
- Tomas Jovaisa
- Clinic of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ieva Norkiene
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Juri Karjagin
- Clinic of Anesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | | | - Lukas Gambickas
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Migle Kalinauskaite
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kauzonas
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
Clinical negligence may be tried under the civil or criminal legal system. Any General Medical Council proceedings are conducted separately. All cost time and money, and may be stressful for the patient and clinicians involved. In order to prove negligence, the claimant must prove the clinician had a duty of care, there was breach of that duty, and that breach caused injury. Interpretation of the law evolves as cases are heard in court and precedents are set. It is important for clinicians to keep up to date with developments in their specialty and good medical practice guidelines.
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Selak T, Selak V. Communicating risks of obesity before anaesthesia from the patient's perspective: informed consent or fat-shaming? Anaesthesia 2020; 76:170-173. [PMID: 32478866 DOI: 10.1111/anae.15126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Affiliation(s)
- T Selak
- Department of Anaesthesia, Wollongong Hospital, Wollongong, NSW, Australia
| | - V Selak
- Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW This narrative review describes the current framework for informed consent discussions for regional anesthesia practice from an ethical and medicolegal stand point as the cornerstone of the patient-physician relationship and the respect for patient autonomy. Recent guidelines and position statements from anesthesia societies have emphasized the importance of these discussions and their appropriate documentation. RECENT FINDINGS Recent studies have shown that patients want to know more about both common and benign, as well as rare but serious adverse events, as it relates to their anesthetic care. Several strategies have been recently recommended as a means to facilitate a meaningful consent discussion and proper documentation in the perioperative environment. SUMMARY Defining the material risks of ultrasound-guided regional anesthetic procedures remains challenging, due in part to the difficulty in quantifying incidence rates of relatively rare events. However, well informed discussions are of great importance to support patient autonomy and lay a strong foundation for the patient-anesthesiologist relationship.
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12
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Ricketts D, Roper T, Rogers B, Phadnis J, Elsayed S, Sokol D. Informed consent: the view from the trenches. Ann R Coll Surg Engl 2018; 101:44-49. [PMID: 30286630 DOI: 10.1308/rcsann.2018.0140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We review some of the recent literature on consent for surgical procedures and suggest a scheme for obtaining surgical consent.
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Affiliation(s)
- D Ricketts
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - T Roper
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - B Rogers
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - J Phadnis
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - S Elsayed
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - D Sokol
- Barrister, Temple , London , UK
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13
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Chrimes NC, Marshall SM. Asking key questions in the consent process - a reply. Anaesthesia 2018. [DOI: 10.1111/anae.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zarnegar R. Informed consent in anaesthesia. Br J Anaesth 2018; 120:883-884. [DOI: 10.1016/j.bja.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/24/2022] Open
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