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Lyne TC, Everton HD, Barkley L, Blaise BJ. Limitations of the consent process in paediatric anaesthesia: the Death during Anaesthesia - Risk and Explanation (DARE) audit. Br J Anaesth 2024; 132:1001-1003. [PMID: 38514375 DOI: 10.1016/j.bja.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Tom C Lyne
- Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, UK
| | - Harry D Everton
- Whittington Hospital, Whittington Foundation NHS Foundation Trust, London, UK
| | - Lisa Barkley
- Paediatric Psychology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin J Blaise
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK.
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Hock KM, Gist K, Fazeli PL, Zaccagni HJ, Sorabella RA, Patrician PA. A descriptive assessment of the informed consent document used by congenital cardiac surgery centres. Cardiol Young 2023:1-6. [PMID: 38044661 DOI: 10.1017/s1047951123004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Informed consent for surgery is a complex process particularly in paediatrics. Complexity increases with procedures such as CHD surgery. Regulatory agencies outline informed consent contents for surgery. We assessed and described CHD surgical informed consent contents through survey dissemination to paediatric CHD centres across United States of America. METHODS Publicly available email addresses for 125 paediatric cardiac clinicians at 70 CHD surgical centres were obtained. Nine-item de-identified survey assessing adherence to The Joint Commission informed consent standards was created and distributed via RedCap® 14 March, 2023. A follow-up email was sent 29 March, 2023. Survey link was closed 18 April, 2023. RESULTS Thirty-seven surveys were completed. Results showed informed consent documents were available in both paper (25, 68%) and electronic (3, 8%) format. When both (9, 24%) formats were available, decision on which format to use was based on centre protocols (1, 11%), clinician personal preference (3, 33%), procedure being performed (1, 11%), or other (4, 45%). Five (13%) centres' informed consent documents were available only in English, with 32 (87%) centres also having a Spanish version. Review of informed consent documents demonstrated missing The Joint Commission elements including procedure specific risks, benefits, treatment alternatives, and expected outcomes. CONCLUSIONS Informed consent for CHD surgery is a complex process with multiple factors involved. Majority of paediatric CHD surgical centres in the United States of America used a generic informed consent document which did not uniformly contain The Joint Commission specified information nor reflect time spent in discussion with families. Further research is needed on parental comprehension during the informed consent process.
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Affiliation(s)
- Kristal M Hock
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katja Gist
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hayden J Zaccagni
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Sorabella
- Department of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Tewfik G, Hesketh P, Chinn L, Srinivasan N, Abdelmalek A. Simulated anesthesia consent discussions demonstrate high level of comprehension and education requirements for patients: A pilot study. PEC INNOVATION 2023; 2:100153. [PMID: 37214539 PMCID: PMC10194181 DOI: 10.1016/j.pecinn.2023.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023]
Abstract
Objective Patient comprehension of informed consent and demonstration of procedural understanding is often lacking in anesthesiology. The purpose of this study was to determine if patient communication in anesthesiology is being conducted effectively, and in a manner that ensures adequate communication between anesthesia professionals and their patients regarding procedures with associated risks and benefits. Methods Anesthesia professionals were recorded in a simulated setting explaining anesthesia procedures of increasing complexity with one control scenario. Score means were calculated, and statistical comparisons made between discussion of anesthesia procedures and the control scenario. Results Calculation of means for 6 readability tests demonstrated the grade level required to understand the medical practitioners' verbal communication was high and increased with complexity of the anesthesia procedure described. The control scenario required a statistically significant lower level of comprehension for the recipient of the information. Conclusion In simulated settings, anesthesia professionals regularly communicate procedural details in a manner that is difficult for the general public to understand. Subjects could communicate in simple terms when discussing a control. Innovation This pilot study demonstrated effective methodology, using artificial intelligence technology for transcription, to assess patient comprehension of verbal communication.
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Affiliation(s)
- George Tewfik
- Corresponding author at: Rutgers New Jersey Medical School, 185 South Orange Ave., Newark, NJ 07103, USA.
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Does the standard medical procedure consent process meet the criteria required for informed consent? - A concept analysis. Nurs Outlook 2023; 71:101916. [PMID: 36681563 DOI: 10.1016/j.outlook.2022.101916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Informed consent is a complex process that is legally required before any surgical procedure. PURPOSE The purpose of this manuscript was to perform a concept analysis of the informed consent process. METHODS The use of dimensional analysis identified three separate yet related perspectives of the informed consent process: legal, health care, and patients. A database search using the Cumulative Index to Nursing and Allied Health Literature and PubMed were performed. FINDINGS A total of 27 publications were reviewed. The legal perspective addresses the requirement of informed consent, which starts with the discussion between the health care provider and the patient undergoing the surgical procedure and ends with a signature on a piece of paper. The health care perspective also addresses the legal requirement but incorporates the goals and objectives of the individual initiating the informed consent discussion. The patients' perspectives also incorporate goals and objectives; however, they differ from that of the health care provider in that they go beyond what happens in the operating room or during hospitalization. DISCUSSION Viewing informed consent through these different yet related perspectives provides insight into this complex process and may enhance the researcher's ability to understand and improve the informed consent process.
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Alderson P, Cohen M, Davies B, Elliott MJ, Johnson M, Lotteria A, Mendizabal R, Stockton E, Stylianou M, Sutcliffe K, Wellesley H. The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study. J Cardiothorac Surg 2022; 17:136. [PMID: 35641980 PMCID: PMC9153234 DOI: 10.1186/s13019-022-01889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Standards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care.
Methods This qualitative research involved: literature reviews about children’s consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children’s informed decisions for heart surgery.
Results The medical, ethics and English legal literature tend to assume legal minors cannot refuse major recommended treatment, and cannot consent until they are 12 years or older. Little is said about informing pre-competent children. If children resist, some anaesthetists rely on sedation and distraction, and avoid much informed discussion, aiming to reduce peri-operative anxiety. However, interviewees reported informing young children, and respecting their consent or refusal before elective surgery. They may delay elective surgery and provide further information and support, aiming to reduce fear and promote trust. Six years of age was commonly cited as the threshold for respecting consent to heart transplantation. Conclusion Differing views about younger children’s competence, anxiety and best interests support different reactions to children’s consent and refusal before elective heart surgery. This paper reports the zero-restraint policy followed for over a decade in at least one leading surgery centre. The related law and literature need to be updated, to take more account of evidence of actual practice.
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Affiliation(s)
- Priscilla Alderson
- Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK.
| | - Marc Cohen
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Ben Davies
- Royal Children's Hospital, Melbourne, Australia
| | | | - Mae Johnson
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Rosa Mendizabal
- Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK
| | - Emma Stockton
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Katy Sutcliffe
- Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK
| | - Hugo Wellesley
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Rosenblatt A, Kremer M, Paun O, Swanson B, Hamilton R, Schwartz A. Parental Decision-Making for Surgery and Anesthesia in Young Children. West J Nurs Res 2021; 44:904-911. [PMID: 34085888 DOI: 10.1177/01939459211021622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Millions of young children undergo surgery and anesthesia each year, yet there is a lack of scientific consensus about the safety of anesthesia exposure for the developing brain. Also poorly understood is parental anesthesia-related decision-making and how neurotoxicity information influences their choices. The theoretical model of parental decision-making generated in this research explicates this process. Interviews with 24 mothers yielded a theoretical framework based on their narratives developed using a qualitative grounded theory analysis. Five major themes emerged from these interviews: emotional processing, cognitive processing, relationships as resources, the mother/child dyad, and the health care context. Mothers described a non-linear, iterative process; they moved fluidly through emotional and cognitive processing supported by relationships as resources and influenced by the health care context. A key element was the subtheme of the medical translator, an individual who provided context and information. The mother/child dyad grounded the model in the relationship with the child.
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Affiliation(s)
- Audrey Rosenblatt
- Ann & Robert H. Lurie Children's Hospital of Chicago, Rush University College of Nursing, Chicago, IL, USA
| | - Michael Kremer
- Rush Center for Clinical Skills and Simulation, Rush University College of Nursing, Chicago, IL, USA
| | - Olimpia Paun
- Department of Community, Systems and Mental Health Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Barbara Swanson
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Rebekah Hamilton
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Alan Schwartz
- Department of Medical Education, University of Illinois Chicago, Chicago, IL, USA
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Tylee MJ, Rubenfeld GD, Wijeysundera D, Sklar MC, Hussain S, Adhikari NKJ. Anesthesiologist to Patient Communication: A Systematic Review. JAMA Netw Open 2020; 3:e2023503. [PMID: 33180130 PMCID: PMC7662141 DOI: 10.1001/jamanetworkopen.2020.23503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Many patients are admitted to the intensive care unit following surgery, and some of them will experience incomplete recovery. For patients in this situation, preoperative discussions regarding patient values and preferences may direct care decisions. Existing literature shows that it is uncommon for surgeons to have these conversations preoperatively; it is unclear whether anesthesia professionals engage with patients on this topic prior to surgery. OBJECTIVE To review the literature on communication between patients and anesthesia professionals, with a focus on discussions related to postoperative critical care. EVIDENCE REVIEW MEDLINE and Web of Science were searched using specific search criteria from January 1980 to April 2020. Studies describing encounters between patients and anesthesia professionals were selected, and data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting were extracted and collated. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. FINDINGS A total of 12 studies including 1284 individual patient encounters were eligible for inclusion in the review. These studies demonstrated that communication between patients and anesthesia professionals related to postoperative care is rare: only 2 studies reported communication regarding adverse postoperative events, and this communication behavior was reported in only 46 of 1284 consultations (3.6%) across all studies. Additional findings were that communication during these encounters is dominated by anesthetic planning and perioperative logistics, with variable discussion of perioperative risks vs benefits and infrequent elicitation of patient values and preferences. Some data suggest that patients wish to be involved in perioperative decision-making but are often limited by an incomplete understanding of risks and benefits. CONCLUSIONS AND RELEVANCE This systematic review found that communication in anesthesia is dominated by anesthetic planning and discussion of preoperative logistics, whereas postoperative critical care is rarely discussed. Most patients who are admitted to an intensive care unit after a major operation will not have had a discussion regarding goals of care specific to protracted recovery or prolonged intensive care with their anesthesiologist.
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Affiliation(s)
- Michael J. Tylee
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Gordon D. Rubenfeld
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Duminda Wijeysundera
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael C. Sklar
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sajid Hussain
- Department of Intensive Care Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Neill K. J. Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Wilson EH, Burkle CM. The Meaning of Consent and Its Implications for Anesthesiologists. Adv Anesth 2020; 38:1-22. [PMID: 34106829 DOI: 10.1016/j.aan.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elizabeth H Wilson
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 CSC, 600 Highland Avenue, Madison, WI 53792-3272, USA
| | - Christopher M Burkle
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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9
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Parental Understanding of Surgical Care in the Neonatal Intensive Care Unit. J Surg Res 2020; 255:118-123. [PMID: 32543376 DOI: 10.1016/j.jss.2020.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pediatric surgeons are routinely required to discuss complex diagnoses and treatment plans with the parents of their patients. Yet, how well this information is understood by its target audience is unknown. To explore this issue, we asked parents of postoperative neonatal intensive care unit patients to describe their children's care in a variety of domains. Our goal was to assess the degree of parental understanding and to identify factors that influenced comprehension. MATERIALS AND METHODS Parents of neonatal intensive care unit patients who underwent a general surgical procedure were asked to complete a survey of their children's care in six domains of comprehension: name of the primary diagnosis, description of the primary diagnosis, description of the purpose of surgery, identification of surgical risks, identification of surgical benefits, and identification of concerning signs or symptoms to look for after discharge. Parental demographic factors such as age, level of education, and socioeconomic status were recorded, as was the presence of a prenatal diagnosis. RESULTS Overall, 66% of participants described their child's primary surgical condition. Even fewer were able to describe a benefit or risk of the procedure. Parental use of outside resources to gain information was found to significantly relate to parental understanding in all domains. Parental level of education also improved comprehension. CONCLUSIONS Parental understanding of surgical procedures, including the events leading up to and after an operation, is an important component of overall patient care. However, we were able to demonstrate that this understanding may be limited in spite of the best efforts of medical professionals. Further investigations should focus on ways in which information can be delivered more effectively to parents.
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Feinstein MM, Pannunzio AE, Lobell S, Kodish E. Informed Consent in Pediatric Anesthesia: A Narrative Review. Anesth Analg 2019; 127:1398-1405. [PMID: 30113400 DOI: 10.1213/ane.0000000000003705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Informed consent for pediatric anesthesia challenges practitioners to navigate complex ethical, medical, and legal ambiguities. A patient's status as a minor does not negate the importance of his or her participation in the decision-making process but, rather, necessitates a nuanced evaluation of age and development to involve the patient to an appropriate extent. Given the complexities involved with pediatric informed consent in anesthesia practice and research, it is important to understand the experience of key stakeholders involved. For this review, we searched Medline, the Cochrane database, PROSPERO, and Clinicaltrials.gov for studies involving pediatric anesthesia informed consent. Inclusion and exclusion criteria were designed to select for studies that included issues related to informed consent as primary outcomes. The following data were extracted from included studies: title, authors, date of publication, study type, intervention, data collection method, participant type (ie, parent, pediatric patient, anesthesia provider), number of participants, pediatric patient age range, and primary outcome measures. Twenty-two articles were included for final review: studies of informed consent in pediatric anesthesia span many aspects of informed consent. Parental understanding has been studied most often (7/22 studies), followed by parental preferences (5/22 studies) and provider-related outcomes (5/22 studies) such as time spent interacting with patients, subjective reporting on amount of training related to informed consent, and provider satisfaction with the informed consent process. Outcomes pertaining to pediatric patients themselves constitute the smallest number of studies, including child anxiety (1/22), child understanding (1/22), and child refusal (1/22). Among the parties involved, parents have been most frequently identified as the subjects of these studies (2719/3805 subjects across all included studies, or 71% of all subjects). Pediatric patients are the least frequently involved subjects of studies that investigate informed consent in pediatric anesthesia (493/3805, or 13% of all subjects). Anesthesia providers and investigators have been study subjects (593/3805, or 16% of all subjects) for a range of topics including time spent interacting with patient, nature of informed consent conversation in relation to trainee status, satisfaction with informed consent process, and priorities for informed consent content. The aim of the present narrative review is to summarize the work that has been done on informed consent for pediatric anesthesia.
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Affiliation(s)
- Max M Feinstein
- From the School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Anthony E Pannunzio
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samuel Lobell
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Kodish
- Department of Pediatric Hematology-Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
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Rehfuss A, Bogaert G, Kogan BA. Spinal anesthesia in children: most pediatric urologists are not on board. J Pediatr Urol 2019; 15:263.e1-263.e5. [PMID: 30930017 DOI: 10.1016/j.jpurol.2019.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In 2016, the Food and Drug Administration issued a warning on general anesthetic medications used for lengthy procedures (>3 h) in children younger than 3 years. Spinal anesthesia can be a safe alternative to general anesthesia for many pediatric urology procedures. It can shorten total operating room (OR) time, provide excellent pain control, and allow parents to reunite with their child immediately after surgery. However, use of spinal anesthesia can also directly affect the operating surgeon (awake patient, time constraints of spinal, and prolonged preoperative time). Members of the Societies for Pediatric Urology (SPU) and European Society of Pediatric Urology (ESPU) were surveyed to get their opinions on the use of spinal anesthesia for routine pediatric urology procedures. It was hypothesized that half of pediatric urologists would favor spinal anesthesia and that SPU members would be more likely to favor spinal anesthesia than their European colleagues. MATERIALS AND METHODS A short survey with five clinical scenarios was created. Scenarios assessed physicians' recommendations regarding timing and the type of anesthesia (general or spinal) for common pediatric urology procedures: undescended testicle, inguinal hernia, hypospadias, phimosis, and phimosis with penoscrotal webbing. Surveys were emailed to members of the SPU and ESPU. Responses and demographic information were collected and analyzed. RESULTS The survey was completed by 113 SPU members (46% response rate for members who opened the invitation) and 109 ESPU members. For all clinical scenarios, < 20% of pediatric urologists from the SPU and <25% from the ESPU favor doing any procedure with spinal anesthesia. The majority of respondents practice in children's hospitals with pediatric anesthesiologists, but roughly half of the responders (54% SPU and 43% ESPU) do not think their anesthesia colleagues would be comfortable performing spinal anesthesia. Furthermore, only 51% of SPU and 36% of ESPU members discuss the possible neurodevelopmental side-effects of anesthesia with parents; similarly, less than half of all respondents think their anesthesia colleagues address these potential side-effects when obtaining consent. The only significant difference between SPU and ESPU responses was that ESPU members tended to delay penile surgery more than SPU respondents. CONCLUSION Whether general anesthesia has any effect on the developing brain of children undergoing routine pediatric urology procedures is unclear. Yet, few pediatric urologists, independent of their region of practice, prefer spinal to general anesthesia. Collaboration in the OR is the key to success, and it is important that pediatric urologists and pediatric anesthesiologists work together to balance the benefits and risks of general and spinal anesthesia.
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Gentry KR, Opel DJ. Reply to Gentry, Katherine; Lepere, Katherine; Opel, Douglas, regarding their comment 'Informed Consent in Pediatric Anesthesiology'. Paediatr Anaesth 2018; 28:674. [PMID: 30133918 DOI: 10.1111/pan.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katherine R Gentry
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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13
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Feinstein MM, Kodish E. Investigating understanding in pediatric anesthesia informed consent. Paediatr Anaesth 2018; 28:565-566. [PMID: 29878545 DOI: 10.1111/pan.13393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Max M Feinstein
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Eric Kodish
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
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