Communication during induction of paediatric anaesthesia: an observational study

Clinical hypnosis: implications in anaesthesia and perioperative care

A randomised trial published in the British Journal of Anaesthesia describes hypnosis compared with general anaesthesia in 60 children undergoing superficial surgery. We describe a definition of clinical hypnosis; the goals and conduct of hypnotic communication; and its potential as both an adjunct and, in suitable cases, alternative to traditional pharmacological anaesthesia.

The interplay between children, their parents and anaesthesia staff during the child's anaesthesia - An observational study

AIMS AND OBJECTIVES

To interpret and understand the interplay between children, their parents, and anaesthetic staff to gain a greater understanding of children being anaesthetised.

BACKGROUND

Anaesthesia induction is a stressful procedure for the child and parents in the technologically advanced environment in the operating room (OR). Anaesthesia staff are a key resource for ensuring safety and interplays, but the meeting is often short, intensive, and can affect the child and the parent.

DESIGN

A qualitative observational design with a hermeneutic approach.

METHODS

Twenty-seven non-participant observations were conducted and videotaped when children were being anaesthetised. The SRQR checklist was used.

RESULTS

The result is presented as a theatre play with three headings; the scene, the actors, and the plot. The scene was not designed for the child or the parent's comfort and could lead to anxiety and insecurity. Four themes described the interplays: The need to be inviting and to be invited, The need for varying compliance, The need for mutual dependence, and The need to give and to receive emotional support. The plot could lead to uncertainty, and the interplay could change between being caring and uncaring depending on the actors.

CONCLUSIONS

The technologically advanced environment in the OR constituted an emotional obstacle, but the anaesthesia staff themselves can be a powerful resource creating a caring environment. The outcome of the plot may depend on the anaesthesia staff's bearing.

RELEVANCE TO CLINICAL PRACTICE

A caring approach in the OR requires a willingness from the anaesthesia staff to invite the child to participate and find a balance between helping the parents to find their place in the OR and support them in supporting their child. The findings can start reflections in the unit on how to create a more caring environment.

Identifying the core attributes of pediatric communication techniques to be taught to anesthetic trainees

BACKGROUND

Anesthetic induction and other procedures performed by anesthetists are potentially stressful for children. Pediatric anesthetists use communication to rapidly establish rapport and engagement with children and reduce anxiety and discomfort. Communication in pediatric anesthesia is increasingly topical, but there is limited discussion regarding which specific techniques should be taught to trainees.

AIMS

The aim of this research was to identify which communication techniques used locally by pediatric anesthetic specialists, trainees, and nurses are viewed as the most effective and valuable to teach trainees.

METHODS

Qualitative semi-structured focus groups (7) and in-depth interviews (7) were used to gather data from 30 specialist pediatric anesthetists, trainees, and assistants from a major tertiary pediatric anesthetic department. Inductive and deductive thematic data analysis explored communication techniques used locally.

RESULTS

The research identified the range of communication techniques being utilized to establish rapport and engage with children, including methods for distraction and focusing attention such as storytelling, guided imagery, and positive suggestions. Thematic analysis revealed a series of core overarching principles for successful application, using social skills within an adaptable, competent, child-centered approach. Drawing on the experiences of specialist practitioners and trainees, teaching these communication techniques would ideally employ an interactive approach involving both modeling and specific communication education with focus on developing communication skills via experiential learning using self-reflection and feedback.

CONCLUSIONS

Within the range of communication techniques being utilized by pediatric anesthetists exist a series of core principles that are essential to engaging and building rapport with children. Focusing on the importance of these common core elements in trainee education, in addition to the range of techniques available, may provide a pragmatic framework for centers providing pediatric anesthesia to consider when designing their trainee curriculum.

Communication skills with children in paediatric anaesthesia: challenges while wearing a face mask

Effective communication with children is a skill, the importance of which is especially highlighted by the COVID-19 pandemic and the ubiquitous wearing of face masks. Anaesthesiology consultants have been shown to display excellent communication skills that facilitate the development of rapid rapport and patient cooperation. Good communication results in positive interactions for hospitalised children, which correlates with improved healthcare outcomes. However, interactions with a child aren't always straightforward, particularly for trainees unfamiliar with certain communication techniques, which are important to use at a time when when the wearing of face masks is commonplace.

Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy

This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

Consent for pediatric anesthesia: an observational study

BACKGROUND

Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery.

METHODS

A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed.

RESULTS

Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P < 0.05, when the consultation was performed by a trainee rather than a consultant anesthetist and when the patient had previous anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025.

CONCLUSIONS

The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk.

Interaction between anaesthetists, their patients, and the anaesthesia team

Communication is a key skill for anaesthetic practice. The 'non-informational' aspects of communication, such as non-verbal elements and the degree to which the style of communication reflects the implied relationship between the sender and the recipient, are relevant to interactions both between anaesthetists and patients and to interactions with other members of staff in the team. Communication and interaction between members of the anaesthesia team in isolation has received less attention than communication in the operating theatre during surgery. Most aspects of such communication are informally learned and developed with experience. Studies of communication at induction of anaesthesia have used qualitative methods to identify a range of styles of talk. This is nominally directed at the patient but also serves to unite and co-ordinate the team to ensure the patient's smooth, safe progress into anaesthesia. In particular, the use of positive words and phrases seems to benefit patient comfort and safety. On emergence, a more limited range of communication styles is found. Handover of the recently anaesthetized patient to recovery room staff is often brief and distracted by concurrent patient-related activities. Both information about the patient, and responsibility for the patient's continuing care, have to be transferred. The handover event also serves as an opportunity to review the care the patient has received and plan for further progress. Anaesthetists and nurses use unspoken and implicit negotiation strategies to achieve the aims of handover without compromising future collaborative work. This is in contrast to the more formalized handover approaches in other safety-critical settings.

Communication between anaesthesiologists and patients: how are we doing it now and how can we improve?

PURPOSE OF REVIEW

The purpose of this review is to present and bring together the relatively small body of recent work on anaesthesiologist-patient communication.

RECENT FINDINGS

Anaesthesiologists and patients may have different 'agendas' during their consultations, with anaesthesiologists focusing more on information and patients more on the emotional aspects of care. As effective communication implies a two-way process, anaesthesiologists should be aware of this. Communication can make good use of written media, video, E-mail and telephone as well as face-to-face interaction. The content of communication, both verbal and nonverbal, is critical but much of this is learned informally despite the recent interest in teaching communication skills. Some recent studies have observed and described how communication is actually performed in practice and these are a useful starting point for reflection and experiment. The few studies to examine whether communication can improve outcomes for patients have all produced broadly positive findings. Communication with children, communicating about risk and dealing with the aftermath of anaesthetic disasters are also reviewed specifically.

SUMMARY

Communication between anaesthesiologists and patients is essential for effective clinical practice. Some practical suggestions are made and pointers to further reading given.

Current world literature

This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 February 2008 and 31 January 2009 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.