Consentimiento.... ¿Quién lo da para la anestesia en niños?
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Consent...who gives it for anaesthesia for children?
Christina Lundgren
Editor-in-Chief
South Afr J Anaesth Analg 2013;19(6):280-281
Informed consent for anaesthesia and surgery has always been associated with fairly controversial issues, none more so than the promulgation of the National Health Act a few years ago, followed by the Children's Act.
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Recuerdo paterno de la información anestesia: informando la práctica del consentimiento informado.
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Parental recall of anesthesia information: informing the practice of informed consent. Tait AR, Voepel-Lewis T, Gauger V. Anesth Analg. 2011 Apr;112(4):918-23. doi: 10.1213/ANE.0b013e31820a9193. Abstract BACKGROUND:Informed consent is a process of sharing information that facilitates the individual patient's right to self-determination. Despite its importance in anesthesia practice, the process of informed consent is rarely audited or examined. As such, there are only limited data with respect to anesthesia consent practices, particularly within the pediatric setting. We designed this study, therefore, to examine the information that parents seek regarding their child's anesthesia, what they are told, who told them, and how much of the information they recall. METHODS:Parents of children undergoing a variety of elective surgical procedures were recruited while their child was in surgery. Parents were interviewed to determine their recall of their child's anesthetic plan, postoperative pain management, and attendant risks and benefits; and then surveyed regarding what information was sought and received, and how satisfied they were with the information. RESULTS: Two hundred sixty-three parents were included. Although the majority (96.2%) recalled receiving information about how their child'sanesthesia would be administered, only 51.1% recalled being given information about the risks of anesthesia and 42.4% recalled how side effects would be managed. Composite scores for parental recall of anesthesia information were generally poor (4.9 ± 2.5 of 10). Furthermore, 50% and 55.7% of parents had no recall of the risks or benefits of anesthesia, respectively, and 82.9% could not recall pain medication side effects. Recall of consentinformation provided by anesthesia providers was significantly better than when provided by surgical personnel (P < 0.01). CONCLUSIONS:Results showed that disclosure of anesthesia information to parents was often incomplete, and their recall thereof, was poor. The finding that recall of consent information provided by anesthesia providers was better than when provided by surgical personnel may serve to further the debate regarding the appropriate vehicles for anesthesia consent.
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| Fotografía infantil ética con fines médicos y de investigación en entornos de bajos recursos: un estudio cualitativo exploratorio. |
Taking ethical photos of children for medical and research purposes in low-resource settings: an exploratory qualitative study.
Devakumar D, Brotherton H, Halbert J, Clarke A, Prost A, Hall J.
BMC Med Ethics. 2013 Jul 9;14:27. doi: 10.1186/1472-6939-14-27.
Abstract
BACKGROUND: Photographs are commonly taken of children in medical and research contexts. With the increased availability of photographs through the internet, it is increasingly important to consider their potential for negative consequences and the nature of any consent obtained. In this research we explore the issues around photography in low-resource settings, in particular concentrating on the challenges in gaining informed consent. METHODS:
Exploratory qualitative study using focus group discussions involving medical doctors and researchers who are currently working or have recently worked in low-resource settings with children. RESULTS: Photographs are a valuable resource but photographers need to be mindful of how they are taken and used. Informed consent is needed when taking photographs but there were a number of problems in doing this, such as different concepts of consent, language and literacy barriers and the ability to understand the information. There was no consensus as to the form that the consent should take. Participants thought that while written consent was preferable, the mode of consent should depend on the situation. CONCLUSIONS: Photographs are a valuable but potentially harmful resource, thus informed consent is required but its form may vary by context. We suggest applying a hierarchy of dissemination to gauge how detailed the informed consent should be. Care should be taken not to cause harm, with the rights of the child being the paramount consideration.
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| Comunicación proveedor de salud-padre-hijo en el entorno quirúrgico preoperatorio |
Healthcare provider-child-parent communication in the preoperative surgical setting.
Kain ZN, MacLaren JE, Hammell C, Novoa C, Fortier MA, Huszti H, Mayes L.
Author information
Paediatr Anaesth. 2009 Apr;19(4):376-84. doi: 10.1111/j.1460-9592.2008.02921.x. Epub 2009 Jan 27.
Abstract
OBJECTIVES:Although preoperative preparation programs were once common, most children currently undergoing outpatient surgery are first exposed to the hospital on the day of the procedure. It is advocated that these outpatient children undergo the preparation just prior to surgery. AIM:To assess the amount of time that healthcare providers spend with children and families on the day of surgery in the preoperative area. MATERIALS AND METHODS:The study used video infrastructure in the preoperative holding area of Yale New Haven Children's Hospital to record all interactions between children, families, and healthcare providers. Videotapes were coded to characterize and quantify behaviors of healthcare professionals. RESULTS: On the day of surgery, healthcare providers spent medians of 2.75-4.81 min interacting with children and parents in the preoperative area. Families spent a median of 46.5 min in the preoperative area. Healthcare professionals spent the most time in medical talk (averages of 42.5-48.2% of time spent with family) and little time was spent in nonmedical talk (range of 6.2-6.9% of time spent with family). Anesthesiologists and surgeons spent 28% and 18% of the interview in talk to children; admitting nurses spent more of the interview talking to children (43%). CONCLUSIONS: Families interact with healthcare providers for only a small proportion of the time they spent in the preoperative area. This is likely to be a result of increased production pressure in the perioperative settings and has implications for providing preparation for surgery on the morning of the procedure.
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