Journal of clinical anesthesia
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Informed consent is a cornerstone and routine component of the ethical practice of modern medicine. Its full theoretical application to specific clinical situations, however, presents a number of ethical dilemmas for health care providers. Obstetric anesthesia, in particular, presents many unique challenges to the process of informed consent. ⋯ The application of principlism to actual clinical situations, the limitations of principlism in the peculiarities of the patient-physician encounter, as well as possible alternative models of ethical discourse is discussed. The process of informed consent can be broken down into seven elements: Threshold elements or preconditions, which include 1) decision-making capacity or competency of the patient, 2) freedom or voluntariness in decision-making, including absence of over-riding legal or state interests; informational elements, including 3) adequate disclosure of material information, 4) recommendation, and 5) an understanding of the above; consent elements, which include 6) decision by the patient in favor of a plan and 7) authorization of that plan. Each of these elements is discussed in turn, and their implications, especially for the anesthesiologist and the obstetric patient, are addressed.
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To determine if the majority of reintubations, a potentially preventable adverse event, were predominantly due to residual muscle relaxant effects, we analyzed our quality assurance database to identify the causes of reintubation. ⋯ Respiratory complications were the most common cause of reintubation in the perioperative period. Complications related to the neuromuscular blocking drugs were the fourth most common cause of reintubation. More reintubations occurred in the operating room than the postanesthesia care unit. Muscle relaxant effect and opioid effect are rare causes of respiratory failure in the anesthetized patient in the immediate postoperative period.
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Subclavian vein cannulation may be complicated by lesions of the peripheral nervous system, such as injury to the recurrent laryngeal nerve, phrenic nerve, and brachial plexus. We describe a case of lesion of the upper trunk of the brachial plexus during multiple attempts at subclavian vein catheterization. This type of complication, ascribed to erroneous application of procedures or anatomical variations, may be minimized by abstaining from multiple attempts at venipuncture.
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Editorial Comment
Informed consent, the parturient, and obstetric anesthesia.