June 6, 2011 at 6:34 pm
It’s actually not that hard to do – you simply write “I do NOT consent to the use of general anesthesia or sedation of any form without my specific written prior approval.” on the surgical/anesthesia consent form. Now that you have established the ground rules, you can have a dialog on what possible anesthesia interventions might be applicable under specific circumstances, what the potential risks and benefits are, and decide on a modified consent based on specific triggers or events based on what you feel comfortable with.
It helps if you have discussed it with your surgeon ahead of time and can tell the anesthesia provider that. You can also do the same with any other procedure/intervention such as intubation or catheterization if you wish.
FWIW, I agree with with you on the overuse of sedation (and will add amnesic drugs such as midazolam to that). Bottom line, they are going to want to do what’s easiest for the OR team – not necessarily what’s best for the patient. Unfortunately, if you leave it up to them, most providers will revert to doing what they are used to and most comfortable with – that’s just human nature. I think that if providers would truly take the time to discuss the risks and potential side effects of these drugs, more patients would opt out.
With the advent of better regional anesthesia techniques, the real need for G/A, along with it’s inherent risks, should be significantly reduced. In India, for example, they have done well over 1000 successful open heart procedures of various types (CABG, valve repair, etc.) on awake, non-intubated patients using thoracic epidural anesthesia. They’ve been doing it there for years – unfortunately it hasn’t caught on here yet….. I believe that areas like this is another place where both the costs and the risks to the patient could be reduced.page.
This post is exactly what I had imagined would happen. I told my surgeon that I was uninterested in general anesthesia for my extremity surgery. I explained fully my previous surgeries, my paradoxical reactions to g/a drugs AND the fact that I couldn't afford this level of intervention. I wanted regional anesthetic ONLY! My surgeon claims he only heard the affordability part, but even that didn't register. He stated afterwards that he only works on unconscious patients. He didn't reveal that to me, or in any way suggest that what I wanted was not important to him. So while I thought that my surgeon and I were on the same page, the opposite was true. I expected my surgeon to make sure that the anesthesiologist (an MD, I never even heard of a CRNA, nor would I have allowed one to be my anesthetist) followed my instructions. The opposite was true. My CRNA also disregarded every single thing I said to him, and the rest of the staff shockingly went along with the whole scheme. Not one single person told me, or in any way indicated that they were not in favor of forcing me to accept way more intervention than I had clearly outlined. In my opinion, the people who work in a medical setting are so intent on doing things "their way" that they totally disregard anything the patient says. Not one person defended my wishes or informed me that they were going to dismiss me in such an egregious way. Yet *I* am the control freak...
The "sedation" I am talking about IS Versed! Here this poster says that Versed is overused. Thank you! However as a drug to insure that the patient accepts everything that the money grubbing lazy people in the medical treatment facility want, it is absolutely perfect! Not only are the patients stricken with an abnormal desire to obey, they usually have amnesia and can't argue about whether or not they agreed to things, and they can't know that it was all completely unecessary...
Since there was no anesthesia/general anesthetic/sedation "informed consent" AT ALL, I was unable to cross out the things that I didn't want. My CRNA even states that I "agreed" to all kinds of stuff that I had no intention of having. I said NO! I got it ALL anyway. Course there were all kinds of excuses as to why that was. They were all lies, but it doesn't matter.
If you look at my post pertaining to how to avoid getting Versed, you will see that some of what this poster says are also what I am advising. However this isn't foolproof! My own sister wrote in big red letters that she wasn't to get Versed and also wrote on her arm where the IV went, not to give her Versed. They agreed and of course she got Versed.
How I wish it was as simple as this poster says it is! I have been pretty much hysterical about medical care ever since my ORIF Distal Radius reduction debacle. I have been very worried about open heart surgery, (or similar) my paradoxical reactions to anesthesia drugs and now Versed, and have even advised my husband to wait until I turn blue before getting me any medical attention. Now this person says that this type of surgery is done in other countries without all of the above. There is hope!? How do you do open heart surgery on a patient whose body fights on, even after being cold cocked by drugs? I understand the suc. etc. but what about when I wake up fighting and in restraints? (I believe that part is called emergence delirium and I think that is why my jerk of a CRNA gave me 4 mls of additional Versed AFTER THE DAMN SURGERY WAS OVER!) Wouldn't I damage myself?
ONE SINGLE CRNA with a syringe of poison caused this kind of ongoing anxiety and the rest of them have rallied behind him and further damaged my trust. Nice going nurses.