Capacity to give surgical consent does not imply capacity to give anesthesia consent: implications for anesthesiologists.

There is precedent in medicine for recognizing and accepting intact decisional capacity and the subsequent ability to provide valid consent in one treatment domain, while simultaneously recognizing that the patient lacks decisional capacity in other domains. As such, obtaining consent for anesthesia for a surgical procedure is a separate entity from obtaining consent for the surgery itself. Anesthesia for surgery and the surgical procedure itself are separate treatment domains and as such require separate consents. Anesthesiologists should understand the independence of these functionally linked consent processes and be vigilant with respect to the informed consent process. The cases reported in this article show that capacity for surgical consent may be inadequate for consent to anesthesia because anesthesia involves more abstract concepts requiring a higher cognitive state than surgery, thus requiring a higher state of cognitive capacity for understanding.

Unrecognized drug-drug interactions: a cause of intraoperative cardiac arrest?

Many physicians overlook, or are unaware of, most drug-drug interactions. In our patient, the local anesthetic used for an axillary block may have been the precipitating drug in a cascade of drug-drug interactions that resulted in a cardiac arrest. The combination of multiple preoperative drug-drug interactions prevented the return of a stable native cardiac rhythm for almost 24 h. The mechanisms of interactions of these frequently used drugs are described, and the reader is guided to sources that identify and simplify the understanding of potentially dangerous drug-drug interactions.

The American Rare Donor Program.

The American Rare Donor Program (ARDP), headquartered in Philadelphia, Pennsylvania, maintains a comprehensive database of donors with "rare blood types." The ARDP secures blood and blood products for difficult-to-transfuse patients. Remarkably, a significant number of physicians, both in the United States and abroad, remain unaware of the unique and critical services that the ARDP provides to critical care specialists and their patients.