RESUMO
A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.
Assuntos
Comportamento do Adolescente/ética , Anestesia Epidural/ética , Dor Pós-Operatória/prevenção & controle , Relações Pais-Filho , Relações Médico-Paciente/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Comportamento do Adolescente/psicologia , Anestesia Epidural/métodos , Anestesia Epidural/psicologia , Neoplasias Ósseas/psicologia , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Dor Pós-Operatória/psicologia , Pais/psicologia , Sarcoma de Ewing/psicologia , Sarcoma de Ewing/cirurgia , Recusa do Paciente ao Tratamento/psicologiaRESUMO
The ideal venue for neonatal surgical procedures has been the subject of a contentious debate between the leading pediatric hospitals throughout the world. Bias toward the location of neonatal surgery tends to be based on institutional practices. The following opposing viewpoints from two leading pediatric institutions in the United Kingdom and the United States highlight the relevant issues.