Do Obstetric Patients Opt to Undergo General Anaesthesia to Avoid Being Conscious Despite Safer Alternatives?

There are various modes of anaesthesia available in the community today. This gives anaesthesiologists the freedom to select those that are safe, efficacious and most suitable for patients. However, patients may not always agree with their anaesthesiologist on the preferred mode of anaesthesia because they may have a different set of priorities, with many of them electing to have the lack of intraoperative awareness as the primary objective. Hence, disagreements between anaesthesiologists and patients may arise and could potentially disrupt doctor-patient relationship. This paper attempts to explore the possible reasons for obstetric patients championing for certain modes of anaesthesia and to provide an insight into the need for adequate patient education.

Determining the Effect of External Stressors on Laparoscopic Skills and Performance Between Obstetrics and Gynecology Residents.

STUDY OBJECTIVE: To evaluate the effect of stress on laparoscopic skills between obstetrics and gynecology residents. DESIGN: Observational prospective cohort study. DESIGN CLASSIFICATION: Prospective cohort. SETTING: Urban teaching university hospital. PARTICIPANTS (PATIENTS): Thirty-one obstetrics and gynecology residents, postgraduate years 1 to 4. INTERVENTION: We assessed 4 basic laparoscopic skills at 2 sessions. The first session was the baseline; 6 months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the 2 sessions. MEASUREMENTS AND MAIN RESULTS: A linear model was used to analyze time. Under stress, residents were more efficient in 3 of the 4 modules. Ring transfer (hand-eye coordination and bimanual dexterity), p = 0.0304. Ring of fire (bimanual dexterity and measure of depth perception), p = 0.0024 and dissection glove (respect of delicate tissue planes), p = 0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, p = 0.0184 and cobra (hand-to-hand coordination), p = 0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection glove p = 0.0605 yielded a nonsignificant increase in penalties. CONCLUSION: Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy.

ACOG Committee Opinion No. 395. Surgery and patient choice.

Acknowledgement of the importance of patient autonomy and increased patient access to information has prompted more patient - generated requests for surgical interventions not necessarily recommended by their physicians. Decision making in obstetrics and gynecology should be guided by the ethical principles of respect for patient autonomy, beneficence, nonmaleficence, justice and veracity. Each physician should exercise judgement when determining whether information presented to the patient is adequate. When working with a patient to make decisions about surgery, it is important for obstetricians and gynecologists to take broad view of the consequences of surgical treatment and to acknowledge the lack of firm evidence for the benefit of one approach over another when evidence is limited.

ACOG committee opinion. Surgery and patient choice: the ethics of decision making. Number 289, November 2003.

The purpose of this Committee Opinion is to provide the obstetrician-gynecologist with an approach to decision making based on ethics in an environment of increased patient information, recognition of patient autonomy, direct-to-consumer marketing, and many alternative or investigational treatments. A process for ethical decision making in surgery is discussed, illustrated by an example of elective cesarean delivery.

ACOG Committee Opinion. Surgery and patient choice: the ethics of decision making.

The purpose of this Committee Opinion is to provide the obstetrician-gynecologist with an approach to decision making based on ethics in an environment of increased patient information, recognition of patient autonomy, direct-to-consumer marketing, and many alternative or investigational treatments. A process for ethical decision making in surgery is discussed, illustrated by an example of elective cesarean delivery.