Asunto(s)
Adenoidectomía/historia , Geografía/tendencias , Tonsilectomía/historia , Adenoidectomía/ética , Adenoidectomía/métodos , Niño , Toma de Decisiones Clínicas , Historia del Siglo XX , Humanos , Otolaringología/economía , Otolaringología/estadística & datos numéricos , Factores Socioeconómicos , Tonsilectomía/ética , Tonsilectomía/métodos , Reino Unido/epidemiologíaRESUMEN
Situations where children refuse to undergo anesthesia and surgery can be challenging for anesthetists. Clear legal guidelines are lacking and decisions often need to be made with a degree of urgency. When a child refuses to cooperate with the induction of anesthesia, it is important to consider the autonomous capacity of the child, the presence of a legally valid consent from a suitable guardian, the urgency with which the surgery needs to proceed and the practical implications of proceeding without the child's cooperation. In this article, case scenarios are used to demonstrate how these considerations can be applied in practice.
Asunto(s)
Anestesia/ética , Procedimientos Quirúrgicos Operativos/ética , Procedimientos Quirúrgicos Operativos/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/ética , Negativa del Paciente al Tratamiento/legislación & jurisprudencia , Anestesia/psicología , Anestesia por Inhalación/ética , Anestesia por Inhalación/psicología , Ansiedad/psicología , Apéndice/cirugía , Niño , Preescolar , Toma de Decisiones , Oído Externo/cirugía , Miedo/psicología , Femenino , Humanos , Consentimiento Informado , Laparotomía , Masculino , Nueva Zelanda , Premedicación , Procedimientos Quirúrgicos Operativos/psicología , Tonsilectomía/ética , Negativa del Paciente al Tratamiento/psicologíaRESUMEN
This is a prospective incidence study of 250 secondary post-tonsillectomy haemorrhages from a population of 2706 tonsillectomies performed over a seven-year period, which aims to ascertain the incidence and character of post-tonsillectomy secondary haemorrhage. Out of 250 post-tonsillectomy secondary bleeds (9.2 per cent of total; 95 per cent CI = 8.2 per cent - 10.4 per cent), 39 patients had a severe bleed (1.4 per cent; 95 per cent CI = 1.2 per cent - 2.1 per cent). The incidence of secondary tonsillectomy haemorrhage increased with age, peaking at 30-34 years in both men and women (p < 0.001), with no statistically significant difference between the two sexes (p = 0.23). The incidence of serious haemorrhage increases in the older age categories (p = 0.005) but is not influenced by gender (p = 0.50). The majority of secondary tonsillectomy haemorrhages presented between the fourth and seventh day post-operation (69.8 per cent). These results now provide the basis for informed consent for a tonsillectomy in our department.