Review | How to talk about the risk of anesthesia

I remember that when I started to participate in anesthesia clinical work, there were often omissions in the anesthesia risk talk, which led to several turnarounds to the second talk.

Although there are detailed evaluation methods for each system in the textbook, how to talk about the risks of anesthesia in front of the patient, and at the same time list the risks in an orderly manner, determines the quality of the conversation.

I personally feel that understanding the pathophysiology of the disease and the process of surgical anesthesia is the prerequisite, but it is more important to analyze the diagnosis and treatment risks in a more systematic and hierarchical manner.

The following is purely personal experience, I hope it will be helpful to young anesthesiologists.

This article takes general anesthesia as an example, other anesthesia methods can be analogized.

The risks related to anesthesia during surgery can be divided into two categories: patients and surgical factors, and anesthesia factors.

Since the surgeon will explain the risks of the operation in detail, and most of these risks are due to the patient's own disease, you only need to focus on it during the conversation.

Patients and surgical factors 1) Risks caused by patients’ diseases.
Patients’ diseases and surgical operations may bring various risks during and after surgery, such as bleeding during hepatectomy, extremely unstable blood pressure during pheochromocytoma, and cerebral instability.
After the release of intracranial pressure in hemorrhage patients, there is a significant drop in blood pressure, patients with fractures are at high risk of pulmonary embolism, and biliary heart reflexes.

2) Possible risks of comorbidities.
Various chronic comorbidities may bring risks that affect the process of surgery.
This category should be our greatest concern.

Every important comorbidity may lead to a poor prognosis, and you should explain them in detail one by one during the conversation.

Hypertension and diabetes may cause intra- and post-operative cardiovascular and cerebrovascular accidents, asthma patients may have recurrences, and myocardial infarction during coronary heart disease operations can significantly affect the prognosis.

Anesthetic factors The anesthetic factors mentioned here refer to the "general" risks of general anesthesia.
Every patient can encounter risks when performing general anesthesia, but certain comorbidities may increase such risks. According to the incidence, it is divided into common and rare risks.

1) Common risks include post-induction hypotension, risk of intubation, tooth damage, postoperative pain, postoperative nausea and vomiting, and postoperative delirium.

The general anesthesia visit list is listed in detail.
These risks are relatively high, but most of them will not have serious complications.

2) Rare risks The incidence of rare risks of anesthesia is very low, but all of them may lead to serious consequences and even life-threatening.

Although the incidence is extremely low, patients are weakly aware of such risks and must be mentioned in the conversation.

Such as allergy to anesthetics, malignant high fever, etc.

In addition, I suggest that serious complications that may occur during the conversation should be briefly summarized after the detailed discussion.

After everything is over, you can ask "What are the questions about tomorrow's anesthesia?" Although most patients can't ask any reliable questions, this sentence can bring patients closer and build trust.

Finally, we need to focus on the risk of anesthesia, it is recommended to take more seriously than light! The above is my understanding of the anesthesia risk talk, and you are welcome to correct and add.

Hope to give you a harvest!