Consent

NeuroSurgery InfoNet

Procedures - Complications

 

 

 

Both patient and surgeon have important roles in the process of informed consent.

 

Surgeon role: 

 

Obtains informed consent. Provides information about the surgical procedure.  During the discussion to obtain consent the surgeon should present to the patients the indications, technical aspects, and explain in detail the most common complications and give an indication of how frequently each occurs. 

 

Indications Techniques Risks Alternatives

 

 

1. Indications

 

The reasons why the operations is recommended. Why it is being done.

 

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Indications Techniques Risks Alternatives

 

 

2. Technical aspects

 

Anatomy of tissues where the surgery will be done including a description of how the respective tissues types heal.

Nearby risky structures (vessels and nerves) are subject to injury which could be associated with adverse (pain, hemorrhage, nerve injury) consequences for the patient.

special equipment: advantages and risks.

 

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Indications Techniques Risks Alternatives

 

 

 

3. Risks and complications

 

Problems that could arise (and have to be dealt with immediately) during surgery, as well as problems that could occur early or later post operatively (with acute and chronic management requirements).

Percentages of risk occurrence and outcome when available and accurate.

 

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Indications Techniques Risks Alternatives

 

 

 

4. Alternatives

 

Therapies (medical as well as surgical) that could be done INSTEAD of (not in addition to ...) the proposed surgery and achieve the same therapeutic objective as the proposed surgery.

 

 

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Indications Techniques Risks Alternatives

 

 

Patient role: 

 

Attentive listening. Formation of appropriate, comprehensive questions relative to the information presented by the surgeon.

 

Once the information has been presented to the patient (or a duly empowered to act as a patient's health care decision maker) and that individual indicates his/her:

1. Comprehension and

2. Assent,

the surgeon (or in some cases a designated agent) signs, as well as the patient (or agent), and a third party (not party to the consent surgery) "witness".

 

Patients rights in most hospitals include the right of the patient (or his/her agent) to at any time and for any reason, revoke a previously granted informed consent.

 

Patient agents (spouses, family members, significant others, friends, conservators, guardians) frequently give informed consent on behalf of neurosurgical patients with intracranial pathology such as brain tumors, ruptured aneurysms, and encephalitis.

 

The surgeon not only signs the same informed consent form as the patient (or representative) but he/she in addition writes a statement in the medical record (patient chart) indicating the nature and content of the informed consent as part of his/her preoperative documentation.

 

The informed consent protects both the patient and the surgeon:

 

Patient: Ensures that patient will be given information necessary to make an "informed" decision about the proposed surgical treatment.

 

Surgeon: Documents that the appropriate information was given and that the patient (or agent) sufficiently understood and agreed to sign the Informed Consent form.

 

 

INFORMED CONSENT

 

Reasons why patients do not “remember informed consent conversation

 

PATIENT

SURGEON

Drugs

  • Pain
  • Psychotropic
  • Antihistamines
  • Recreational
  • Alcohol

Language

  • English
  • Other
  • Jargon
  • Abbreviated
  • Misleading
  • Coercive

Language

 

Not mentally competent

  • Insufficient intelligence
  • Pyschotic
  • Demented
  • Hysterical/Fearful

 

Litigation

 

Munchausen’s/20 gain

 

 

Friends and/or relatives

Pro:            translators

            “medical” background – familiarity with terms

 

 

 

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Informed Consent by Procedure

  Aneurysm clipping
  Anterior cervical discectomy
  Carpal tunnel release
  Glioma resection
  Lumbar laminectomy
  Lumbar microdiscectomy
  Transsphenoidal craniotomy
  Ventriculoperitoneal shunt
  Ventriculostomy
 

     Organization of Informed Consent
 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

 

 

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  Neurosurgeon explaining craniotomy during process of getting the patient's  informed consent.

 

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  Aneurysm clipping

 

 

     

    The proposed surgery

A curved in incision of the skin.

Division and separation of the scalp and muscles on the skull.

One or more dime-size holes (burr holes) in the skull connected with a bone saw.

     What can go wrong

The skin incision can 

     Alternatives

 

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  Anterior cervical discectomy

 

 

 

    What is the proposed surgery

     What can go wrong

Injury to the tissues that must be retracted to approach and expose the front of the vertebral column to provide enough room for the neurosurgeon to moved instruments to remove the intervertebral disc and place a bone graft (with plate and screws).

The recurrent laryngeal nerve that supplies the vocal cord on the same side of the neck as the skin incision (usually right) can be injured by retraction.  If the injury is severe function may not ever return but in the majority of cases function (ability to move both vocal cords to speak normally) of the injured cord recovers.  

  

     What are the alternatives

 

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  Carpal tunnel release

 

 

     

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

 

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  Glioma resection

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

 

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  Lumbar laminectomy

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

 

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  Lumbar microdiscectomy

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

 

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  Transsphenoidal craniotomy

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

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  Ventriculoperitoneal shunt

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

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  Ventriculostomy

 

 

     What is the proposed surgery.

     What can go wrong.

     What are the alternatives.

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