Effective communication between patients and anesthesiologists is a fundamental aspect of safe and patient-centered surgical care. These preoperative discussions are designed not only to inform patients about the risk they will face during their procedure but also to build trust, reduce anxiety, and support shared decision-making. Recent research highlights both advancements and ongoing challenges in ensuring that these conversations are comprehensive and meaningful.

Typically, the preoperative consultation is the first direct interaction between the patient and the anesthesiologist and often occurs shortly before surgery. This limited time frame makes it crucial for anesthesiologists to communicate clearly and efficiently. The main objectives during these meetings are to alleviate patient and family anxiety, assess the patient’s readiness for anesthesia, explain the planned anesthetic approach, have discussions on risk and potential complications, and obtain informed consent.

A critical part of these discussions involves explaining both common and rare risks associated with anesthesia. More frequent but less severe risks, such as nausea, vomiting, sore throat, or minor dental injuries, are discussed alongside rare but serious complications like allergic reactions, nerve injury, or even death. Patients often have specific concerns, such as the fear of not waking up, experiencing paralysis, or suffering pain after surgery. Addressing these concerns directly can help patients feel more secure and informed.

Beyond discussing risk, anesthesiologists are responsible for informing patients about applicable alternative anesthetic options, such as regional or local anesthesia, and even the possibility of forgoing anesthesia in certain cases. Even if these alternatives are less suitable, patients have the right to know and participate in the decision-making process. This approach is central to the ethical and legal standards of informed consent, which is not just a signature on a form but a dynamic, patient-focused process.

Despite the recognized importance of these conversations, studies show that patient understanding of anesthesia risks and alternatives is often limited. Anesthesiologists may unintentionally overwhelm patients with technical jargon or focus too much on procedural details, rather than ensuring that the patient truly understands the information. Additionally, discussions about postoperative care, long-term outcomes, or the patient’s personal values and preferences are sometimes overlooked, even though patients often express a desire to be involved in these aspects of their care.

For anesthesiologists to provide the safest care, they rely on patients to disclose all relevant health information, including chronic illnesses, medications, and lifestyle factors like alcohol or drug use. Honest and complete disclosure is vital, as factors such as alcohol dependence or certain medications can significantly influence anesthetic risk and management. For example, stopping alcohol abruptly before surgery can lead to withdrawal and increase the likelihood of complications. Open and honest dialogue allows anesthesiologists to tailor their approach and offer appropriate guidance to minimize risk.

The effectiveness of discussions about the risk associated with anesthesia ultimately depends on the anesthesiologist’s communication skills and their ability to foster a collaborative relationship. Training in communication has been shown to improve patient satisfaction and reduce legal risks. By actively engaging patients, addressing their individual concerns, and documenting the interactive nature of the consent process, anesthesiologists can enhance both safety and the overall patient experience.

In summary, discussions between patients and anesthesiologists about anesthesia risk before the procedure are multifaceted and require clear communication, empathy, and a commitment to shared decision-making. Ongoing efforts to improve these interactions through education, technology, and training are essential to advancing patient-centered care in the perioperative environment.

References

1. Spofford CM, Szeluga DJ. From beginning to end in anesthesia: a 3-part series on obtaining informed consent, handling a difficult airway, and delivering bad news. Simul Healthc. 2013 Aug;8(4):262-71. doi: 10.1097/SIH.0b013e3182888d1d. PMID: 23598860.
2. Waisel DB, Ruben MA, Blanch-Hartigan D, Hall JA, Meyer EC, Blum RH. Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter. Anesthesiology. 2020 Jan;132(1):159-169. doi: 10.1097/ALN.0000000000002999. PMID: 31770142.
3. Pascarella MR, Walls JD, Liu R, Chen L. Anesthesia Providers are Obligated to Give Patients the Alternatives to General Anesthesia when Obtaining Informed Consent. Transl Perioper Pain Med. 2014;1(2):5-8. PMID: 25568886; PMCID: PMC4283849.
4. King JS, Moulton BW. Rethinking informed consent: the case for shared medical decision-making. Am J Law Med. 2006;32(4):429-501. doi: 10.1177/009885880603200401. PMID: 17240730.
5. Salgaonkar SV, Kulkarni AD, Chapane SP. Assessment of communication skill during process of preoperative visit and informed consent by anesthesiology residents. J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):548-553. doi: 10.4103/joacp.JOACP_414_19. Epub 2022 Jan 6. PMID: 35340972; PMCID: PMC8944364.