Black J D B, Cyna A M
Department of Women's Anaesthesia, Children's Hospital and University of Adelaide, Adelaide, South Australia, Australia.
Anaesth Intensive Care. 2006 Apr;34(2):254-60. doi: 10.1177/0310057X0603400209.
Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists' beliefs about informed consent, the type of consent obtained and its documentation. Of 542 questionnaires distributed, 291 responses (54%) were suitable for analysis. The five most commonly discussed risks were post dural puncture headache, block failure, permanent neurological injury, temporary leg weakness and hypotension. Obstetric anaesthetists reported discussing a mean of 8.0 (SD 3.8) and 10 (SD 3.8) risks in the labour and antenatal settings respectively. Nearly 20% of respondents did not rank post dural puncture headache among their top five most important risks for discussion. Seventy percent of respondents indicated that they believe active labour inhibits a woman's ability to give 'fully informed consent'. Over 80% of respondents obtain verbal consent and 57 (20%) have no record of the consent or its discussion. Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.
麻醉师在分娩时实施区域镇痛前，在法律上有义务获得患者同意并告知其重大风险。我们对澳大利亚和新西兰麻醉师学院中对产科麻醉有特别兴趣的顾问成员进行了调查，以确定并比较他们报告在分娩前和分娩期间与产妇讨论的区域镇痛风险。我们还询问了产科麻醉师对知情同意的看法、所获得的同意类型及其记录情况。在分发的542份问卷中，有291份回复（54%）适合进行分析。最常讨论的五个风险是硬膜外穿刺后头痛、阻滞失败、永久性神经损伤、暂时性腿部无力和低血压。产科麻醉师报告称，在分娩和产前阶段分别平均讨论了8.0（标准差3.8）和10（标准差3.8）个风险。近20%的受访者未将硬膜外穿刺后头痛列为最重要的五个讨论风险之一。70%的受访者表示，他们认为活跃分娩会抑制女性给出“充分知情同意”的能力。超过80%的受访者获得了口头同意，57人（20%）没有同意或其讨论的记录。产科麻醉师报告称，在分娩时提供区域镇痛前，他们花了很大力气告知患者风险。对于分娩中的女性，使用标准化表格作为风险提醒并记录讨论情况，口头同意可能是合适的。对于分娩时区域镇痛的风险水平需要达成共识。
