Scale to help describe the frequency of risks.
Quoting risks can be difficult as the exact numbers will vary from case to case depending on patient factors, the type of surgery being performed, the types of drugs likely to be administered and of course, the grade and skill of the anaesthetist. However, it is good practice to have a grasp of the risks for an average patient having an average operation and these are listed in Table 24.1[4]. The same risks for a child in good health having minor surgery are quoted in Table 24.2[5].
| Side effect | Risk | Other information |
|---|---|---|
| Nausea | 1 in 3 | Dependent on operation type, drugs used, gender etc |
| Sore throat (ETT) | 2 in 5 | |
| Sore throat (LMA) | 1 in 5 | |
| Shivering | 1 in 4 | |
| Damage to tongue/lips | 1 in 20 | |
| Damage to teeth | 1 in 4500 | |
| Damage to eyes | 1 in 2800 | |
| Post-operative chest infection | 1 in 5 | For major abdominal surgery |
| Accidental awareness | 1 in 20 000 | From NAP5 data. Smaller interview studies have suggested the risk to be as high as 1 in 1000 |
| Anaphylaxis | 1 in 10 000–20 000 | |
| Nerve damage | 1 in 1000 | E.g. ulnar or common peroneal nerve injury from compression |
| Death/brain damage | 1 in 100 000 | |
| Death following Caesarean section (general anaesthetic) | 17 in 100 000 |
| Side effect | Risk |
|---|---|
| Headache | 1 in 10 |
| Sore throat | 1 in 10 |
| Nausea and vomiting | 1 in 10 |
| Dizziness | 1 in 10 |
| Agitated on waking | 1 in 5 |
| Severe allergic reaction | 1 in 10 000 |
| Death | 1 in 100 000 |
Taking consent can be particularly challenging in the labouring woman. One may argue that when someone is in significant pain that they no longer have capacity to give consent. In the case of an emergency caesarean section, it is rare, but not unheard of, for a mother to refuse the treatment to save her unborn child. This would involve a multidisciplinary team approach so you would never be alone in this situation, and is beyond the scope of this book. A more likely situation to find oneself in is a labouring mother asking for an epidural when she had previously stated she would not want to have an epidural. In these situations we have to rely on the opinions of relatives, midwives, a birthing plan if available and our own expert judgement. Trying to explain the risks of an epidural to a woman in labour can be difficult. In some trusts ladies are given written information about pain relief in labour when at antenatal clinic. However, it remains prudent to offer some information to the labouring women at the time of request for help. It is important to at least ask them if they would like to hear the risks and encourage them to read the information card, if your Trust supplies one. It is preferable to quote the main risks as listed in Table 24.3[6]. Since the publication of the NAP3 report many people use its results to inform the consent process. Please see Chapter 34 for more information.
| Side effect | Risk |
|---|---|
| Epidural not working perfectly | 1 in 8 |
| Hypotension | 1 in 50 |
| Headache | 1 in 100 |
| Nerve damage (temporary) | 1 in 1000 |
| Nerve damage (longer than 6 months) | 1 in 13 000 |
| Epidural abscess | 1 in 50 000 |
| Meningitis | 1 in 100 000 |
| Epidural haematoma | 1 in 170 000 |
| Reduced Glasgow Coma Score (GCS) | 1 in 100 000 |
| Severe injury/paralysis | 1 in 250 000 |
Consent for regional anaesthesia can prove more challenging as many of the potential problems are less easy to understand for the lay person than potentially having a sore throat or feeling sick. It is therefore important to emphasize the degree of risk in a way the patient will understand. Table 24.4 will help with this[7].
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