Informed consent involves discussing the anesthetic plan, alternatives, and potential complications. The patient must demonstrate decision-making capacity; that is, understanding, appreciation, reasoning, and choice. Consent must be voluntary, and free from coercion. Descriptions should be made in layman’s terms and conducted in the patient’s native language, using a trained medical interpreter when appropriate. Children should not be used as interpreters, although adult family members may serve as interpreters if the patient signs a waiver of disclosure stating they choose to waive access to a hospital-appointed translator.
Explanation of general anesthesia. Many aspects of anesthetic management are outside the realm of common experience and must be explicitly defined. Examples of this include endotracheal intubation, mechanical ventilation, invasive hemodynamic monitoring, regional anesthesia techniques, blood product transfusion, and postoperative ICU care.
Alternatives. Alternatives to the suggested, management plan should be presented as they may become necessary if the planned procedure fails or if there is a change in clinical circumstances.
Risks. Risks associated with anesthesia-related procedures should be disclosed in a manner that the average person would find helpful in decision making. The best-case/worst-case communication tool is useful to guide this discussion. Offering the most likely situation is clarifying for patients as well. The discussion should also include complications that occur with a relatively high frequency and those that are just remote risks.
Regional anesthesia. The risks of regional and neuraxial anesthesia include infection, local bleeding, nerve injury, headache, drug reaction, and possible failure to provide adequate anesthesia. Certain regional anesthetic techniques may carry more specific risks, for example, pneumothorax after an infraclavicular nerve block, and should be weighed against the associated benefits specific to the patient. General anesthesia and its attendant risks should also be discussed as it could become necessary.
General anesthesia. The risks of airway instrumentation include sore throat, hoarseness, and dental injury. The anesthetic agents may cause nausea and vomiting or produce an allergic reaction. The possibility of intraoperative awareness, pulmonary or cardiac injury, stroke, postoperative visual loss, postoperative cognitive dysfunction, postoperative intubation, ICU admission, or death should be discussed when appropriate.
Blood transfusion. The risks associated with blood transfusion are fever, hemolytic reactions, and infection. Current data assessing blood donations demonstrates a prevalence of hepatitis B virus ~1:1 to 1.5 million donations, human immunodeficiency virus ~1:1.6 to 2.3 million donations, and hepatitis C viruses ~1:2 to 2.6 million donations.
Vascular cannulation. The risks of intravenous catheters include injury of peripheral nerves, tendons, blood vessels, and site infection causing a phlebitis or cellulitis. Hemothorax, pneumothorax, and central line bloodstream infection are risks associated with central venous access.
Extenuating circumstances. Anesthetic procedures may proceed without informed consent in emergency situations as consent is assumed under dire circumstances.