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No decision about me without me

Last post 19 Dec 2018, 6:51 PM by Mark Davies. 0 replies.
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  •  19 Dec 2018, 6:51 PM 2705

    No decision about me without me

    Decision analysis provides an interesting and informative approach to this important clinical problem. In this instance however, its usefulness is limited by the patchy evidence base (the vast majority of papers identified did not fulfil inclusion criteria) and over-reliance on expert opinion (time to mask rescue & AFOI). The authors postulate that some mothers may accept the increased risk of CICO following RSI in order to reduce potential fetal harm from an extended time interval until delivery. They state also that “due to the urgency .. it is probable that the anaesthetist may have to make the decision on behalf of the patient”, whilst acknowledging that many would be reluctant to perform an RSI when faced with this clinical scenario. When significant difficulties can be anticipated, recent guidance on consent [2] makes it clear that whenever possible a patient with capacity must be informed and involved. Making assumptions or taking deciusions on their behalf, however well-intentioned, is inappropriate. We feel the paper would probably have benefited from the involvement of patients - particularly at the discussion stage. Any such change in anaesthetic practice will certainly require that.

    S. Curtis

    M. Davies

    Royal Liverpool & Broadgreen University Hospitals NHS Trust,

    Liverpool, UK.

    Email: mwd@mac.com


    No external funding and no conflicts of interest declared.



    1. Krom AJ, Cohen Y, Miller JP, Ezri T, Halpern SH, Ginosar Y. Choice of anaesthesia for category‚Äź1 caesarean section in women with anticipated difficult tracheal intubation: the use of decision analysis. Anaesthesia 2017; 72: 156-71.

    2. Association of Anaesthetists of Great Britain and Ireland. Consent for anaesthesia, 2017. Anaesthesia 2017; 72: 93-105.

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