Nasotracheal intubation for head and neck surgery

We were interested to read the letter entitled Consent for anaesthesia (Chapman & Wolff. Anaesthesia 2002; 57: 710) as we grapple with the problem of what and how much to tell patients about their anaesthetic. As a follow up to the audit of Drs Chapman and Wolff, we asked a group of 100 patients the same questions before and then after surgery and whether, in retrospect, they felt they had received an appropriate amount of information. Before surgery, the patients were asked to indicate their preference as follows: 1. I would like to be given a full and detailed explanation of the anaesthetic, any possible alternatives, together with all the risks and benefits of each technique. 2. I would like a simple description of the anaesthetic together with an explanation of the main risks and benefits. 3. I expect that my best interests will be followed and I would like to be told as little as possible about the anaesthetic. The postoperative questions were: 1. Did you receive an appropriate amount of information about the anaesthetic prior to the operation? 2. If no, would you have liked less information or more information either written or verbal? We also collected basic demographic data of age, gender and occupation. Of the 100 patients presenting for general or urological surgery, 88 were elective and 12 urgent. The gender ratio was male 44, female 56, and the age distribution is shown in Table 1. The results of the audit are summarised in Tables 2 and 3: When broken down by gender, there was little difference in the amount of information desired or received. When analysed by age, the majority in each age group wanted Level 2 information except in the over 80s who preferred Level 3 (minimal) information. There were more in the 40–59 age group who wanted Level 1 than in other age groups, but a consistent one-third in each group between 20 and 80 years only wanted Level 3. No trends emerged with regard to occupational group. In contrast to the audit by Chapman and Wolff, the majority of our patients wanted Level 2 information, i.e. a simple explanation of the procedure and main risks and benefits (which perhaps reflects our more elderly population). Patients wanting Level 1 information were in a minority regardless of age. Nevertheless, it was gratifying that 83% of those wanting Level 1 and over 90% of those wanting partial or minimal information were satisfied with what they were told. At present, all our patients get a pamphlet about coming to theatre but not one purely dedicated to anaesthesia, although we are planning to introduce new ones based on the Royal College of Anaesthetists published booklets. However, this audit reminds us that about a third of our patients only want minimal information anyway and are happy with what they are getting. More detailed written information probably should be offered