Letters Risks from not adopting full consent process

Consent for anaesthesia—sleepwalking into trouble

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6189 (Published 21 November 2016) Cite this as: BMJ 2016;355:i6189
  1. Michael H Basler, consultant in anaesthesia and pain management,
  2. Alan J R Macfarlane, consultant anaesthetist,
  3. Sonya McKinlay, consultant anaesthetist
  1. Glasgow Royal Infirmary, Glasgow G4 0SF, UK
  1. michael.basler{at}ggc.scot.nhs.uk

The Royal College of Surgeons has highlighted the operational issues raised after the Montgomery judgment on consent,1 which have wider implications.2

Anaesthesia in the UK has resisted formal consent and relies on the preoperative visit as the foundation for discussion of techniques. Obstetric and regional anaesthesia are the leading anaesthetic causes of litigation.3 Although regional anaesthesia in obstetrics has been associated with reduced maternal mortality, in other contexts its mortality benefits are less certain,4 and long term functional outcome benefits seem limited to a few operations.5 Complications are rare, but material risk must be discussed.

Redesign of many surgical pathways has led to preoperative assessment by non-anaesthetists and same day admission becoming routine, which leaves less time for interaction between anaesthetist and patient. We think that introducing written consent for anaesthesia would safeguard the need for an adequate discussion between doctor and patient. Where the majority of discussion about anaesthesia before surgery is undertaken by non-anaesthetic staff, accurate communication of risk needs to be ensured; better informed patients may reduce litigation.

Choosing the right regional anaesthetic technique for the right operation and the right patient can have many benefits, but in some circumstances the (rare) material risks may outweigh those of general anaesthesia. Like surgery, anaesthesia must now work to ensure that litigation cases after a regional anaesthetic complication are never lost because of inadequate consent.


  • Competing interests: None declared.


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