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D B Waisel

Publications and source records attributed to D B Waisel.

12 recordsLinked to original sources
PubMed1998

Recall of risks following labor epidural analgesia.

STUDY OBJECTIVE: To ascertain patients' recall of the risks of labor epidural analgesia from a discussion of informed consent during active labor. DESIGN: Survey analysis following an intervention. SETTING: Labor and delivery unit of a tertiary-care teaching hospital. PATIENTS: 101 ASA physical status I and II parturients in active labor. INTERVENTIONS: Patients were given a standardized discussion of the risks of labor epidural analgesia. MEASUREMENTS AND MAIN RESULTS: Within 24 hours of the informed consent discussion, patients were first asked to recall risks, and then asked to identify risks from a true and false list. Patients recalled 2.0 +/- 1.3 risks (mean +/- SD), with 12% recalling at least four risks, 37% recalling at least three risks, 66% recalling at least two risks, and 87% recalling at least one risk. There was no difference in level of recall between primiparas and multiparas, or in patients with mild and moderate pain scores versus those patients with severe pain scores. CONCLUSIONS: Recall of risks by parturients is similar to the recall of risks by other patients, and it does not appear to be affected by parity or the reported level of pain.

Adult↗
PubMed1998

Regional anesthesia equipment checkout recommendations: a case report and discussion.

The use of an apparatus checkout list is common in medicine and anesthesia. After being involved in a case in which the separation of a spinal introducer hub from its shaft during subarachnoid block required surgical removal of the retained shaft, a search for related cases was undertaken. The Medline database from 1966 to 1997 was used to identify defects and problems related to centroneuraxis equipment. Using these data, a regional anesthesia equipment checkout list of six recommendations was created in the spirit of other anesthesia checkout lists. The recommendations are to (1) ensure the proper fit and length between the needle and its stylet (particularly if using resterilized needles), (2) check for defects in the needle hub and shaft union by applying axial traction to the hub, (3) flush the needle with the distal end occluded, checking for defects in the hub-shaft junction or in the shaft itself, (4) check for malalignment between the needle hub and shaft, (5) examine the catheter for consistency in diameter and ensure the catheter can be introduced into the needle, and (6) flush the catheter, checking for the presence, patency, and location of distal holes. These recommendations must undergo further review before they are accepted as a practice standard.

Adult↗
PubMed1998

Field block for cranial surgery in World War II.

During World War II, physicians with minimal training were often thrust into the role of anesthetist. To educate these men, experts in anesthesia taught simple, conservative, and effective anesthetic techniques, such as the field block. Field blocks are the ideal "no frills" anesthetic because they are low-risk procedures that require minimal equipment. Unfortunately, many of the field blocks used during World War II are no longer taught. We present one technique that has fallen from favor, the field block for cranial surgery, both to educate about anesthesiology during World War II and to provide knowledge for the practicing military physician. The modern military anesthesiologist must be capable of anesthetizing patients under any conditions. First response care teams may find the technique of field block for cranial surgery useful in providing emergency anesthesia care.

Anesthesia, Conduction↗
PubMed1997

Informed consent.

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Anesthesiology↗
PubMed1995

The cardiopulmonary resuscitation-not-indicated order: futility revisited.

This paper reviews the advent of unilateral do-not-resuscitate orders. Unilateral do-not-resuscitate policies presume that cardiopulmonary resuscitation is a medical therapy and that physicians have no obligation to undertake a medical therapy that does not offer achievable and appropriate goals. Four do-not-resuscitate policies from U.S. hospitals and some of the significant published proposals are reviewed. We conclude that anything other than a physiologic definition of futility is indefensible because of imposed value judgments, imprecise definitions of quantitative and qualitative futility, inexact data, lack of certitude of economic benefit, and the role of autonomy for the patient and physician.

Consensus↗
PubMed1995

The benefits of the explanation of the risks of anesthesia in the day surgery patient.

STUDY OBJECTIVE: To ascertain the benefits of the preoperative discussion of the risks of anesthesia with parents of ASA status I or II pediatric day surgery patients. DESIGN: Survey analysis. SETTING: Pediatric day surgery unit. PATIENTS: 54 parents of ASA status I or II pediatric day surgery patients between the ages of 7 months and 16 years. INTERVENTIONS: After informed consent for the anesthetic was obtained by a member of the anesthesiology team, the parent(s) were given a questionnaire on their feelings about the explanation of the risks of anesthesia. MEASUREMENTS AND MAIN RESULTS: The questionnaire evaluated how parents felt about their understanding of the risks of anesthesia, the effect of hearing the risks of anesthesia on their anxiety levels, and the benefits of hearing the risks of anesthesia. Over 90% of the parents felt that they understood the risks of anesthesia, that the discussion of the risks would have no effect on their decision to proceed with surgery, and that the explanation of the risks is desirable; 92% considered the explanation desirable either out of a sense of responsibility or because they welcomed better understanding. CONCLUSIONS: Our study suggests the benefits of the explanation of the risks of anesthesia appear to be rooted in satisfying parental responsibility and understanding, and not in providing information for decision making or anxiety relief. Anesthesiologists should not feed compelled to always detail all the risks, but should seek to satisfy individual parental needs.

Adolescent↗