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Patients who speak with a healthcare provider for 15 to 30 minutes during the informed consent process gain a better understanding of the surgical procedure that they are about to undergo, according to a recent study.

What's more, the longer the discussion, the greater the comprehension, say researchers in the federal Veterans Health Administration, who published their findings in the June issue of the Journal of the American College of Surgeons. Patients who were asked to repeat back some of the information that had been explained showed even higher comprehension scores.

Researchers affiliated with 8 VA medical centers nationwide used a computerized informed consent program during pre-op discussions with 575 patients scheduled to undergo hip arthroscopy, carotid endarterectomy, laparoscopic cholecystectomy or prostatectomy. After standard informed consent discussions, patients were quizzed on how much they understood.

In spite of cultural, language and education level barriers, "all patients benefited from what we found was the strongest influence on patient comprehension - extending the amount time spent on informed consent discussions," wrote co-author Aaron S. Fink, MD, an attending surgeon at the Atlanta VA Medical Center, in a press release.

Kent Steinriede

Ultrasound guidance improves the accuracy of identifying anesthetic spread when placing peripheral nerve blocks and reduces the incidence of block-related complications, according to new research.

Physicians at the Sunnybrook Health Sciences Centre in Toronto, Canada, assessed the abilities of 8 anesthesia residents and fellows and 12 staff anesthesiologists to recognize the spread of a simulated local injection around raisin targets embedded in a semi-opaque gelatin model.

The study's participants were instructed to place a 22-gauge nerve block needle next to the model's target structures using ultrasound guidance. After placement, the participants notified a research assistant, who either injected 1mL of water or made no injection at all. The participants were then asked to confirm or deny that the injection took place.

The study, published in the July issue of the journal Regional Anesthesia and Pain Medicine, showed that residents and fellows correctly identified the injection's spread - or lack of spread - 91% of the time, while staff anesthesiologists demonstrated a 93% accuracy rate.

Colin McCartney, MD, a Sunnybrook anesthesiologist and the study's lead investigator, says that ultrasound is an easy way for anesthesia providers to determine that local anesthetic spread occurs in the correct place.

"This is tremendously important as failure to ensure the correct spread can lead to intravenous injection of local anesthetic with convulsions and cardiac arrest in patients," he says. Other advantages of using ultrasound guidance during regional anesthesia include reducing PONV and faster post-op discharges.

Daniel Cook

Are your ORs equipped mostly with battery-powerd drills and K-wire drivers, or do your surgeons depend on pneumatic devices? Tell us in this week's online poll, and check back next week for the results.

Last week's InstaPoll asked with alternative agents you're using at your facility in the face of the propofol shortage. The results, based on 107 responses: