1. Jamal Tashkandi FANZCA

4. 4 years old boy Wt. 14Kg elective adeno - tonsillectomy Eczema and Asthma Multiple allergies (milk, sesame, strawberry, eggs, peanut and possible other food items) and Omnicef

5. Preoperatively discussed with his parents the issues of allergy in details, Informed them re-drugs contains food extract super anxious mother

6. Discussion Informed consent = Risks & benefits to discuss Known risks i.e. rare but the detriment severe common but the detriment slight

7. Examples: Common adverse effects of GA: nausea, vomiting, sore throat. Less common but not rare adverse effects spinal headache and dental trauma

8. Rare adverse effects which are unpredictable anaphylaxis, awareness, neurological damage or death in healthy people Adverse effects related to pre-existing disease death in a patient with recent myocardial infarction undergoing emergency surgery

9. inhalation of Sevoflurane with 100% O 2 Fentanyl 20 mcg Propofol 20 mg Dexamethasone 4 mg Metoclopramide 4 mg Easy intubation

10. severe bronchospasm rapid desaturation rapid bradycardia call for help was initiated CPR + adrenaline + fluids sPO2 15%-100%, lasts for 7min bradycardia last for 3min

11. extubated in the OR PACU breathing spontaneously O 2 Saturation 92-98% on RA Fully conscious and talking

12. Parents were called and informed Referred to the pediatrician to follow up Referred to Allergy Clinic

13. How to break bad news to patient’s family?

14. Communication in difficult situations do the job well = rehearse Minimise long term distress in relatives and doctor Minimise the risk of litigation Maximise the eventual acceptance of bad news

15. If a potential medico-legal implications: ensure information is supplied to insurers internal hospital protocol is followed

16. It is important: To expressing sympathy and regret for the situation of the patient No explicit admission of liability of blame should be made

17. Private room, free from interruption Establish what to call him/her All must be sitting, at same level Ensure body language is appropriate Check the knowledge of the person(s)

18. Fire a warning shot to give the person(s) time to prepare his/herself: “I’m afraid I have bad news…” Allow pauses for the news to sink in Deliver confirmed information Do not use jargon

19. Allow pauses at all steps for: - reflection - for the news to sink in - express emotions and concerns

20. Express sympathy without accepting any blame for the incident Verbalise acceptance of person’s emotional responses “I can see that this is very distressing for you..”

21. Check the person’s understanding “Would you like me to repeat that ?.......tell you more ?.... Elicit concerns and information needs “Do you feel I have covered all your concerns ?...

22. Offer further contact

23. Record the substance of the interview in the chart