Clarification statement on consent and risk of death in children

The following is a joint statement from the Royal College of Anaesthetists (RCoA) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI).

In December 2021 the RCoA and APAGBI in conjunction with several other medical royal colleges and the Association of Anaesthetists published a best-practice guidance: Paediatric Imaging under General Anaesthetic. This was produced following the unexpected death of a child having an MRI scan under general anaesthesia.

There has been some anxiety expressed to both the College and APAGBI about the need to discuss the risk of death from anaesthesia in otherwise apparently healthy children. This is never an easy issue to discuss and clearly will be tailored according to the perceived risk, the attitudes of the parents/carers and the expected benefits of the scan.

Guidance on professional standards and ethics for doctors in this regard is provided in a recent publication by the General Medical Council: Decision Making and Consent. This document gives explicit guidance about "Finding out what matters to patients” and “Discussing benefits and harms” and colleagues are urged to read, understand and work to the recommendations.

It should be acknowledged that the risk from modern anaesthesia in the U.K. is extremely small, but never zero. Discussions of this nature are best held at a preoperative assessment to allow for understanding and reflection and only as a last resort should they be held on the day of procedure. A new risk infographic published by the APA and RCoA may help inform this discussion.