Informed consent and parental choice of anesthesia and sedation for the repair of small lacerations in children

This study investigated the issue of informed consent by surveying parent preferences for local anesthesia and sedation in the repair of small lacerations in their children in the emergency department (ED). Of the 45 ED patients with actual lacerations receiving a suture repair, 11 requested tetracaine-adrenaline-cocaine (TAC), 25 requested infiltrated lidocaine, and 9 were not given a choice (lidocaine administered because of wound proximity to a mucous membrane site). All 45 patients preferred nonsedation over sedation. In 44 of 45 patient cases, parents preferred to be included in the medical decision-making for their children. Of the 94 non-ED cases (interviewed in private offices) with a hypothetical chin laceration, 16 preferred TAC and 78 preferred infiltrated lidocaine. Sixty-seven of 94 preferred nonsedation over sedation. In 89 of 94 patient cases, parents preferred to be included in the medical decision-making for their children. Favorable points of continuous informed consent were presented, with risks, benefits, and alternatives disclosed. From the data presented, the following conclusions were drawn: (1) parents preferred infiltrated local anesthesia more commonly than topical local anesthesia; (2) parents preferred nonsedation over sedation under the clinical circumstances described; (3) parents overwhelmingly preferred to be included in the medical decisions affecting their children.