Accepting randomization: confidence and comfort
COPD
COPD, ASTHMA, HEART DISEASE
When interviewees discussed patients whose randomization to REGAIN they accepted, they described feeling confident that either anesthesia approach would be safe for these patients.I would’ve done either one. I’m comfortable doing either technique. […] The patient was within the safety factors for both techniques. […] I kept it within the realm of safe care for the patient. The techniques had to follow safe medical practice for me to be even considering REGAIN for this to pick techniques randomly. (interviewee 12)I thought that he would have done fine with either anesthetic. […] This patient didn’t have significant heart disease. While he was billed as someone with COPD and well-controlled asthma, his pulmonary status was fine. So I also thought a general anesthetic would have been just fine for him, as well. (interviewee 6)In these cases, anesthesiologists’ determination to proceed with randomization usually did not rely on drawing an equivalence between the outcomes that would be achieved by the respective anesthesia approaches. Rather, the approaches were deemed to independently meet the anesthesiologist’s standard for what constituted safe care. In a minority of randomized cases, interviewees did compare the options, as in the following:[The patient was] super sharp. He was coherent. […] And it was a very easy decision. […] I mean, if he wasn’t a REGAIN patient, given his mental status was so good and his age, I would have probably tried to tell him that I thought spinal was safer. But I didn’t think there was a huge differential, so we went ahead and randomized. […] Sometimes I had to speak to family members and say, I wouldn’t even be approaching you if I didn’t believe that either way was safe for your family member. (interviewee 7)In rare accounts such as this, however—in which a comparison of the relative benefits of the approaches appears to have driven the determination to OK randomization—the disposition evinced remained one of confidence that both options would ultimately allow for a safe operation.