Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Anesthesiologists are charged with the duty to ensure the well-being of people undergoing diagnostic and therapeutic procedures by expertly managing their perioperative care, attentive and continuous monitoring, and providing pain and anxiety relief through effective, professional interpersonal communication and pharmacologic interventions.^1,2 The professional ethos of the field of anesthesiology is anchored in patient-centered care and respect for each patient’s human dignity while upholding the pillars of medical ethics, particularly autonomy and beneficence.³

Pediatric patients and people with intellectual and developmental disabilities (I/DDs) are often unable or unwilling to cooperate for the placement of a peripheral intravenous (IV) catheter prior to induction due to fear and anxiety related to healthcare providers, procedures, and/or environments. Several alternative approaches commonly used by anesthesiologists for gaining IV access in these patients include the use of oral or intranasal premedication, inhalational agents, and intramuscular (IM) injections.^4–7 These techniques help transition a patient into a sedated or anesthetized state to facilitate IV placement and ultimately execute the developed anesthetic plan safely without risk of precipitating dangerous behavioral outbursts or creating traumatic memories.

As within any community of practice, communication between members of the anesthesia healthcare team (eg, anesthesiologists, trainees, and others) often includes colloquialisms. Commonly used idioms for describing the use of an IM injection often include the word “dart,” such as “we are going to dart the patient, then get an IV.” These colloquialisms can be heard across all settings where anesthesia practice and training occur as well as in other healthcare specialties like emergency medicine, pediatric dentistry, and oral and maxillofacial surgery. Some common phrases derived from this terminology include “darting the patient,” or performing a “k(etamine) dart.” Such terms or phrases, particularly when caring for patients with I/DDs, insinuate similarities to the practice of using projectile dart drug delivery systems shot from a rifle, pistol, or blowpipe to facilitate chemical immobilization of large and/or dangerous animals by animal handlers and veterinarians.^8,9 Therefore, using “dart” and similar terminology may be degrading to a person’s dignity and humanity.

For anesthesiologists to remain steadfast to their professional ethos, it is vital they remain continuously aware of the potential negative impact their words may carry when communicating. The article by Awdish et al¹⁰ recently discussed “never words” commonly employed in interactions between healthcare team members, critically ill patients, and caregivers that can have unintended negative consequences (eg, “the patient is circling the drain”).

Mindful reflection on the impact words can carry is exemplified in the efforts to end the use of the “R word.” The term “mental retardation” has evolved to be degrading and hurtful and is now associated with intentional, insulting stereotypes.¹¹ The American Academy of Developmental Medicine and Dentistry (AADMD) in partnership with the Special Olympics continues to implore medical and dental schools as well as other professional healthcare organizations to help educate their members that use of the “R word” must be eliminated. The “R word” is hateful and degrading to people with I/DDs, and the AADMD emphasizes that using people-first language to describe this population (eg, “people with intellectual disabilities”) is more conscientious and appropriate. These efforts by the AADMD to change communications describing a group of individuals are more than just semantics. They demonstrate professionalism and help build respect for and understanding of patients that have intellectual disabilities.¹¹

The same can be said for the negative connotation when referring to “darting” patients in anesthesia-related communications. It is time we consider such colloquialisms as “never words.” Terminology within the existing healthcare vernacular should be used when discussing IM injections used for anesthesia care (eg, “we plan to perform an IM injection in preop, place our monitors, and then transfer to the OR once the patient is sedated and place an IV”). Like the “R word,” efforts to change anesthesia-related communications to avoid using any degrading terminology help demonstrate professionalism and foster a humanizing approach when caring for patients with I/DDs. Anesthesiologists, trainees, and other healthcare team members can express their dedication to dignified and humanistic care for all patients by eliminating the use of the term “dart.”