Acceptably aware during general anaesthesia: ‘Dysanaesthesia’ – The uncoupling of perception from sensory inputs

Pandit, J. J.

doi:10.1016/j.concog.2014.05.007

Cited by 35 publications

(26 citation statements)

References 85 publications

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“…This is likely to be more important than attempting to abolish memory retrospectively using drugs. There were occasional descriptions of disembodied experiences that may be interpreted as consistent with several proposals made in the anaesthetic literature on states of mind variously termed 'cognitive unbinding' [32], 'disconnectedness' [33] or 'dysanaesthesia' [34,35]. Or, these may reflect the sensation of paralysis or misinterpretions by patients of their unusual experiences as dreams.…”

Section: Psychological Experiences and Nap5 Resultssupporting

confidence: 49%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

et al. 2014

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The 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients' experiences ranged from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for < 5 min, yet 51% of patients (95% CI 43-60%) experienced distress and 41% (95% CI 33-50%) suffered longer-term adverse effect. Distress and longer-term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's interpretation of what is happening at the time of the awareness seemed central to later impact; explanation and reassurance during suspected 1102

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Section: Psychological Experiences and Nap5 Resultssupporting

confidence: 49%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

et al. 2014

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“…This is despite guidance from the National Institute for Health and Care Excellence [41], a full year before the activity survey was conducted, notwithstanding some criticism [42]. The isolated forearm technique is even less frequently employed, despite prominent debate in the literature [43][44][45][46]. The use of depth of anaesthesia monitors in Ireland is somewhat higher, 9% of all general anaesthetics [18,19], but it is unknown if this pattern is mirrored in other countries.…”

Section: Specific Depth Of Anaesthesia Monitoringmentioning

confidence: 88%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out‐of‐hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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“…These wide estimates do not reflect some imprecision on our part, but are very robust data and indicate to us that AAGA is not a single entity [5,6]. The 'doughnut' diagram in Absalom and Green's editorial [7] (itself based upon a bar chart presented elsewhere [8]) nicely encapsulates this notion. Different methods (Brice vs NAP5) detect different aspects of a heterogenous condition.…”

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confidence: 94%

Clarifying NAP5

Cook

Pandit

2014

Anaesthesia

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Acceptably aware during general anaesthesia: ‘Dysanaesthesia’ – The uncoupling of perception from sensory inputs

Cited by 35 publications

References 85 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

Clarifying NAP5

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