Prevention of Intraoperative Awareness in a High-Risk Surgical Population

Avidan, Michael S.; Jacobsohn, Eric; Glick, David B.; Burnside, Beth; Zhang, Lini; Villafranca, Alexander; Karl, Leah; Kamal, Saima; Torres, Brian A.; Evers, Alex S.; Gradwohl, Stephen C.; Lin, Nan; Palanca, Ben Julian A.; Mashour, George A.

doi:10.1056/nejmoa1100403

Cited by 498 publications

(350 citation statements)

References 38 publications

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“…Avidan et al recently reported on Etaa monitoring in high-risk awareness patients. 71 Maintaining anesthetic depth with Etaa of 0.7-1.3 MAC multiples was found to be reassuringly safe.…”

Section: Potential Beneficial Therapeutic Effects Associated With Higmentioning

confidence: 95%

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brattwall

Warrén-Stomberg

Hesselvik

et al. 2012

Can J Anesth/J Can Anesth

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“…Avidan et al recently reported on Etaa monitoring in high-risk awareness patients. 71 Maintaining anesthetic depth with Etaa of 0.7-1.3 MAC multiples was found to be reassuringly safe.…”

Section: Potential Beneficial Therapeutic Effects Associated With Higmentioning

confidence: 95%

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brattwall

Warrén-Stomberg

Hesselvik

et al. 2012

Can J Anesth/J Can Anesth

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“…Over several decades, the incidence appears to have consistently reported to be approximately 1-2:1000 general anaesthetics [7][8][9][10][11][12]. It has been reported to be higher in obstetric (1:384 [13]), cardiac (1:43 [14]), and paediatric (1:135 [15]) anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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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“…22 décrivent une analyse secondaire de patients issus d'une étude publiée antérieurement sur l'éveil sous anesthésique chez des patients à risque élevé de souvenirs de l'évènement. 23 Dans leur analyse, les investigateurs ont comparé quatre caractéristiques anesthésiques chez 319 patients roux autodéclarés et 1595 patients ayant d'autres couleurs de cheveux appariés sur les scores de propension.…”

Section: Les Roux Et Les Anesthésiquesunclassified

“…21 In this issue of the Journal, Gradwohl et al 22 describe a secondary analysis of patients drawn from a previously published study of anesthetic awareness in patients at high risk for recall. 23 In their current analysis, the investigators compared four anesthetic characteristics in 319 self-reported redheads and 1,595 propensity-matched patients with other hair colours.…”

mentioning

confidence: 99%

Red hair and anesthetic requirement

Sessler

2015

Can J Anesth/J Can Anesth

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Prevention of Intraoperative Awareness in a High-Risk Surgical Population

Cited by 498 publications

References 38 publications

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brief review: Theory and practice of minimal fresh gas flow anesthesia

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

Red hair and anesthetic requirement

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