The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data

Abstract

SummaryAccidental awareness during general anaesthesia with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project was designed to investigate the reported incidence, predisposing factors, causality and impact of accidental awareness. A nationwide network of local co-ordinators across all UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymised reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorised into main types by a multidisciplinary panel, using a formalised process of analysis. The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorisation was also defined for each report. Patient experience and sequelae were categorised using current tools or modifications of such. The 5th National Audit Project methodology may be used to assess new reports of accidental awareness during general anaesthesia in a standardised manner, especially for the develop-1078

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

“…If so, a detailed handover must be delivered to the incoming anaesthetist and this should be recorded in the anaesthetic record. A handover checklist is useful, and one example of this is the ‘ABCDE’ aide memoir suggested in the NAP5 report 13, 14, 15. When taking over care of a patient (including when returning after relief for a break), the incoming anaesthetist should conduct a check to ensure that all appropriate monitoring is in place with suitable alarm limits (see below).…”

Factors associated with patient‐reported procedural memory following emergency department procedural sedation with ketamine and propofol: A prospective cohort of 563 patients

“…This is arguably a more patient‐centred and clinically relevant outcome than recall but is prone to interviewer and recollection bias. We elected to use a scripted questionnaire as used for the assessment of accidental awareness in anaesthesia to help define and clarify the intended period of amnesia and improve differentiation of procedural memory from other perceptual disturbances, hallucinations and dreamlike states …”

“…In our study, a standardised script was used to assess memory . The questions were as follows: What was the last thing you remember before your procedure? What was the next thing you remember? Can you remember anything between those two periods? Did you experience pain between those periods? …”

Peri-operative management of the obese surgical patient 2015

“…However, due to the increased risk of AAGA in the obese, it is important that maintenance is commenced promptly after induction of anaesthesia 38. Fat‐insoluble volatile agents such as desflurane or sevoflurane have a faster onset and offset than isoflurane.…”