The incidence of intra‐operative awareness in the <scp>UK</scp>: under the rate or under the radar?

Avidan, Michael S.; Mashour, George A.

doi:10.1111/anae.12215

Cited by 29 publications

(15 citation statements)

References 30 publications

(67 reference statements)

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“…A similar survey conducted in Ireland, using as denominator an estimate of anaesthetic activity that was conducted in parallel [18], reported a similarly low incidence (1:23 000) [19]. These surveys suffer from potential limitations, including failure of patients to report the event, memory of the anaesthetist for the incident, bias, and also possible systems failures reventing the anaesthetist's being made aware of the report [20].…”

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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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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“…The accuracy of our method in detecting all cases of AAGA relies upon the ability of the healthcare system to transmit the report to anaesthetists: as Avidan and Mashour previously commented, we may be 'under the rate, or under the radar' [40]. The fact that most reports were made to anaesthetists does not exclude the possibility that reports were made to others, but not transmitted to anaesthetists, and therefore not detected by local co-ordinators.…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2014

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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

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“…In the NAP5 report, 14 cases of awareness in obstetric anaesthesia were reported -approximately 10% of reports -while obstetric general anaesthetics represented only 0.8% of the total general anaesthetics given (though the validity of both numerator and denominator in determining an incidence of awareness is questionable, as pointed out previously [7,8]). This apparent over-representation of obstetrics reflects what is already known about obstetric general anaesthesia: that it is a high-risk area for anaesthetic awareness [9,10].…”

Section: Awareness and Obstetric Anaesthesia: A Perfect Stormmentioning

confidence: 99%

Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports

Lucas

Yentis

2015

Anaesthesia

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The incidence of intra‐operative awareness in the UK: under the rate or under the radar?

Cited by 29 publications

References 30 publications

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

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

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

Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports

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