Anesthesia Awareness???

[howsoonisnow]

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anesthesia awareness?

[dyosa]

Strategies to Prevent and Manage Anesthesia Awareness
Under general anesthesia, a patient is given medications that are expected to relieve the pain of surgery and prevent consciousness. If either of these fails, the patient may awaken and be aware of the procedure.

Although the incidence of anesthesia awareness is relatively low, at about 0.1% to 0.2%, that percentage translates to 20,000 to 40,000 incidences a year in the United States.1 For the patient, awareness is frightening and can lead to debilitating emotional injury.

For anesthesiologists, it ranks second only to death as a dreaded complication. Health care organizations that perform procedures requiring general anesthesia can help prevent and manage anesthesia awareness. Below are five key strategies to consider when developing, implementing, and improving an anesthesia awareness policy.

1. Educate clinical staff about anesthesia awareness. The anesthesia professional must balance the psychological risks of awareness against the physiological risks of excessive anesthesia for many critical medical conditions. Inform staff about common causes of or factors contributing to the risk for anesthetic awareness, including the following:
* Excessive use of neuromuscular blockers
* Equipment failure or misuse
* Inadequate anesthesia
* Increasing use of intravenous (IV) delivery of anesthesia versus inhalation
* Premature lightening of anesthesia at the end of the procedure to facilitate operating room turnover
* High American Society of Anesthesiologists (ASA) physical status values (III–IV)
2. Identify patients at increased risk for an awareness experience. Certain types of surgery may be prone to awareness issues, including trauma, cardiac, abdominal, thoracic, ophthalmologic, and obstetric procedures. The incidence of awareness also tends to be increased when the dose of general anesthetic must be decreased and carefully titrated to decrease significant side effects. Sicker patients undergoing major surgery may be more prone to increased risk of awareness.2 Discuss with such patients, before surgery, the potential for anesthesia awareness.
3. Proactively reduce risk of anesthesia awareness. Awareness episodes often occur at times of high patient stimulation, such as intubation or incision. Stay informed about the research and data that discuss causes and ways to prevent awareness during surgery. Strategies to reduce awareness include the following:
* Consider premedication with amnesic drugs (for example, benzodiazepines, scopolamine), particularly for light anesthesia
* Administer more than a “sleep dose” of induction agents if they will be followed immediately by tracheal intubation
* Avoid muscle paralysis unless absolutely necessary and use only the amount clinically required if necessary
* Conduct periodic maintenance of the anesthesia machine and its vaporizers, and meticulously check the machine and its ventilator before administering anesthesia
4. Apply available anesthesia monitoring techniques effectively. Monitoring to prevent anesthesia awareness can be challenging. Traditional clinical monitoring (such as blood pressure and heart rate) cannot identify or prevent awareness instances.2 Be alert to patients on betablockers, calcium channel blockers, and other drugs that can maskphysiologic responses to inadequate anesthesia. New technologies have the potential to significantly reduce the likelihood of awareness. For example, the Bispectral Index® (BIS) uses a processed electroencephalogram derivative to monitor anesthetic effects on the brain.
5. Identify, manage, and—if appropriate—refer patients who have experienced awareness. Provide appropriate postoperative follow-up of all patients who have undergone general anesthesia, including children. Acknowledge and manage the occurrence of anesthesia awareness with compassion and diligence.

Auditory perceptions and being unable to move or breathe are the most commonly described sensations. Patients also report feeling (1) anxiety or stress, pain, (2) the endotracheal tube, and (3) surgery without pain. Implicit recall emerges indirectly through painful, often inexplicable, psychological difficulties that appear following surgery, including sleep disturbances, dreams and nightmares, flashbacks, and anxiety. Explicit recall is responsible for the most traumatic and horrific incidents of anesthetic awareness and may, in rare cases, lead to post-traumatic stress disorder.

When patients report anesthesia awareness, management can carry out the following steps:

* Apologize to the patient
* Record a detailed account of the patient’s experience in the chart
* Assure the patient of the credibility of his or her account and sympathize with the patient’s suffering
* Explain what happened and its reasons (for example, the necessity to administer light anesthesia in the presence of significant cardiovascular instability)
* Offer necessary counseling or support, including referral to a psychiatrist or psychologist
* Notify the patient’s surgeon, nurse, and other key personnel about the incident

[krstnal]

we have always been taught in school about the possibility of awareness during the surgery...i can only imagine what the patient felt when under anesthesia...but sometimes doctors and nurses also need to communicate during the surgery so hopefully out of respect they can do that quietly...