From: David P. Dillard [mailto:jwne@astr...]
Sent: Monday, November 15, 2004 12:58 AM
To: Net-Gold; Temple Gold Discussion Group; Temple University Net-Gold
Archive; myarchives1@yaho...; MediaMentor Discussion Group
Subject: [Net-Gold] MEDICAL: ANESTHESIOLOGY : MEDICAL: PRACTICE: ISSUES:
Joint Commission on Accreditation of Healthcare Organizations.
Preventing, and Managing the Impact of, Anesthesia Awareness
MEDICAL: ANESTHESIOLOGY : MEDICAL: PRACTICE: ISSUES: Joint Commission on
Accreditation of Healthcare Organizations. Preventing, and Managing the
Impact of, Anesthesia Awareness
Anesthesia awareness, also called unintended intraoperative awareness,
occurs under general anesthesia when a patient becomes cognizant of some
or all events during surgery or a procedure, and has direct recall of
those events. Because of the routine use of neuromuscular blocking
(also called paralytics) during general anesthesia, the patient is often
unable to communicate with the surgical team if this occurs.
The frequency of anesthesia awareness has been found in multiple studies
to range between 0.1 percent and 0.2 percent of all patients undergoing
general anesthesia.(1,2,3) The administration of general anesthesia to
million patients annually in the United States translates to the
occurrence of 20,000 to 40,000 cases of anesthesia awareness each year.
Patients experiencing awareness report auditory recollections (48
percent), sensations of not being able to breathe (48 percent), and pain
(28 percent).(1) Over 50 percent of these patients are reported to
experience mental distress following surgery, including an indeterminate
number with post-traumatic stress syndrome.(2,3) Some patients describe
these occurrences as their "worst hospital experience," and some
to never again undergo surgery.
The incidence of awareness is reported to be greater in patients in
the dose of general anesthetic must be smaller and carefully titrated to
decrease significant side effects, for example, a patient who is
hemodynamically unstable. Procedures typically identified as falling
this category are some cardiac, obstetric and major trauma cases.(4)
Factors contributing to the risk of anesthesia awareness include the
increasing use of intravenous (IV) delivery of anesthesia, as opposed to
inhalation, and the premature lightening of anesthesia at the end of
procedures to facilitate OR turnover.
Monitoring patients under general anesthesia to prevent anesthesia
awareness can be challenging. Despite a variety of available monitoring
methods, awareness is difficult to recognize while it is occurring.
Typical indicators of physiologic and motor response, such as high blood
pressure, fast heart rate, or movement, or hemodynamic changes, are
masked by the use of paralytic agents to achieve necessary muscle
relaxation during the procedure, as well as the concurrent
of other drugs necessary to the patient's management, such as
beta-blockers or calcium channel blockers.
To overcome the limitations of current methods to detect anesthesia
awareness, new methods are being developed that are less affected by the
drugs typically used during general anesthesia. These devices measure
brain activity rather than physiological responses.
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