The Thai Anesthesia Incident Monitoring study (Thai AIMS): an analysis of 21 awareness events (original) (raw)
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Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2007
The authors determined predictors of intra-operative recall of awareness in the Thai Anesthesia Incidents Study (THAI Study). To study a multi-centered registry of anesthesia in 20 hospitals across Thailand. Structured data collection forms of patients who underwent general anesthesia and experienced intra-operative recall of awareness between March 1, 2003 and February 28, 2004, were reviewed by three independent anesthesiologists. One case of awareness was matched to four controls by age, gender, and level of hospitals. Univariate analysis (p < 0.1) and logistic regression (p < 0.05) identified characteristics associated with intra-operative recall of awareness. Eighty-one cases were matched with 324 controls in the nested case control study. From univariate analysis, risk factors were cardiac surgery, cesarean delivery, upper abdominal surgery, i.v. anesthetics, depolarizing muscle relaxant, non-depolarizing muscle relaxant, and nitrous oxide (p < 0.1). The predictors fr...
An Analysis of Intraoperative Recall of Awareness in Thai Anesthesia Incidents Study (THAI Study
2005
Objectives : This study aimed to analyze intraoperative awareness using database of Thai Anesthesia Incidents Study (THAI Study) with regard to frequency, contributing factors, preventive and corrective strategies. Material and Method : Details of intraoperative recall of awareness were recorded prospectively by attending anesthesiologists or nurse anesthetists in standardized record forms during February 1,2003 to July 31, 2004. Participating hospitals included 7 university hospitals, 5 tertiary care hospitals, 4 secondary care hospitals, and 4 primary care hospitals. All data were analyzed to identify contributing factors, preventive and corrective strategies. Results : Among 126078 general anesthetized cases, there were 99 cases of intraoperative recall of awareness. Awareness was found in female patients more than male patients (63% versus 37%). The majority of patients had ASA PS 1 and 2. Cardiac, obstetric, and lower abdominal surgery were involved in anesthesia awareness more than other type of surgery. Patients experiencing awareness reported sound (62%), pain (51%), feeling operated without pain (33%), and paralysis (25%). There was slight impact of anesthesia awareness in Thai patients (only 13% had temporary emotional stress and 13% had mild anxiety) despite small percentage of proper management by reassurance and psychiatric consultation (15%). The contributing factors included inadequate knowledge (67%), inadequate medication dosage (44%), and inadequate care from inexperience (11%). Awareness incidents were documented to be preventable in 36% of patients and partially preventable in 38 % of patients. The corrective strategies included guideline practice (30%), additional training (28%), quality assurance activity (19%), and improved supervision (16%). Conclusion : The incidence of intraoperative recall of awareness in this study was 0.08%. Patients reported sound, pain, feeling operated without pain, and paralysis. Corrective strategies included guideline practice, additional training, quality assurance activity, and improved supervision.
International Journal of Risk & Safety in Medicine, 2021
BACKGROUND: Despite the improvement of anesthetic-related modalities, the incidence of unintended intraoperative awareness remains at around 0.005–0.038%. OBJECTIVE: We aimed to describe the intraoperative awareness incidents that occurred across Thailand between January to December, 2015. METHODS: Observational data was collected from 22 hospitals throughout Thailand. The awareness category was selected from incident reports according to the Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study database and descriptive statistics were analyzed. The awareness characteristics and the related factors were recorded. RESULTS: A total of nine intraoperative awareness episodes from 2000 incidents were observed. The intraoperative awareness results were as follows: experience of pain (38.1%), perception of sound (33.3%), perception of intubation (9.5%) and feeling of paralysis (14.3%). The observed factors that affect intraoperative awareness were anesthesia-related (100%),...
Anesthesiology Research and Practice
Introduction. Awareness with recall of intraoperative events is an infrequent but potentially devastating complication of general anesthesia, with a reported incidence of 0.1-0.2% in low-risk patients. Higher incidence is expected in resource-limited operation room setups and in high-risk patients. Awareness can result in significant distress to patients and long-term psychological consequences, including symptoms associated with posttraumatic stress disorder, anxiety, night mares, night terror, dissatisfaction with surgical service, and sometimes even suicide. Objective. To assess the magnitude and associated factors of awareness with recall under general anesthesia in Amhara regional state referral hospitals. Method. An institution-based cross-sectional study was conducted on 1065 patients who underwent surgery under general anesthesia from January 1 to June 30, 2018. The study participants were selected by systematic random sampling from 4 referral hospitals. The modified Brice q...
British Journal of Anaesthesia, 2015
Background: Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. Methods: English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses. Results: Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%). Conclusions: Data from this registry confirm the serious impact of anaesthesia awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.
Incidence of awareness in patients undergoing elective surgeries during general anesthesia
2022
Introduction: General Anesthesia (GA) is reversible loss of consciousness. Awareness occurs when there is an explicit recall of intraoperative events with or without pain. It can cause distress, anxiety, chronic fear, depression, post-traumatic stress disorder, etc. There is an increasing concern over claims regarding awareness during anesthesia. Materials and Methods: The study was done on 188 patients. GA was administered as needed using Total Intra Venous Anaesthesia (TIVA), Mask, Supra glottic device, or Endo Tracheal Tube (ETT). Patients were encouraged to report any awareness in any form during the entire procedure voluntarily and were also directly questioned through a structured questionnaire in the recovery room, one hour and 24 hours after surgery. Results: Eighty-four females and 104 males with a mean age of 39.9 years constituted the study. In all, 89.3% of subjects underwent general anesthesia with ETT, 7.4% with a supraglottic device, and 2.1% and 1% with mask and TIVA, respectively. Patients recalled events just before induction (holding an oxygen mask-49%, receiving a painful injection-21%) and soon after emergence (shifting to a trolley-26.3%, holding an oxygen mask-17.2%) but did not complain of intraoperative awareness. No incidence of awareness was reported by any patient or at direct questioning. Conclusion: There was no incidence of awareness in any patient in our study.
Prevalence of Anesthesia Awareness during Surgery
2017
Awareness during surgery is an intense issue for the anesthetist and the patient also. Such episodes are the reason for two percent of the legitimate cases against anesthetists while patients with intraoperative awareness encounter depict it as the most painful thing they have ever experienced. Pain, anxiety and failure to respond because of muscle loss of motion frequently prompt the circumstance called posttraumatic stress disorder which requests psychiatric help. The way that there are patients who report intraoperative experience, even a few days after surgery, brings up issues about the way the anesthetic medications meddle with the systems of memory and consciousness. Although, in list of sources, there are ponders demonstrating that even profoundly anesthetized patients can be impacted by auditory stimuli without being able to review them. Intraoperative checking of the anesthesia profundity is imperative for the avoidance of this issue. From all the accessible gadgets just t...
BMC Anesthesiology
Background Awareness with recall under general anesthesia remains a rare but important issue that warrants further study. Methods We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics. Results The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was emp...
Research Square (Research Square), 2022
Background Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there is a wide variation in the incidence intraoperative awareness and in the practices and attitudes of depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists' practice and attitudes toward DoA monitoring and their estimation of the incidence of intraoperative awareness. Methods A descriptive cross-sectional survey of the Jordanian anesthesiologists working in public, private, and university hospitals was utilized using questionnaire developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Con dence Intervals (95%CI) were reported and compared between groups using chi-square tests. Results A total of 107 physicians participated and completed the survey. About one-third of the participant (34.6%; 95% CI 26.1-44.2) had never used a DoA monitor and only 6.5% (96% CI) reported using it as a "daily practice". The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5-83.5) believed that currently available DoA monitors are effective for DoA monitoring, and only 4.7% (95%CI 1.9-10.8) reported it as being "invalid". Most participants reported that the main purpose of using the DoA monitor was to prevent awareness (86.0%; 95%CI 77.9-91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9-72.2), and reduce recovery time (57%; 95%CI 47.4-66.1). The event rate of intraoperative awareness was estimated at 0.4% among participated anesthesiologists. Most of participants' hospitals lacked policy intended to prevent intraoperative awareness. Conclusions Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.
Awareness of Patients Regarding Anesthesia
The Professional Medical Journal, 2018
Awareness of patients regarding anesthesia & their attitude towards basic types of anesthesia techniques. Objective: The purpose of this study was to assess the knowledge of patients regarding anesthesia, their attitudes towards basic types of anesthesia techniques and effect of previous experience of anesthesia on the awareness. Study design: Descriptive observational study. Place and duration of study: This descriptive, prospective study was conducted in the isra university hospital Hyderabad, Sindh, Pakistan from 2nd August 2013 upto 8th March 2014. Patients and Methods: Two hundred thirty one patients were included in the study after taking verbal informed consent. All patients who were scheduled for elective surgery were interviewed while patients who had refused from participation, have language barrier, psychiatric disease, had lack of sufficient mental capacity due to poor health status and patients undergoing emergency surgeries were excluded from the study. Patients were interviewed in their local language upon arrival in the preoperative area of operation theatre. Self made questionnaire was filled. All the data was entered on SPSS version 16. Frequency and percentages were calculated to show the results. Mean with SD of patients age was computed. Chi-square test was applied to assess the affect of previous experience of surgery on patient's knowledge regarding anesthesia. P value less than 0.05 was taken as significant. Results: Total 231 patients were included in the study. Mean age of the patients was 36 ± SD 1.01. Fifty one (22.1%) patients were illiterate; while 54 (23.4%) patients were graduate. 103(44.6%) patients had previous experience of surgery/ anesthesia while 128(55.4%) patients had no experience. Out of 231 patients, 111 (48.1%) patients were aware of different type of anesthesia techniques while 120(51.9%) patients were not aware. Out of 103 patients, who had previous exposure of anesthesia, 64 patients answered correctly about different types of anesthesia techniques while 81 patients who had no previous exposure of anesthesia, answered incorrectly (P value = 0.000). Fifty three patients who had previous exposure of anesthesia answered correctly that anesthetist is a qualified doctor, while 62 patients answered incorrectly who had no previous exposure (P value=0.546). Out of 231 patients, 91 (39.39%) patients were in favor of having general anesthesia while 52(22.51%) patients were in favor of regional anesthesia, while 88(38.0%) had left the choice on surgeon. Conclusions: Results of the study show poor knowledge of patients regarding anesthesia and anesthesiologists. Majority of the patients were in favor of having general anesthesia rather regional anesthesia. There is need to correct the misconceptions of patients and to educate the public.