Unintended intraoperative awareness: An analysis of Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) (original) (raw)
Related papers
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.
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...
The Thai Anesthesia Incident Monitoring study (Thai AIMS): an analysis of 21 awareness events
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
This was a prospective descriptive multicenter study of anesthesia-related adverse incidents from 51 hospitals across Thailand from January to June 2007. Possible accidental EBI data were extracted and analyzed using descriptive statistics by 3 reviewers. Results: Thirty-two cases (1.6%) of EBI were reported from a total of 1,996 Thai AIMS incidents. EBI occurred more often in females (71.9%). Most of the incidents happened in the operating theater (93.8%) and the most common surgical specialties were general and gynecological surgery (20.6% each). Two cases had hypoxemia and 1 case required respiratory supported postoperatively. Most incidents (65.6%) were first recognized via monitoring equipment which was detected by pulse oximeter (71.4%) and airway pressure measurement (4.8%). Ninety six percent of cases were considered preventable. Anesthetic factors and system factors were found to involve in 62.5% and 11.8% of incidents respectively. The major contributing factors were inexperience of the performers (84.4%), lack of knowledge (40.6%), haste (21.9%) and communication failure (9.4%). The incident would be minimized by having prior experience of incident, high awareness and experienced assistants available. Three main strategies to prevent the incident included additional training, improvement supervision and established guideline practice. Conclusion: Accidental endobronchial intubation was reported as 1.6% of anesthetic adverse event in Thai AIMS. Majority of the incidents were contributed by anesthesia and system factors. High awareness, experience of performers and additional training would decrease the incidents and improve anesthetic outcome.
Research Square (Research Square), 2019
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 identi ed from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics. Results: The low number of identi ed cases suggests an under-reporting bias. Nonetheless, some important themes emerge from this small series that can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identi ed 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 employed, and the index value suggested an adequate depth of consciousness throughout the case. Conclusions: Provider-reported adverse event data in the immediate post-operative period is likely insensitive for detecting cases of intraoperative awareness. Themes identi ed in this series of cases of awareness under general anesthesia provide important reminders for anesthesia providers for maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.
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...
Risk Factor for Intraoperative Awareness
Brazilian Journal of Anesthesiology, 2012
Background and objectives: The intraoperative awareness is an adverse event in the general anesthesia, and may occur in approximately 20,000 cases per year, which justifies the study of the risk factors for this event. The objective of this study was to review this subject in order to reduce the incidence of intraoperative awareness and psychological sequelae incurring from this incident, which may result in post-traumatic stress disorder with negative repercussions on the surgical patient social, psychic and functional development. Content: It was conducted a review of the intraoperative awareness assessing its different phases during general anesthesia such as dreaming, wakefulness, explicit and implicit memory, as well as the analysis, consequences and prevention of its main related factors. Conclusions: The reduction of awareness incidence during anesthesia is related to the anesthesiologist improved scientific and technical performance, involving issues such as monitoring, comprehension of the anesthesia activity components, hypnotic and analgesic drugs, neuromuscular blocking agents, autonomic and motor reflex control, in addition to the risk factors involved in this event.
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.
International Journal of Medical Anesthesiology, 2021
Background: In order to assess and improve quality of patient care in perioperative period, knowledge of patient perspective is most important. A Prospective Clinical Audit was done on Quality of Anaesthesia and Accidental Awareness in patients undergoing elective surgery under General Anaesthesia. Aims a) The primary aim is to assess the quality of peri-operative anaesthesia care and patient satisfaction using a validated patient reported outcome measure. b) To establish an estimate of accidental awareness during general anaesthesia. Settings and Designs: This was a cross-sectional, prospective audit on elective post-operative patients who underwent surgery under routine balanced general anaesthesia at a tertiary health care centre. Total 94 post-operative cases, who underwent surgery within last three months, were included in the audit. Material and Methods: Audit protocol was presented to competent Institutional Ethics committee and approval taken. The patients included in the audit had received routine balanced general anaesthesia for their surgery along with prophylactic analgesic, antiemetic and antacid intra-operatively. Anaesthetists randomly visited to the patients 24 hours after surgery and distributed structured questionnaires to the participants. Basic demographic information was collected from medical record and patients. We used Bauer Patient Satisfaction Questionnaires to obtain data regarding anaesthesia related discomfort and Modified Brice Questionnaire was used to assess Accidental Awareness during Anaesthesia. Statistical Analysis: SPSS software for Windows version 21.0 was used for data analysis. Categorical data was presented as frequency and proportion whereas continuous data was presented as mean and Standard Deviation. Results: Mean age of study subjects was-51.81(16.82). Most of the cases belonged to ASA Grade III&IV (82.9%). When evaluating the questions on anaesthesia-related discomfort, the most frequent complaint of "pain at the surgical site" (54.26%), irritation in throat/sore throat in (39.36%), thirst (36.17%) and (23.40%) patients were drowsy after recovery from anaesthesia. Overall satisfaction rate was 100%, with care provided by Anaesthesia Department. However, 8.51% and 3.19% patients were not satisfied with pain therapy after surgery and information provided by the anaesthetist respectively. More than half (57.45%) could recall the voices they heard was the first thing to happen after waking up from anaesthesia and 9 (9.57%) could feel endotracheal tube in their throat during recovery from anaesthesia. We found one (1.06%) incidence of intraoperative AAA (Accidental Awareness during Anaesthesia). Conclusion: Only one fourth patients were drowsy immediate after surgery and (9.57%) could feel endotracheal tube in their throat during recovery from anaesthesia. High risk group (ASA III and IV) were at higher risk (1.06% in our audit) for Accidental Awareness during Anaesthesia.
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.
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...