What is anaesthetic awareness, what causes it and how does it affect patients?
By Naomi Todd
The Fifth National Audit Project known as the “NAP5 Report” (Accidental Awareness during General Anaesthesia in the United Kingdom) was launched on 10th September 2014 at the Royal Society for Medicine, by the Royal College of Anaesthetists (RCoA), in collaboration with the Association of Anaesthetists of Great Britain and Ireland.
The NAP5 project reported that as many as three patients each week report consciousness during an operation because they are not given sufficient anaesthetic. In the largest study of its kind, scientists suggests that around one patient in every 19,000 spontaneously experience ‘accidental awareness’ after not being given enough general anesthetic.
Anaesthetic awareness occurs when general anaesthesia is intended but the patient remains conscious.
A new report from the RCoA and the Association of Anaesthetists of Great Britain and Ireland, found that some surgeries, such as cardiothoracic operations and caesarean sections, carry a higher risk than others, and people who have been given muscle relaxants are also more likely to suffer this complication.
Professor Jaideep Pandit, Consultant Anaesthetist in Oxford and Project Leader, reporting for ‘Anaesthesia UK’ on 10 September 2014 explained:
“…We found that patients are at higher risk of experiencing awareness during caesarean section and cardiothoracic surgery, if they are obese or when there is difficulty managing the airway at the start of anaesthesia. The use of some emergency drugs heightens risk, as does the use of certain anaesthetic techniques. However, the most compelling risk factor is the use of muscle relaxants, which prevent the patient moving. Significantly, the study data also suggest that although brain monitors designed to reduce the risk of awareness have a role with certain types of anaesthetic, the study provides little support for their widespread use.”
Studies also showed that the majority of failures are said to occur before surgery starts or after it finishes.
According to the recent studies, the majority of episodes of awareness are short-lived, and do not always cause concern. However, 51% of episodes led to distress and 41% to longer-term psychological harm. Patients described feelings of dissociation, panic, extreme fear, suffocation and even dying. Longer-term psychological harm often included features of post-traumatic stress disorder.
It is clear that more needs to be done to prevent anaesthetic awareness to avoid patients suffering what can be long lasting psychological harm.
Professor Tim Cook, Consultant Anaesthetist in Bath and co-author of the NAP5 Report commented in BBC News Health on 10 September 2014:
“…The project dramatically increases our understanding of anaesthetic awareness and highlights the range and complexity of patient experiences. NAP5, as the biggest ever study of this complication, has been able to define the nature of the problem and those factors that contribute to it more clearly than ever before. As well as adding to the understanding of the condition, we have also recommended changes in practice to minimise the incidence of awareness and, when it occurs, to ensure that it is recognised and managed in such a way as to mitigate longer-term effects on patients…I hope this report will ensure anaesthetists pay even greater attention to preventing episodes of awareness.”
The project report includes clear recommendations for changes in clinical practice, including the introduction of a simple anaesthesia checklist to be performed at the start of every operation, and the introduction of an Awareness Support Pathway, which is a structured approach to the management of patients reporting awareness.
We are experienced in handling anaesthetic awareness cases where this has occurred as a result of negligence, for example if the anaesthetist has not correctly calculated the correct amount of anaesthetic required or failed to note a problem with equipment. We understand that anaesthetic awareness can be extremely traumatic and our clients can suffer serious psychological injuries which need to be fully investigated. We recognise the importance of ensuring our clients are adequately compensated for the suffering they have endured.
I was really pleased to read about the research that has been carried out and the recommendations that more steps need to be taken to reduce the incidence of anaesthetic awareness.
If you have suffered anaesthetic awareness, please contact a member of our clinical negligence team for further advice.