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| |  JCAHO: 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 agents (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 21 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 determine to never again undergo surgery.
The incidence of awareness is reported to be greater in patients in which 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 into 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.
More Information: http://www.jcaho.org/about+us/news+l...ert/sea_32.htm
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