Patient with awareness

  1. What do you think of a patient who had a resting HR of 43, initial BP of 114/58 (athlete, no cardio probs) who was kept at about 120/60 and a HR of 65-83 for about 2 hours, and had intraoperative recall? The patient informed the surgeon of her low resting HR which caused alarms to go off during a previous procedure, but the surgeon never informed the anesthesiologist. Do you think it was a case of inadequate communication/care, or just bad luck?
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  2. Visit Mana_Tangata profile page

    About Mana_Tangata

    Joined: Feb '05; Posts: 24

    38 Comments

  3. by   jewelcutt
    The resting heart rate really had nothing to do with recall, the amount of exhaled anesthetic is how we monitor and prevent recall. An increased HR could mean multiple things (I was asked once to state the 17 or more reasons HR increases during anesthesia), but we most likely associate it to a patient having pain or being dry. And we always observe preop vital signs, so I'm sure the anesthesiologist was aware of the increased HR and didn't need to be informed of the baseline by anyone else. Anesthesia is very stressful physiologically to a patient and we try to maintain them pretty steady but it can be difficult to do.
  4. by   mwbeah
    Was midazolam (Versed) used preop?
  5. by   yoga crna
    There are a lot of reasons for recall, most of which are related to the anesthesia vaporizer being empty or not being turned on. The patient's heart rate may show a response to pain and is one of the many signs an anesthetist uses to regulate the depth of anesthesia.

    May I ask what your interest is in the scenerio? My gut feeling is that you are an attorney or work for one and are trying to gather information for a case. If so, this is probably not the best forum to get information. Here, we are interested in the practice of anesthesia and not looking to find fault of an isolated practitioner using limited facts.

    Maybe I am off base, if so I apologize. But, it is important that you don't try to make conclusions on limited information and for questionale motives.

    Yoga
  6. by   Mana_Tangata
    Quote from mwbeah
    Was midazolam (Versed) used preop?

    No Versed or other pre-op meds. She was on sevoflurane, dilaudid, N2O, rocuronium, pretty typical amounts. Her HR at intake was 66, but probably high due to nerves. It doesn't look like the anesthesiologist was aware of her low hemodynamics.
  7. by   Mana_Tangata
    Hi,

    I'm the patient, not an attorney. I'm trying to figure out why it happened to me. I didn't want to say that up front because I wanted honest opinions, which I though might be hard for people to give if they knew where I was coming from. I understand that this forum is just folks' individuals opinions.
    For those of us that have gone through it, it's really hard to get any answers. Everyone is so afraid of being sued.






    Quote from yoga crna
    There are a lot of reasons for recall, most of which are related to the anesthesia vaporizer being empty or not being turned on. The patient's heart rate may show a response to pain and is one of the many signs an anesthetist uses to regulate the depth of anesthesia.

    May I ask what your interest is in the scenerio? My gut feeling is that you are an attorney or work for one and are trying to gather information for a case. If so, this is probably not the best forum to get information. Here, we are interested in the practice of anesthesia and not looking to find fault of an isolated practitioner using limited facts.

    Maybe I am off base, if so I apologize. But, it is important that you don't try to make conclusions on limited information and for questionale motives.

    Yoga
  8. by   CRNAsoon
    Quote from Mana_Tangata
    Hi,

    I'm the patient, not an attorney. I'm trying to figure out why it happened to me. I didn't want to say that up front because I wanted honest opinions, which I though might be hard for people to give if they knew where I was coming from. I understand that this forum is just folks' individuals opinions.
    For those of us that have gone through it, it's really hard to get any answers. Everyone is so afraid of being sued.

    Mana_Tangata,

    I hope that you get the answers that you're searching for. Good Luck!

    CRNAsoon
  9. by   yoga crna
    Mana,
    I am sorry that you had recall and hope that you will receive the answers you are seeking.

    Recall is very rare in anesthesia, but it does receive a lot of press when it happens because it can be so horrific.

    Unfortunately, you will probably never know exactly what happened and trying to analyze the anesthetic record for the answers are going to be futile. For the future, I would be sure to tell the anesthetist of your prior experience and ask for special attention be given to it not happening again. I would give you an amnesic, such as midolazam, plenty of analgesics (depending on the type of surgery) and a lot of hand holding. I don't use a BIS monitor and agree with the majority of anesthesia providers around the world that it is not necessary to prevent or diagnosis recall. I hope you are not a shill for the Aspect Co. who market the device. I am very paranodid these days.

    By the way, the anesthesia technique that you listed seem to be appropriate. It is very difficult to judge another person's anesthesia technique, without more information or being there.

    Yoga
  10. by   gaspassah
    i have stated other peoples first hand opinions of bis since i had never worked with it. however i have started working with it recently and i think it's bunk.
    my rationale is, bp went up raise end tidal agent and the bis number went up. lowered the agent after the significant stimulation, bis go down. turn n2o off ad add air bis go down. seems i get the inverse ratio for some reason, and i didnt have it on backward either. i have worked with some quality crnas and monitoring vs and pupils still work. i think bis not being reliable could lead ppl to give too little anesthetic and cause awareness also.
    just my .02
    d
    Last edit by gaspassah on Feb 15, '05 : Reason: content
  11. by   Mana_Tangata
    Quote from yoga crna
    Mana,
    I am sorry that you had recall and hope that you will receive the answers you are seeking.

    Recall is very rare in anesthesia, but it does receive a lot of press when it happens because it can be so horrific.

    Unfortunately, you will probably never know exactly what happened and trying to analyze the anesthetic record for the answers are going to be futile. For the future, I would be sure to tell the anesthetist of your prior experience and ask for special attention be given to it not happening again. I would give you an amnesic, such as midolazam, plenty of analgesics (depending on the type of surgery) and a lot of hand holding. I don't use a BIS monitor and agree with the majority of anesthesia providers around the world that it is not necessary to prevent or diagnosis recall. I hope you are not a shill for the Aspect Co. who market the device. I am very paranodid these days.

    By the way, the anesthesia technique that you listed seem to be appropriate. It is very difficult to judge another person's anesthesia technique, without more information or being there.

    Yoga

    I am not an attorney or a shill for Aspect. I'm not sure that I want to get this discussion, but the first thing my anesthesiologist said regarding the incident was that a BIS monitor would not have helped me. While I've been doing research I've come across an amazing animosity towards Aspect, it seems like they have really pissed people off. As a patient, I have to say that I don't really care.

    I agree that I probably won't find answers in my anesthesia record. I have to say for all of you out there, though, that it matters. When I looked at mine and saw that my anesthesiologist had converted my weight from lbs to kgs wrong, transcribed my temperature at intake wrong, gotten the medications that I was currently on wrong, as well as the date/time wrong, it was pretty depressing. For all I know he gave me the best of care possible, maybe something he did saved my life, but when I see all the mistakes on my record it makes me feel like I was as important as a hamburger patty at McDonald's.
  12. by   gaspassah
    mana i do feel for you and your experience i hope you didnt take my post as offensive as it wasnt meant to be. it appears you may have hit the nail on the head without realizing it see below. wouldnt exude much confidence in my opinion.

    When I looked at mine and saw that my anesthesiologist had converted my weight from lbs to kgs wrong, transcribed my temperature at intake wrong, gotten the medications that I was currently on wrong, as well as the date/time wrong,
  13. by   DutchgirlRN
    I just saw a story on the news about this today. It seems that Centennial Medical Center here in Nashville is going to be the first one in the country to have some type of equipment that tells the anesthesia what's going on with the brain. What they said is that the patients brain wakes up but the body doesn't so you can't do anything, say anything or move anything. Sounded really scary to me, I'm sorry you had to go through that. They said it's usually caused by either too low of a dose of anesthetics or not the proper combination of them. I'll look for something in the paper about it.
    Last edit by DutchgirlRN on Feb 15, '05
  14. by   DutchgirlRN
    WHAT IS ANESTHESIA AWARENESS?


    Anesthesia Awareness, or intra-operative awareness, is perhaps the most helpless and terrifying feeling in the world. It occurs when one is supposed to be completely asleep under full general anesthesia, but the brain is not asleep. Usually your body is paralyzed; you have a tube down your throat; you can't speak or move to alert the doctors that you are awake. If you do manage to move, as I did, the usual response from the anesthesiologist is to simply administer another dose or doses of paralytic drug; not considering the possibility that the patient is awake.


    I'VE NEVER HEARD OF ANESTHESIA AWARENESS. WHY NOT?


    It's one of the best-kept secrets in anesthesia, and one of the least-known phenomena in the medical or legal fields in general, yet recent studies indicate awareness is reported 100 times per working day, and we know that under-reportage may be as much as a third. Pediatric cases may occur 4-6 times as often. Those figures work out to 20,000 - 40,000 times per year! The anesthesia community is in deep denial of the number of times intra-operative happens, denies patient reports of the problem, fails to make the occurrence known to the surgeon or other hospital caretakers, and grossly underestimates extent and the length of the after-effects of anesthesia awareness.


    WHAT CAUSES ANESTHESIA AWARENESS?


    In my opinion, the most prevalent cause of anesthesia awareness is lack of care and attention on the part of the anesthesiologist. In a 1999 syndicated radio interview the President of the American Society of Anesthesiologists admitted that "drugs are sometimes mislabeled or administered in the wrong order, and tanks do run dry."
    Patients seldom get to meet their anesthesiologist more than five minutes before surgery; they have no choice of doctors or any chance to check out credentials or even know whether the person administering anesthesia is an M.D. or nurse anesthetist; or whether he/she will be monitoring only your surgery, or several other surgeries at the same time. Patients are rarely told whether they will be paralyzed, or if and what type of monitors will be used to determine the level of consciousness of the patient.

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