NAP5 2014: Awareness under General Anaesthesia

 

All comers: 1 in 20k

 

Risk factors:

Patient

·      Young adult

·      Female

·      Obese

·      PHx awareness

Surgery

·      GA LUSCS (1 in 670)

·      Cardiac (1 in 8600)

·      Thoracic

·      Neuro

Anaesthesia

Drugs:

·      Paralysis 16x (1 in 8k with, 1 in 135k without!)

·      TIVA (2x)

·      RSI

·      Thiopentone

Induction problems:

·      Difficult airway

·      Hypotension

·      Transfer from anaesthetic room into theatre

Circumstances

·      No consultant

·      Emergency

·      Out of hours

·      Busy

 

When does it occur?

Induction

50%

·      Esp. forget to turn on gas

Maintenance

30%

·      Esp. switch to TIVA

Emergence

20%

·      Esp. turn off gas too early

TIVA

 

·      Esp. switch to TIVA

·      Esp. non-TCI

·      Esp. failure to deliver drug (disconnection, IV tissuing)

·      Esp. during transport

 

Don’t (my notes)

·        Paralyse unnecessarily

·        Turn the gas on too late

·        Turn the as off to early

·        Neglect to re-dose propofol if difficult airway

·        Be blasé about TIVA (i.e. proper giving set / line of sight / TCI / EEG)

·        Trust processed EEG alone

·        Leave drugs unlabelled (especially relaxants, also cefazolin vs thiopentone)

 

 

Feedback welcome at ketaminenightmares@gmail.com