NAP5 2014: Awareness under General Anaesthesia

 

Background:

·         It’s a psychological disaster

·         It means failure. Patients only demand:

1.       I don’t want to die

2.       I don’t want to be maimed

3.       I don’t want to feel anything

 

Risk factors:

Patient

·      Young

·      Female

·      Obese

·      PHx awareness

Surgery

·      GA LUSCS 1 in 670

·      Cardiothoracic 1 in 8600

Anaesthesia

·      Anaesthetic type

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

o  TIVA 2x

·      Problems at induction

o  Difficult airway

o  Hypotension

·      Trainee

Circumstances

·      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 stop it too early)

·         Transfer

 

Don’t (my notes)

·         Paralyse unnecessarily

·         Fail to reverse paralysis before turning gas off

·         Turn the gas on too late (or not re-dose propofol if difficult airway)

·         Turn gas off too early

·         Not take TIVA seriously (use proper giving set / line of sight / TCI / EEG)

·         Trust processed EEG alone

·         Mix up your drugs (e.g. cefazolin and thiopentone)

 

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