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Topic: Intraoperative awareness

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	Anesthesia awareness - Wikipedia, the free encyclopedia
		Anesthesia awareness, or "intra-operative awareness" occurs during general anesthesia, when a patient is paralyzed with muscle relaxants but not enough general anesthetic or analgesic to prevent consciousness or, more importantly, the sensation of pain and the recall of events.
		The prevalence of anesthesia awareness ranges from 0.1% to 0.2 %, or up to 4000 cases per year.
		Inadequate education about the full impact of awareness leads to an inadequate response by anesthesiologists and delayed treatment for victims.
	en.wikipedia.org /wiki/Intraoperative_awareness (342 words)

	ASA June 1996 Newsletter
		The true incidence of intraoperative awareness and recall is poorly documented but varies according to the type and depth of the anesthetic technique.
		The patient profile for malpractice claims for intraoperative awareness and whether the rate of claims is changing are unknown.
		Awareness claims resulted in a lower payment than other anesthesia malpractice claims, with a median payment of $18,000 for recall during general anesthesia, compared to a median payment of $100,000 for nonawareness claims [see Table 1].
	www.asahq.org /Newsletters/1996/06_96/feature3.htm (1195 words)

	allnurses.com Nursing for Nurses - View Single Post - JCAHO: Preventing, and managing the impact of, anesthesia ...
		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.
		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.
		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.
	allnurses.com /forums/showpost.php?s=006ab8ee323fc585f7a6e8cc9a7584b2&p=921642&postcount=1 (303 words)

	The Worldwide Anaesthetist : Journal club 26 January 2000
		The degree of awareness may be gauged by the presence of explicit (conscious, deliberate recollection of events) or implicit (where conscious recognition is not required) memory of intraoperative events.
		The largest of 6 studies on awareness during cardiac surgery, is by Phillips et al, and involves 700 patients who all received benzodiazepines, low dose fentanyl and a volatile anaesthetic agent intraoperatively.
		Light anaesthesia may be planned for sick patients, and informing such a patient of the possibilty of awareness might increase the level of anxiety and predispose the patient to the risk of developing myocardial ischaemia.
	www.anaesthetist.com /anaes/jnl/2000/tempe.htm (1365 words)

	Ontario Ministry of Health and Long-Term Care - Health Care Professionals - Medical Advisory Secretariat - OHTAC - ... (Site not responding. Last check: 2007-10-15)
		The aim of general anesthesia is to produce hypnosis (lack of awareness and recall), analgesia (lack of response to noxious stimuli, or pain relief), and areflexia (lack of movement, or a quiet surgical field).
		Because awareness during general anesthesia and recall of intraoperative events happens rarely, the small RCTs were not adequately powered to show the impact of consciousness monitors on awareness in anesthetized patients.
		In both of the large studies that demonstrated a lower incidence of intraoperative awareness (i.e., the Bi-Aware RCT and European prospective study), the anesthesia was deep during maintenance (a mean BIS score of 44.5 [SD, 6.8] in the Bi-Aware trial, and a mean BIS score of 38 [SD, 8] in the European study).
	www.health.gov.on.ca /english/providers/program/mas/reviews/review_bis_0604.html (2125 words)

	Risks of Anesthesia Page 4
		Intraoperative awareness ("waking up" during surgery) has received a lot of media attention in the last few years.
		The ASA defines intraoperative awareness as "when surgical patients dream during surgery, have some awareness of their surroundings or may recall an event" (ASA, 2004).
		However, anesthesiology researchers say the value of brain-wave monitoring to prevent intraoperative awareness is uncertain, as there are reported cases of awareness despite BIS monitoring, thus the monitor appears to be less than 100% effective (O'Connor, Daves, Tung, Cook, Thisted, and Apfelbaum, 2001).
	www.corexcel.com /courses3/html/body_anesthesia_page4.htm (2040 words)

	Intraoperative awareness due to malfunction of a Siemens 900B ventilator -- Slinger et al. 37 (2): 258 -- Canadian ...
		Intraoperative awareness due to malfunction of a Siemens 900B ventilator -- Slinger et al.
		Intraoperative awareness due to malfunction of a Siemens 900B ventilator
		A case of intraoperative awareness during a thoracotomy is described.
	www.cja-jca.org /cgi/content/abstract/37/2/258 (155 words)

	1rc3
		In clinical practice, anaesthetists may not be familiar with techniques for detection of conscious awareness with recall in patients, in the postoperative period.
		The incidence of conscious awareness is approximately 20% for obstetrical, major trauma and cardiac surgery[6].
		Other forms of memory for intraoperative events can be difficult to detect in patients, but could be responsible for a modification of their behaviour.
	www.euroanesthesia.org /education/rc_nice/1rc3.html (1560 words)

	Infection Control Today - Study Documents U.S. Incidence of Intraoperative Awareness
		The study, known as the AIM trial, evaluated 19,576 patients and documented that awareness with recall occurs in the U.S. at a rate between one to two cases per 1,000 patients receiving general anesthesia.
		Results also documented an additional 46 reports of possible awareness where investigators were not able to obtain sufficient data to confirm awareness, and 1,182 (6 percent) reports of intraoperative dreaming.
		As part of this commitment, awareness experts from around the world have collaborated to define the scope of the problem of awareness and to determine the impact of additional monitoring on patient outcomes," said Paul Manberg, PhD, vice president of clinical, regulatory and quality assurance for Aspect.
	www.infectioncontroltoday.com /hotnews/48h30112134.html (844 words)

	MEDNEMO.it presenta ANESTESIA.tk - Sito Italiano di Anestesia - Dott. L. Vicari
		Among outpatients, there were five cases of awareness and recall (one with clear intraoperative recollections and four with doubtful intraoperative recollections).
		The incidence of clear intraoperative recollections was 0.07% in outpatients and 0.13% in inpatients.
		In conclusion, awareness and recall are rare complications of general anesthesia, and outpatients are not at increased risk for this event compared with inpatients undergoing general anesthesia.
	www.mednemo.it /abstracts/anestesia/2002/luglio/020702ane.htm (5628 words)

	January/February 2000 - Point-Counterpoint: BIS Monitor
		There simply have not been enough studies comparing the incidences of awareness in patients who received general anesthesia and were monitored by BIS devices vs. awareness episodes in patients who were given the same type of anesthesia and not monitored by BIS.
		If a doctor were sued by a patient alleging intraoperative awareness in a case where a BIS monitor was used, I wonder if Aspect (the company that manufactures BIS monitors) would be willing to defend the device in court alongside the anesthesiologist.
		I also believe that intraoperative awareness is so uncommon that using BIS monitors for every case is simply not cost effective.
	www.outpatientsurgery.net /2000/os01/os01f5.html (1608 words)

	awareness - General Practice Notebook (Site not responding. Last check: 2007-10-15)
		Awareness in the context of anaesthesia is the state of the patient being alert and receptive to sensory information under general anaesthesia.
		The indices of depth of anaesthesia may be poorly calibrated with respect to awareness, e.g.
		Attempts at detecting awareness have entailed the use of EEG processing, evoked auditory stimuli and monitoring ECG R-R intervals.
	www.gpnotebook.co.uk /cache/1832189997.htm (200 words)

	Questmark Partners
		The first study, known as the AIM trial, studied 19,576 patients and documented that awareness with recall occurs in the U.S. at a rate between 1 to 2 cases per 1,000 patients receiving general anesthesia.
		Studies show that awareness can be traumatic for patients and result in the development of psychological problems, including Post Traumatic Stress Disorder, severe anxiety, nightmares, flashbacks, and avoidance of medical personnel.
		Commenting on the awareness research, Nassib Chamoun, president and CEO of Aspect stated, "For years, clinicians have asked for clinical research that documents the incidence of awareness and the impact of BIS technology on this problem.
	www.questmarkpartners.com /aspect10_03.htm (1112 words)

	Wake-Up Call (washingtonpost.com)
		Williams, who said he drifted in and out of consciousness during the three-hour operation, is a victim of an uncommon, largely unrecognized and often psychologically devastating experience known as anesthesia awareness, or intraoperative awareness.
		JCAHO's action was prompted in part by a trio of studies published earlier this year about the frequency of intraoperative awareness -- which is estimated to affect one or two of every 1,000 patients receiving general anesthesia -- and the ability of newer brain wave monitoring devices to detect it.
		Anesthesiologists in particular have been loath to talk to patients about intraoperative awareness, which one recent study characterized as "second only to death as a 'dreaded' complication" among anesthesiologists.
	www.washingtonpost.com /ac2/wp-dyn/A4207-2004Nov22 (2777 words)

	Closed Claims: Awareness during anesthesia
		We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia.
		All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care.
		Results: Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, i.e., recall of events while receiving general anesthesia.
	depts.washington.edu /asaccp/ASA/Abstracts/Anesth90_1053_1061.shtml (328 words)

	Muscle relaxants, balanced anaesthesia and awareness (Site not responding. Last check: 2007-10-15)
		he incidence of awareness during insufficient anaesthesia is reported to be one per cent.
		Experiences of awareness are disturbing to patients, who are usually benefited by a sympathetic and forthright explanation of the event.
		Since no adequate sign or test exists for detection of awareness during very light anaesthesia or with associated paralysis, more meticulous attention is required in using relaxants or the balanced technique.
	www.general-anaesthesia.com /awareness-musrelax.html (138 words)

	SSM Online - News
		The first study, known as the AIM trial, examined 19,576 patients and documented that awareness with recall occurs in the United States at a rate between one and two procedures per 1,000 patients receiving general anesthesia.
		Studies show that awareness can be traumatic for patients and result in the development of psychological problems, including posttraumatic stress disorder, severe anxiety, nightmares, flashbacks, and avoidance of medical personnel.
		In this study, routine use of BIS monitoring reduced the incidence of awareness with recall by 78%.
	www.ssmonline.org /News/ViewRelease.asp?ReleaseID=3904 (471 words)

	Anesthesia awareness definition - Medical Dictionary definitions of popular medical terms
		Anesthesia awareness: The situation that occurs when a patient under general anesthesia becomes aware of some or all events during surgery or a procedure, and has direct recall of those events.
		Factors contributing to the risk of anesthesia awareness include the increasing use of intravenous (IV) delivery of anesthesia, as opposed to inhalation anesthesia, and the premature lightening of anesthesia at the end of procedures to facilitate turnover of the operating room.
		To overcome the limitations of current methods to detect anesthesia awareness, new methods are being developed that are less affected by the drugs typically used during general anesthesia.
	www.medterms.com /script/main/art.asp?articlekey=40143 (670 words)

	AORN Journal: Monitoring for Intraoperative Awareness
		Bispectral analysis (BIS) is emerging as the most promising prevention of intraoperative awareness and monitor of the hypnotic state.
		The reported incidence of patient awareness during anesthesia depends on the type of anesthesia, strength of the stimulus, and the timing and persistence of attempts to elicit recall.
		Awareness during a surgical procedure can lead to a number of immediate or delayed psychological problems.
	www.findarticles.com /cf_dls/m0FSL/6_68/53459794/p1/article.jhtml (1140 words)

	IngentaConnect Awareness During General Anaesthesia: Extent of the Problem and A... (Site not responding. Last check: 2007-10-15)
		Fortunately, the incidence of awareness with explicit recall of severe pain is low, with a frequency of fewer than 1 event in 3000 anaesthetic episodes.
		The incidence of subconscious awareness with implicit recall of auditory perception, and of amnesic but conscious awareness, is methodologically very hard to assess but can be as high as 100%, depending on the anaesthetic regimen used.
		The highest incidence of intraoperative awareness is associated with the use of specifically acting, mostly receptor-mediated drugs, such as opioids, benzodiazepines or the weak anaesthetic nitrous oxide, given alone or in combination.
	www.ingentaconnect.com /content/adis/cns/2000/00000014/00000003/art00001 (491 words)

	Anesthetic Awareness Fact Sheet -- Public Information/Patient Resources (Site not responding. Last check: 2007-10-15)
		There are two distinct types of anesthetic awareness, or intraoperative awareness, that can occur under general anesthesia: Anesthetic awareness with explicit recall and anesthetic awareness with implicit recall.
		There are no precise figures available to gauge the frequency of anesthetic awareness during general anesthesia cases, but estimates have ranged from 0.2 percent to 0.7 percent, or as high as 40,000 incidents annually.
		Patients who believe they have experienced anesthetic awareness should never be afraid to discuss frankly their events or their feelings about the events with their anesthesia providers.
	www.aana.com /patients/aware/factsheet.asp (371 words)

	Intraoperative awareness (Site not responding. Last check: 2007-10-15)
		Anesthesia awareness, or "intra-operative awareness" occurs during general anesthesia, when a patient receives muscle relaxants but not enough generalanesthetic or analgesic to prevent consciousness or, more importantly, recall of events.
		The experience is often extremely traumatizing for the patient who is unable to communicate his or her distress due to themuscle relaxants.
		The prevalence of anesthesia awareness ranges from 0.1% to 0.2 %, or up to4000 cases per year.
	www.therfcc.org /intraoperative-awareness-195920.html (255 words)

	Awareness under anaesthesia (Site not responding. Last check: 2007-10-15)
		Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable.
		One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs.
		Awareness experiences frighten patients and impact their implicit and explicit memories in ways that can leave a lifetime of residual emotional and psychological problems ranging from sleep disturbances, nightmares, and daytime anxiety that may subside with time to development of post-traumatic stress disorder.
	www.anaesthetized.com /awareness.htm (182 words)

	Victims of awareness. (Site not responding. Last check: 2007-10-15)
		However, the average risk for developing mental sequelae after awareness, and the average severity and the duration of symptoms has not previously...
		However, the average risk for developing mental sequelae after awareness, and the average severity and the duration of symptoms has not previously been illustrated in a consecutive series of awareness cases.
		METHODS: Nine patients among 18 consecutive, prospectively identified cases of intraoperative awareness with recall could be located after approximately 2 years and agreed to an interview about possible persisting problems.
	www.accelerated-learning-online.com /research/victims-awareness.asp (514 words)

	Considerations for Policy Development: Unintended Intraoperative Awareness -- In the News (Site not responding. Last check: 2007-10-15)
		Anesthesia awareness is also referred to as unintended intraoperative awareness and occurs infrequently under general anesthesia when a patient becomes cognizant of some or all events during a procedure and has direct recall of those events.
		Unintended intraoperative awareness occurs during general anesthesia when a patient regains consciousness and becomes cognizant of some or all of the events occurring during surgery or a procedure.
		Following the notification of a suspected awareness episode, an anesthesia provider will interview the patient as soon as possible and take a detailed account of the episode to determine if the account is consistent with intraoperative awareness (confirmed awareness), or classified as possible awareness or intraoperative dreaming.
	www.aana.com /news/2005/news041305.asp (2013 words)

	General anaesthesia - Wikipedia, the free encyclopedia
		It is extremely important that the patient answer these questions truthfully so that the anaesthesia provider can select the proper anaesthetic.
		For instance, a heavy drinker or drug user who does not disclose their chemical uses could be undermedicated which could then lead to awareness under anaesthesia or dangerously high blood pressure.
		Note will be take of the last meal ingested (including gum chewed!), and any fluids consumed, a history of Acid-indigestion or regurgitation is also sought.
	www.wikipedia.org /wiki/General_anesthesia (908 words)

	Aspect Medical Systems \| Investors
		The B-Aware study is one of the largest anesthesia-related investigations ever conducted and the largest to document the value of BIS monitoring in reducing the risk of patients inadvertently waking during surgery.
		The study examined 2,500 patients considered to have a high risk of awareness during surgery, either because they had experienced it before or because they were undergoing procedures such as heart surgery where a light anesthetic is preferable.
		The Safe 2 trial was a prospective historical control trial that examined the general patient population and found a 77 percent reduction in the incidence of awareness with recall when BIS monitoring was used.
	www.corporate-ir.net /ireye/ir_site.zhtml?ticker=ASPM&script=410&layout=0&item_id=576653 (720 words)

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