Accidental awareness during general anaesthesia – a narrative review

Summary Unintended accidental awareness during general anaesthesia represents failure of successful anaesthesia, and so has been the subject of numerous studies during the past decades. As return to consciousness is both difficult to describe and identify, the reported incidence rates vary widely. Similarly, a wide range of techniques have been employed to identify cases of accidental awareness. Studies which have used the isolated forearm technique to identify responsiveness to command during intended anaesthesia have shown remarkably high incidences of awareness. For example, the ConsCIOUS‐1 study showed an incidence of responsiveness around the time of laryngoscopy of 1:25. On the other hand, the 5th Royal College of Anaesthetists National Audit Project, which reported the largest ever cohort of patients who had experienced accidental awareness, used a system to identify patients who spontaneously self‐reported accidental awareness. In this latter study, the incidence of accidental awareness was 1:19,600. In the recently published SNAP‐1 observational study, in which structured postoperative interviews were performed, the incidence was 1:800. In almost all reported cases of intra‐operative responsiveness, there was no subsequent explicit recall of intra‐operative events. To date, there is no evidence that this occurrence has any psychological consequences. Among patients who experience accidental awareness and can later remember details of their experience, the c...
Source: Anaesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research