Awarness During Anesthesia- PPT -josh Flashcards
What is “ the state of being conscious; awareness of one’s own existence, sensation, thoughts, surroundings, etc”
Consciousness
What is “ having knowledge,conscious, cognizant”
Awarness
what % of Pt’s are concerned that they would not be asleep during their surgery
> 50%
For the anesthetists, _____ under anesthesia rancks second only to death as a “dreaded” complication
awareness
Which sx’s have the highest incidence of awareness during anesthesia?
Trauma (11-43%)
OB (c/s)- 11.8%-1968 / 0.9% 1991
Cardiac 1977 5.8% / 0.3% 1998
General 1.2% 1960 / 0.11-0.16% 2000
what are the 5 most common pt perceptions of awareness
- Sounds and conversations 89-100%
- Sensation of paralysis 85%
- Anxiety and panic
- helplessness and powerless
- pain 39%
What are 3 of the least common pt perceptions of awareness?
- Visual perceptions
- Intubation or tube
- Feeling the oporation w/o pain
what are the 2 main after-effects of awareness during general anesthesia?
- mental after-effects
- Medico-legal After-effects
the cause of the mental after-effects of awareness can be caused by 37% of pt’s being responded to by healthcare professionals in what 3 ways r/t thier reports of awareness
- Disbelief
- Ignorance
- Anger
14% of pt’s w/ awareness were told that their awareness was what?
- just a bad dream
- All in your imagination
- Were medicated or hallucinating
- had a 7th sense
what are some of the after-effects of surgical awareness
- Sleep disturbances (fear of falling asleep)
- Repetitive nightmares (54%)
- Anxiety and panic (55%)
- Depression
- Flashbacks
- Avoidance of medical care
- Preoccupation of death
- PTSD (14.3% to 22%)
what are the medico-legal after-effects of awareness?
very large compensations
what are risk factors for awareness?
- No volatile used
- Female
- OB/GYN procedure
- Opioid only
- Muscle relaxants
what are main causes/factors of awareness?
- Light anesthesia
- malchine malfunction or misuse of tech
- Increased anesthestic requirements
main causes/factors of awareness
what are the causes of light anesthesia
- N2O/opioid/relaxant anesthesia
- Myocardial depression
- hypovolemia
- C-section
- Difficult intubation
- Premature d/c of anesthestic
main causes/factors of awareness
what are causes of machine malfunction or misuse
- Failure to check equip
- Vaporizer and circuit leaks
- IV infusion errors
- Accidental adm of muscle relaxant to awake pt
main causes/factors of awareness
what are causes of increased anesthestic requirement?
- Varibility of anesthestic requirement for IV agent
- chronic ETOH, opoid, and cocaine abuse
what are 10 ways to prevent awareness?
- Amnestic premeds
- Vigilance w/ equip and monitoring
- Minimize complete Neuromuscular blockade
- Supplement N2O/opioid anesthesia w/ volatile anesthesia
- Maintain 0.8-1.0 MAC of a potent VAA itself
- Administer adequate dose of induction drug
- Obtain informed consent for high risk pt’s
- Mask auditory input
- Provide education
- Monitor for awareness
what is the best way to detect awareness?
- Structured postoperative interview
what are 5 great questions to ask during your potop awareness interview questioning
- What is the last thing you remember b4 going to sleep for the operation?
- what is teh first thing you remember after waking up after the operation?
- Do you remember anything between?
- Did you have any dreams?
- What was the most unpleasant thing you remember from your operation and anesthesia?
what are some clinical signs of awareness (AKA light anesthesia) and unreliable
- Sympathetic activities:
- Increased HR
- Increased BP
- sweating
- pupillary dilation
- Lacrimation
main causes/factors of awareness
what are some ways to monitor for awareness?
- ISOLATED FOREARM TECH
- EEG
- BIS
AEP
IFT: the isolated forearm technique was originally described by Tunstall in obstetric anaesthesia. A tourniquet is applied to the patient’s upper arm and inflated above systolic blood pressure, before the administration of muscle relaxants. Movement of the arm, either spontaneously or to command, indicated wakefulness, although not necessarily explicit awareness. At 15 - 20 minutes the anaesthetist lets the tourniquet down, and may then reinflate it if further muscle relaxant is required. Some would argue that response to command during surgery is a late sign when attempting to prevent awareness; however, not all patients responding have any recall.
what are 5 ways to manage a pt w/awareness
- Detailed interview w/ pt
- Verify pt’s account
- Sympathize
- Try to explain what happened
- reassure about non-repetition
- Apologize
- Offer psychological support
- Record interview
- Informs pt’s surgeon, RN, and hospitals lawyer
- Visit pt daily during hospital stay and keep in contact by telephone
- Don’t delay referral to a psychologist or psychiatrist
Conclusions:
Incidence of awareness in GA is ___%
0.1-0.2%
Conclusions:
What is the incidence of awareness in cardiac sx
0.3%
Conclusions:
lower dose of anesthestics are associated w/ ______ incidence of intra-op awareness;
higher
Conclusions:
Standard physiologic monitoring is not reliable, such as AEP or BIS; however ______ signs are much more unreliable
Clinical
Conclusions:
the Psychiatric after-effect of awareness renages from no effect to _____
PTSD
Conclusions:
There is no evidence that any kind of ________ would affect the incidence of awareness
- premedication
Conclusions:
if prolonged laryngoscopy is required, one should not forget to add more ______ or ______
Induction agent
or
inhalation agent
Conclusions:
in a critical hemodynamic situation, ____ instead of General anesthestics may be aceptable
BZD
Conclusions:
to prevent awareness _____ should be used as sparingly as possible
NMBs
Conclusions:
if a pt has a hx of awareness under GA, it would be wise to use a _____
monitor
Conclusions:
if the pt has suffered from awareness, ________ consultation and _________ is recommended
- psychiatric
- Follow-up
Conclusions:
Just a fun fact….
most of her conclusions were not in the main slides.. odd
Another odd fact……
Wearing headphones for just an hour will increase the bacteria in your ear by 700 times
one more for good luck
A duck’s quack doesn’t echo, and no one knows why
