A recent study has highlighted the risk factors and consequences for patients of accidental awareness during general anaesthesia, including long term psychological harm.
Accidental awareness is one of the most feared complications of general anaesthesia for both patients and anaesthetists, says the report, and occurs when anaesthesia is administered but the patient remains conscious. Patients spontaneously report this failure of general anaesthesia in approximately one in every 19,000 cases, according to the report by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.
The study found that the majority of episodes of awareness are short lived, occur before surgery starts or after it finishes, and do not always cause concern to patients. However, 51% of all episodes led to distress and 41% to longer term psychological harm.
Sensations experienced included tugging, stitching, pain, paralysis and choking. Patients described feelings of dissociation, panic, extreme fear, suffocation and even dying. Longer term psychological harm often included features of post-traumatic stress disorder.
The project report includes clear recommendations for changes in clinical practice, including the introduction of a simple anaesthesia checklist to be performed at the start of every operation, and the introduction of an Awareness Support Pathway – a structured approach to the management of patients reporting awareness.
These two interventions are designed to decrease errors causing awareness, says the report, and to minimise the psychological consequences when it occurs.
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