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AN AUDIT FOUND MOST ANESTHESIA AWARENESS AVOIDABLE
THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.
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OKAY BACK FROM THE BRAIN MONITOR 🖥️
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WHAT THE NATIONAL AUDIT FOUND ✅
Two Anesthetist Bodies Ran A National Audit In The UK And Ireland
It Looked Into Accidental Awareness During General Anesthesia
Three Quarters Of The Awareness Cases Were Judged Preventable
In 12 Percent The Care Was Judged Good And Not Preventable
Contributing Factors In Most Cases Included Medication
Patient Factors And Education Or Training Were Also Named
A Second Audit Paper Listed What Increased The Risk Of Awareness
Female Sex Was A Risk Factor
Younger Adults Had A Higher Risk But Children Did Not
Obesity And Previous Awareness Were Also Risk Factors
A Junior Trainee As The Anesthetist Raised The Risk
Operating Out Of Hours And Emergencies Were Included
Obstetric Cardiac And Thoracic Surgery Were Named
Use Of A Drug That Paralyzes Muscles Counted Too
A Patient's General Health Grade And Race Were Not Risk Factors
Use Or Omission Of Nitrous Oxide Was Not A Risk Factor
The Audit Recommends An Anesthetic Checklist
It Would Be Part Of The WHO Safer Surgery Checklist
Its Purpose Is To Aid In Preventing Accidental Awareness
Authors Of A US Case Commentary Also Advise On Dosing
They Say The Dose Needs Adjusting For Every Patient Individually
Their Advice Is To Reverse The Paralysis Before Anesthetic Drugs Stop
The Patient Can Then Move If Anesthesia Is Too Light
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THE BRAIN MONITOR TRIALS DISAGREED 📈
A Brain Monitor Called BIS Was Tested For Decreasing Awareness
The Bispectral Index Is A Scale Based On Brain Electrical Activity
One Trial Randomly Allocated Adults At High Risk Of Awareness
Of 2,463 Eligible And Consenting Patients 1,225 Got The Brain Monitor
1,238 Were Allocated To Routine Care
There Were Two Reports Of Awareness In The Brain Monitor Group
The Routine Care Group Had 11 Reports Of Awareness
A Second Trial Compared The Brain Monitor With Exhaled Gas Levels
2,000 Patients Were Randomly Assigned To One Of The Methods
967 And 974 Patients In The Two Groups Were Assessed
Two Cases Of Definite Awareness Occurred In Each Group
Awareness Occurred Even When Both Measures Were Within Target
The Authors Said Their Findings Do Not Support Routine Monitor Use
A Third Trial At Three Centers Randomized 6,041 High Risk Patients
7 Of 2,861 Interviewed Monitor Patients Had Definite Awareness
2 Of 2,852 Interviewed Gas Group Patients Had Definite Awareness
The Authors Said The Monitor's Superiority Was Not Established
A Fourth Trial Enrolled Unselected Patients At Three Hospitals
Unselected Means The Patients Were Not Picked For High Risk
The Study Was Terminated Because Of Futility
At Interim 11 Of 9,376 Gas Group Patients Had Definite Awareness
8 Of 9,460 Brain Monitor Patients Had Definite Awareness
The Trial Could Not Detect A Difference Between The Two Methods
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WHAT THE POOLED EVIDENCE SAYS 🕯️
A Cochrane Review Pooled Studies Of The Brain Monitor
It Included 52 Studies With 41,331 Participants
Its Data Were Split Into Two Comparisons
Against Clinical Signs The Brain Monitor May Reduce Awareness
The Review Rated That Evidence As Low Certainty
Clinical Signs Are Criteria Such As Blood Pressure Or Heart Rate
That Comparison Covered Patients Unselected Or At High Risk
27 Studies With 9,765 Participants Contributed To That Result
Only Five Of Those Studies Reported How Often Awareness Happened
Awareness With The Brain Monitor Was Three Per 1000
It Was Nine Per 1000 When Clinical Signs Guided Anesthesia
The Review Also Compared The Brain Monitor With Gas Measurement
It Found No Evidence Of A Difference Between Them
That Result Covered 5 Studies And 26,572 Participants
In That Comparison Awareness Was One Per 1000 In Both Groups
The Review Used GRADE To Downgrade All Outcomes To Low Certainty
It Concluded That Awareness Is Infrequent And The Evidence Imprecise
Other Researchers Looked At What Awareness Does To Patients
One Paper Calls Being Conscious During Surgery A Traumatic Event
Its Authors Say That Event May Result In Chronic PTSD
Authors Following Up The First Trial Say Prevention Is Justified
Registry Data Confirm A Serious Impact For Some Patients
They Suggest Patients Need More Systematic Responses And Follow Up
