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Karen B. Domino - One of the best experts on this subject based on the ideXlab platform.
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patient perspectives on intraoperative Awareness with explicit recall report from a north american anaesthesia Awareness registry
BJA: British Journal of Anaesthesia, 2015Co-Authors: Christopher D. Kent, George A. Mashour, Robin R. Bruchas, Karen L. Posner, Shawn L Mincer, A E Harvey, Karen B. DominoAbstract:Background Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended Awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. Methods English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia Awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses. Results Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an Awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%). Conclusions Data from this registry confirm the serious impact of anaesthesia Awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.
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Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry
British journal of anaesthesia, 2012Co-Authors: Christopher D. Kent, George A. Mashour, N. A. Metzger, Karen L. Posner, Karen B. DominoAbstract:Background Anaesthetic Awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. Methods The Registry recruited subjects who self-identified as having had anaesthetic Awareness. Inclusion criteria were a patient-reported Awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. Results Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. Conclusions Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic Awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
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Anesthesia Awareness: Narrative Review of Psychological Sequelae, Treatment, and Incidence
Journal of Clinical Psychology in Medical Settings, 2011Co-Authors: Robin R. Bruchas, Christopher D. Kent, Hilary D. Wilson, Karen B. DominoAbstract:Awareness during general Anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of Awareness during general Anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an Anesthesia Awareness experience exists. The incidence of Anesthesia Awareness ranges from 0.1 to 0.2% (e.g., 1–2/1000 patients). Increased recognition of Awareness during general Anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.
Marco Cascella - One of the best experts on this subject based on the ideXlab platform.
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Awareness during emergence from Anesthesia: Features and future research directions.
World journal of clinical cases, 2020Co-Authors: Marco Cascella, Sabrina Bimonte, Nagoth Joseph AmruthrajAbstract:The Anesthesia Awareness with recall (AAWR) phenomenon represents a complication of general Anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from Anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the Anesthesia plan is too early lightened at the end of Anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of Anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.
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Anesthetic dreaming, Anesthesia Awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery.
Oncotarget, 2017Co-Authors: Marco Cascella, Maria Rosaria Muzio, Roberta Fusco, Domenico Caliendo, Vincenza Granata, Domenico Carbone, Giuseppe Laurelli, Stefano Greggi, Francesca Falcone, Cira Antonietta ForteAbstract:// Marco Cascella 1 , Roberta Fusco 2 , Domenico Caliendo 1 , Vincenza Granata 2 , Domenico Carbone 3 , Maria Rosaria Muzio 4 , Giuseppe Laurelli 5 , Stefano Greggi 5 , Francesca Falcone 5 , Cira Antonietta Forte 6 and Arturo Cuomo 1 1 Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 2 Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 3 Department of Emergency Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italia 4 Division of Infantile Neuropsychiatry, UOMI, Maternal and Infant Health, Torre del Greco, Napoli, Italia 5 Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 6 Psychology, Division of Pain Medicine, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia Correspondence to: Marco Cascella, email: m.cascella@istitutotumori.na.it Keywords: Anesthesia, Anesthesia Awareness, deep, intravenous, sedation Received: February 27, 2017 Accepted: March 21, 2017 Published: April 19, 2017 ABSTRACT Background. Anesthetic dreaming and Anesthesia Awareness are well distinct phenomena. Although the incidence of intraoperative Awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, Anesthesia Awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods. Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation Anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and Anesthesia Awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results. Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during Anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of Anesthesia Awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions. Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.
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Consciousness fluctuation during general Anesthesia: a theoretical approach to Anesthesia Awareness and memory modulation.
Current medical research and opinion, 2016Co-Authors: Marco Cascella, Vincenzo Schiavone, Maria Rosaria Muzio, Arturo CuomoAbstract:With Anesthesia Awareness as a model of study we debate the both fascinating and dangerous phenomenon called consciousness fluctuation that takes place during surgical Anesthesia. In accordance with current scientific knowledge this paradox is the consequence of our limits in both precise knowledge of Anesthesia mechanisms and our inability to accurately assess the level of Anesthesia with brain monitoring. We also focus on the relationships between memory and Anesthesia, as well as the possibility of interfering with memory during general Anesthesia.
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A 7-Year Retrospective Multisource Analysis on the Incidence of Anesthesia Awareness With Recall in Cancer Patients: A Chance of Collaboration Between Anesthesiologists and Psycho-Oncologists for Awareness Detection.
Medicine, 2016Co-Authors: Marco Cascella, Vincenzo Schiavone, Maria Rosaria Muzio, Cira Antonietta Forte, Daniela Viscardi, Farrokh Mehrabmi-kermani, Francesco De Falco, Daniela Barberio, Arturo CuomoAbstract:Although randomized controlled studies reported an incidence of Anesthesia Awareness with recall ∼1 to 2 per 1000 (0.1-0.2%), recent data from the NAP5 study showed an incidence of only 1:19,600. Although in a prospective study many tools for Anesthesia Awareness detection can be used, a retrospective analysis requires a careful collection of information.The aim of the study was to evaluate the incidence of Anesthesia Awareness with recall in a cohort of cancer patients through a multisource retrospective analysis, and the clinical description, including the psychological outcome, of the cases detected. We also tested whether our retrospective analysis would be improved by a routinely psycho-oncological assessment. As secondary endpoints we evaluated the use of depth of Anesthesia monitoring over a large cohort of patients, and the correlation between the brain monitoring and the incidence of Awareness.We have carried out a 7-year retrospective analysis in a large cohort of cancer patients on the incidence of Awareness with recall during general Anesthesia. Of 35,595 patients assessed for eligibility, 21,099 were studied. We analyzed all data from the operative rooms' database, the Anesthesia records, and from the database of the surgical divisions. In addition we examined reports from psychologists and spontaneous reports to the quality team of the hospital.Two certain cases of Awareness were detected, with an incidence of 1:10,550 (0.0095%). They occurred during elective surgery, in female patients without other risk factors. One case came from the report of a psychologist. In both episodes, brain monitoring was not applied and no long-term psychological sequelae were reported.Despite the limitations, our investigation suggests that the incidence of Anesthesia Awareness is very low, also in a specific cohort of patients, such as the cancer patients, and even when the depth of Anesthesia monitoring is rarely used. The limitations caused by both the retrospective analysis and the absence of specific tools for direct Awareness detection, such as structured interviews, can be filled with an effective postoperative psychological assessment which is often of routine in a cancer center. This observation could suggest the usefulness of inserting specific questions within the psychological tools commonly used by psycho-oncologists.
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Frontiers in Anesthesia: Old Acquaintances and New Perspectives in Brain Monitoring of General Anesthesia
2015Co-Authors: Marco CascellaAbstract:Until a few years ago to determine the depth of Anesthesia, the anesthetists exploited only a series of physical signs of the patient. In 1994, Sigland Chamoun described a novel measure of the level of consciousness during general Anesthesia: the Bispectral (BIS) analysis. It was the beginning of a revolution in Anesthesia monitoring, indeed during the last 15-20 years a number of EEG-based technologies have become commercially available. Unfortunately, none of these technologies has definitively solved the problem of the Anesthesia Awareness, thus assessment of depth of Anesthesia is still a serious problem. Through these considerations this work focuses on new perspectives in brain monitoring.
Marc J. Bloom - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of discordant elevations of state entropy and bispectral index in patients at amnestic sevoflurane concentrations: a historical cohort study
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2018Co-Authors: Richard H. Epstein, Joni M. Maga, Michael E. Mahla, Eric S. Schwenk, Marc J. BloomAbstract:Background Processed electroencephalogram (EEG) monitors help assess the hypnotic state during general Anesthesia or sedation. Maintaining the bispectral index (BIS) or state entropy (SE) between 40 and 60 has been recommended to mitigate Anesthesia Awareness. Nonetheless, SEs > 70 were frequently observed at end-tidal sevoflurane concentrations unlikely to allow Awareness. We sought to determine the prevalence of elevated discordant measurements during BIS and SE monitoring. Methods Electronic data collected over 11 months at two academic hospitals were retrospectively reviewed. At the hospital using SE, all cases were included with patients ≥ 18 yr and sevoflurane administered for at least 30 min during surgery. A cohort of cases propensity matched by age and American Society of Anesthesiologist Physical Status were selected from the hospital using BIS. Elevated discordant EEG indices were defined as values > 70 occurring during stable end-tidal sevoflurane concentrations > 1.5%. The odds ratio (OR) based on the probability of a case having at least one elevated discordant SE or BIS lasting ≥ two minutes (primary endpoint) was calculated. Results At each hospital, 3,690 cases were studied. The mean (95% confidence interval [CI]) incidence of cases with at least one interval of an elevated discordant EEG index lasting at least two minutes was 3.6% (2.8% to 4.4%) for SE compared with 0.24% (0.17% to 0.27%) for BIS (pooled OR, 17.0; 95% CI, 8.3 to 34.7; P < 0.001). Conclusions The prevalence of an elevated discordant EEG index is much greater with SE than with BIS. Elevated index values occurring at anesthetic concentrations well above the Awareness threshold need to be assessed to determine if they indicate an inadequate depth of Anesthesia requiring treatment or if they simply reflect the underlying monitoring algorithm. Contexte Les moniteurs d’électroencéphalographie (EEG) dont les données ont été analysées contribuent à évaluer l’état hypnotique pendant l’anesthésie générale ou la sédation. Le maintien de l’index bispectral (BIS) ou de l’entropie basale (SE, pour state entropy ) entre 40 et 60 a été recommandé pour réduire l’incidence de l’éveil peropératoire. Toutefois, des entropies basales > 70 ont fréquemment été observées à des concentrations télé-expiratoires de sévoflurane peu susceptibles de permettre un éveil. Nous avons tenté de déterminer la prévalence de mesures discordantes élevées pendant le monitorage du BIS et de l’entropie basale. Méthode Les données électroniques colligées sur une période de 11 mois dans deux hôpitaux universitaires ont été rétrospectivement passées en revue. Dans l’hôpital utilisant l’entropie basale comme mesure, tous les cas de patients ≥ 18 ans et auxquels on avait administré du sévoflurane pour un minimum de 30 min pendant la chirurgie ont été inclus. Une cohorte de propension de cas appariés selon l’âge et le système de classification du statut physique de l’American Society of Anesthesiologists (ASA) a été sélectionnée parmi les données colligées dans un autre hôpital utilisant le BIS. On a défini les indices d’EEG discordants élevés tels que des valeurs > 70 survenant durant des concentrations télé-expiratoires stables de sévoflurane > 1,5 %. Le rapport de cotes (RC) fondé sur la probabilité d’un cas ayant au moins une valeur d’entropie basale ou de BIS discordante élevée ≥ deux minutes (critère d’évaluation principal) a été calculé. Résultats Au total, 3690 cas ont été étudiés dans chaque hôpital. L’incidence de cas dans l’intervalle de confiance (IC) à 95 % moyen présentant au moins un intervalle d’un indice d’EEG discordant élevé durant au moins deux minutes était de 3,6 % (2,8 % à 4,4 %) lorsque l’entropie basale a été utilisée comme mesure, par rapport à 0,24 % (0,17 % à 0,27 %) lorsqu’on a utilisé le BIS (RC groupé, 17,0; IC à 95 %, 8,3 à 34,7; P < 0,001). Conclusion La prévalence d’un indice d’EEG discordant élevé est bien plus importante avec l’entropie basale qu’avec le BIS. Des valeurs d’indice élevées survenant avec des concentrations anesthésiques bien au dessus du seuil d’éveil doivent être évaluées afin de déterminer si elles indiquent une profondeur d’anesthésie inadaptée qui nécessite un traitement ou si elles reflètent simplement l’algorithme de monitorage sous-jacent.
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Prevalence of discordant elevations of state entropy and bispectral index in patients at amnestic sevoflurane concentrations: a historical cohort study.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2018Co-Authors: Richard H. Epstein, Joni M. Maga, Michael E. Mahla, Eric S. Schwenk, Marc J. BloomAbstract:Background Processed electroencephalogram (EEG) monitors help assess the hypnotic state during general Anesthesia or sedation. Maintaining the bispectral index (BIS) or state entropy (SE) between 40 and 60 has been recommended to mitigate Anesthesia Awareness. Nonetheless, SEs > 70 were frequently observed at end-tidal sevoflurane concentrations unlikely to allow Awareness. We sought to determine the prevalence of elevated discordant measurements during BIS and SE monitoring.
George A. Mashour - One of the best experts on this subject based on the ideXlab platform.
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patient perspectives on intraoperative Awareness with explicit recall report from a north american anaesthesia Awareness registry
BJA: British Journal of Anaesthesia, 2015Co-Authors: Christopher D. Kent, George A. Mashour, Robin R. Bruchas, Karen L. Posner, Shawn L Mincer, A E Harvey, Karen B. DominoAbstract:Background Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended Awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. Methods English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia Awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses. Results Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an Awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%). Conclusions Data from this registry confirm the serious impact of anaesthesia Awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.
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Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry
British journal of anaesthesia, 2012Co-Authors: Christopher D. Kent, George A. Mashour, N. A. Metzger, Karen L. Posner, Karen B. DominoAbstract:Background Anaesthetic Awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. Methods The Registry recruited subjects who self-identified as having had anaesthetic Awareness. Inclusion criteria were a patient-reported Awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. Results Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. Conclusions Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic Awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
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Anesthesia Awareness: When the Mind Is Not Suppressed
Suppressing the Mind, 2009Co-Authors: George A. MashourAbstract:In approximately 1–2 general anesthetics/1000, adequate hypnosis and amnesia are not achieved, leading to intraoperative Awareness and subsequent explicit recall. “Anesthesia Awareness,” as it is sometimes called, is one of the most feared complications of surgery by both patients and physicians alike. A significant proportion of these patients develops long-term psychological sequelae, including posttraumatic stress disorder. In this chapter I discuss the incidence, risk factors, prevention, and postoperative consequences of Anesthesia Awareness.
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Inverse zombies, Anesthesia Awareness, and the hard problem of unconsciousness.
Consciousness and cognition, 2008Co-Authors: George A. Mashour, Eric LarockAbstract:Abstract Philosophical (p-) zombies are constructs that possess all of the behavioral features and responses of a sentient human being, yet are not conscious. P-zombies are intimately linked to the hard problem of consciousness and have been invoked as arguments against physicalist approaches. But what if we were to invert the characteristics of p-zombies? Such an inverse (i-) zombie would possess all of the behavioral features and responses of an insensate being, yet would nonetheless be conscious. While p-zombies are logically possible but naturally improbable, an approximation of i-zombies actually exists: individuals experiencing what is referred to as “Anesthesia Awareness.” Patients under general Anesthesia may be intubated (preventing speech), paralyzed (preventing movement), and narcotized (minimizing response to nociceptive stimuli). Thus, they appear—and typically are—unconscious. In 1–2 cases/1000, however, patients may be aware of intraoperative events, sometimes without any objective indices. Furthermore, a much higher percentage of patients (22% in a recent study) may have the subjective experience of dreaming during general Anesthesia. P-zombies confront us with the hard problem of consciousness—how do we explain the presence of qualia? I-zombies present a more practical problem—how do we detect the presence of qualia? The current investigation compares p-zombies to i-zombies and explores the “hard problem” of unconsciousness with a focus on Anesthesia Awareness.
Christopher D. Kent - One of the best experts on this subject based on the ideXlab platform.
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patient perspectives on intraoperative Awareness with explicit recall report from a north american anaesthesia Awareness registry
BJA: British Journal of Anaesthesia, 2015Co-Authors: Christopher D. Kent, George A. Mashour, Robin R. Bruchas, Karen L. Posner, Shawn L Mincer, A E Harvey, Karen B. DominoAbstract:Background Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended Awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. Methods English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia Awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses. Results Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an Awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%). Conclusions Data from this registry confirm the serious impact of anaesthesia Awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.
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Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry
British journal of anaesthesia, 2012Co-Authors: Christopher D. Kent, George A. Mashour, N. A. Metzger, Karen L. Posner, Karen B. DominoAbstract:Background Anaesthetic Awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. Methods The Registry recruited subjects who self-identified as having had anaesthetic Awareness. Inclusion criteria were a patient-reported Awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. Results Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. Conclusions Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic Awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
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Anesthesia Awareness: Narrative Review of Psychological Sequelae, Treatment, and Incidence
Journal of Clinical Psychology in Medical Settings, 2011Co-Authors: Robin R. Bruchas, Christopher D. Kent, Hilary D. Wilson, Karen B. DominoAbstract:Awareness during general Anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of Awareness during general Anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an Anesthesia Awareness experience exists. The incidence of Anesthesia Awareness ranges from 0.1 to 0.2% (e.g., 1–2/1000 patients). Increased recognition of Awareness during general Anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.