Largest ever study of awareness during general anaesthesia

Posted by egg3 at Sep 15, 2014 10:02 AM |
University of Leicester plays key role in new study that identifies risk factors and consequences for patients, including long-term psychological harm

Accidental awareness during general anaesthesia (AAGA) occurs when general anaesthesia is intended but the patient remains conscious. It is one of the most feared complications of general anaesthesia for both patients and anaesthetists.

The largest ever study of awareness, the 5th National Audit Project (NAP5), which has been conducted over the last three years by the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) found a patient reporting rate of 1 per 19,000 operations. This incidence of spontaneous patient reports of awareness is much lower than estimates of awareness when patients are specifically asked about it after anaesthesia, which are as high as 1 in 600.

The researchers - including Professor Michael Wang (pictured) from the University's School of Psychology - studied 3 million general anaesthetics from every public hospital in UK and Ireland, and studied more than 300 new reports of awareness.

The extensive study showed 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. Despite this, 51% of 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.

Professor Wang, Professor of Clinical Psychology at the University, is an author of the study. He said: “Our research has demonstrated the importance of understanding the range of long term reactions to AAGA and the need to be familiar with the characteristics of post-traumatic stress disorder following AAGA as well as its effects on quality of life.

“We must understand the significance of ‘awake paralysis’ and how this can lead to longer-term psychological impacts. Many patients are left with persistent psychological problems which greatly impair quality of life. Commonly AAGA patients present with post traumatic stress disorder, other new anxiety states and/or clinical depression.”

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