New survey reports low rate of patient awareness during anesthesia

The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) today publish initial findings from a major study which looked at how many patients experienced accidental awareness during general anaesthesia.

The survey asked all senior anaesthetists in NHS hospitals in the UK (more than 80% of whom replied) to report how many cases of accidental awareness during general anaesthesia they encountered in 2011. There are three million general anaesthetics administered each year. Study findings are published in Anaesthesia, and The , the peer-reviewed journals of the AAGBI, and RCoA respectively.

Previous reports have suggested a surprisingly high incidence of awareness of about one in 500 general anaesthetics. The current report found it to be much less common in the UK with one episode known to anaesthetists in every 15,000 general anaesthetics. The report also reports very low use of brain : with only 2% of anaesthetists routinely using it.

The survey is part of a major study called the Fifth National Audit Project (NAP5) taking place over three years. NAP5 is thought to be the largest study of its kind ever conducted and is funded entirely by the profession.

Professor Jaideep Pandit, Consultant Anaesthetist in Oxford and lead author, said, "Anaesthesia is a medical speciality very much focussed on safety and . We identified accidental awareness during anaesthesia as something which concerns patients and the profession. The profession is therefore undertaking this major study so that we can better understand the problem and work to reduce the likelihood of it happening to patients."

"We are particularly interested in patient experiences of awareness. Although we know that some patients do suffer distress after these episodes, our survey has found that the vast majority of episodes are brief and do not cause pain or distress."

"Our study will continue to explore the reasons for the differences between our figures and previous reports. Anaesthesia in the UK is administered only by trained doctors and is a consultant-led service. Whether this – or other factors such as differences in patient sensitivity to anaesthetic drugs or different detection rates influence the reported numbers – is something we will be studying in the rest of the project."

Professor Tim Cook, co-author and a Consultant Anaesthetist in Bath said, "Risks to patients undergoing general anaesthesia are very small and have decreased considerably in the last decades. Anaesthesia doctors in the UK undergo the same level of training as surgeons and physicians. Of the three million general anaesthetics administered in the NHS each year, only a very small number of patients experience awareness during anaesthesia, with the majority of these occurring before surgery starts or after it finishes."

"While our findings are generally reassuring for patients and doctors alike, we recognize that there is still more work to be done. We are spending the next year studying as many of the cases as possible to learn more from patients' experiences. It is hoped that the findings included in the final report, due out early 2014, will increase our understanding of accidental awareness during so that the anaesthetic profession can further increase safety for patients."

"Anaesthetists have always put patients first and will continue to do so. This study, which comes just after the publication of the Francis report, shows that anaesthetists are clearly listening to and have acted positively to address a major patient concern."

More information: Pandit et al. "A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK" Anaesthesia 2013. DOI: 10.1111/anae.12190

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