| FOR RELEASE: February 1, 2007 |
CONTACT: Donna E. Habich
Brittny C. Dziadula
(847) 825-5586 |
“Anesthesia Awareness” Rates May Be Much Lower Than Previously Reported
CHICAGO—Anesthesia awareness is a rare event in which a patient undergoing general anesthesia may regain consciousness and have recall of some events during surgery. Although recent literature and media reports have put the incidence of anesthesia awareness at around 1 to 2 per 1,000 surgeries, new data from one large regional medical system shows that the number may actually be much lower when a program like Continuous Quality Improvement (CQI) is used.
The February issue of the journal Anesthesiology features a new report based on data collected over a three-year period. Findings from the report, Intraoperative Awareness in a Regional Medical System: A Review of Three Years’ Data, show that the incidence of intraoperative awareness may be as low as 1 in 14,000 surgeries—and closer to 1 in 42,000 for patients who are not considered to be at higher risk.
The study authors reviewed CQI data on more than 87,000 patients undergoing general anesthesia from 2002 through 2004 at facilities where the physician group, Southeast Anesthesiology Consultants, provided anesthesia. The facilities, located around the Charlotte, North Carolina region, included an 861-bed academic medical center, six community hospitals and one ambulatory surgery center. The collected data represented a wide variety of patient populations.
Southeast Anesthesiology Consultants uses a CQI program to continuously monitor and improve anesthetic practice. CQI provides real time feedback on all aspects of the patient’s anesthetic care. Patients were interviewed twice during a 48-hour postoperative period, and were asked questions designed to determine if they had experienced intraoperative awareness. All cases that met the criteria for awareness were examined by the CQI committee to assess the need to modify anesthetic practice and were included in the report.
The CQI program includes the Quality Assurance (QA) process which aids in the collection of information on all surgical patients throughout their hospital stay. This data tool covers the patient’s entire anesthetic experience and represents more than 50 quality indicators, which are used to assess patient comfort and quality of care.
All general anesthetics were delivered under the supervision of Board-certified anesthesiologists. The practice does not utilize brain function monitors in the operating rooms at any of the locations where it provides anesthesia.
Recovery room nurses initially questioned the patients in the postanesthesia care unit about the possibility of awareness. The CQI team then interviewed patients within one to two days after their anesthetic. During each interview the patient was again questioned about the anesthesia experience and the possibility of awareness.
The CQI program also focuses on surveying all surgical patients in person or by mail and asking them to describe their experiences in detail before, during and after their surgery.
Based on previous literature, the study authors expected they might find that the incidence of awareness at a teaching hospital would be higher than that at other types of facilities, due to the difficulty of the cases. However, the difference in the rates between the teaching hospital and the community hospitals was not statistically significant.
From the 211,842 anesthetics delivered during the study period, 177,468 (83.12%) were followed by the QA process. Of those, a total of 87,361 patients were identified as meeting the study criteria by being over 18 years of age and undergoing a general anesthetic. (Awareness is not an issue for patients undergoing regional or local anesthesia, as it is expected that patients will be awake or aware during all or part of the procedure.)
This study found six cases where patients reported events that could be classified as “awareness” or “recall.” Four of these cases were found in patients undergoing cardiac surgery (one of the categories at higher risk for awareness). The patients with recall were found to be older (over 55) and were under anesthesia longer. All incidents of awareness occurred in cases where neuromuscular blocking agents (which immobilize the patient) were used.
The approach to anesthetic delivery taken by Southeast Anesthesiology Consultants is similar to that outlined in the intraoperative awareness practice advisory developed by the American Society of Anesthesiologists and approved in 2005. This addresses the preoperative evaluation, equipment checklists, drug selection based on the individual case and various types of patient monitoring.
According to the study’s lead author, Richard J. Pollard, M.D., “Although it is not known what factors contributed to the significant discrepancy between previously reported awareness rates and those found among this group of patients, the findings support the idea that following a combination of recommended protocols and quality improvement processes can result in a very low occurrence of awareness.”
Editor’s Note: For an interview with Dr. Richard J. Pollard or more information on the CQI program, please contact Michele Houck at 704-248-5440.
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For additional information on this study, go to: http://www.anesthesiology.org
Link to ASA practice advisory on intraoperative awareness:
http://www.asahq.org/publicationsAndServices/AwareAdvisoryFinalOct05.pdf
Link to ASA patient brochure on anesthesia awareness:
http://www.asahq.org/patientEducation/Awarenessbrochure.pdf
Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 41,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.
Visit our Web site at <http://www.asahq.org>