5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors†‡ J.J. Pandit, J. Andrade,

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5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors†‡ J.J. Pandit, J. Andrade, D.G. Bogod, J.M. Hitchman, W.R. Jonker, N. Lucas, J.H. Mackay, A.F. Nimmo, K. O'Connor, E.P. O'Sullivan, R.G. Paul, J.H.M.G. Palmer, F. Plaat, J.J. Radcliffe, M.R.J. Sury, H.E. Torevell, M. Wang, J. Hainsworth, T.M. Cook British Journal of Anaesthesia Volume 113, Issue 4, Pages 549-559 (October 2014) DOI: 10.1093/bja/aeu313 Copyright © 2014 The Author(s) Terms and Conditions

Fig 1 Certain/probable and possible accidental awareness during general anaesthesia cases (shaded bars), compared with patient characteristic distribution from the activity survey (dots with lines) of (a) age, (b) body habitus, and (c) ASA physical status. British Journal of Anaesthesia 2014 113, 549-559DOI: (10.1093/bja/aeu313) Copyright © 2014 The Author(s) Terms and Conditions

Fig 2 Certain/probable and possible accidental awareness during general anaesthesia cases by speciality (bars) compared with distribution in the activity survey (dots and line). Three cases in bariatric and transplant surgery have been omitted as they were not specified in the activity survey. ENT, ear, nose, throat; maxfax, maxillofacial surgery; ortho, orthopaedic surgery; eye, ophthalmology; X-ray, radiology; general surgery includes urology and other specialities not listed. British Journal of Anaesthesia 2014 113, 549-559DOI: (10.1093/bja/aeu313) Copyright © 2014 The Author(s) Terms and Conditions

Fig 3 Representation of some components of anaesthesia practice in certain/probable and possible accidental awareness during general anaesthesia reports (bars) compared with distribution in the activity survey (dots and lines). Propofol in first bar refers to its use as an induction agent, as distinct from a later bar (TIVA) where its use is referred to for maintenance. TIVA, total i.v. anaesthesia; TCI, target-controlled infusion; N2O, nitrous oxide; RSI, rapid sequence induction; NMB, neuromuscular block; DOA, specific depth of anaesthesia monitor. British Journal of Anaesthesia 2014 113, 549-559DOI: (10.1093/bja/aeu313) Copyright © 2014 The Author(s) Terms and Conditions

Fig 4 A proposed NAP5 anaesthesia component (AC) checklist of the World Health Organization checklist (NAP5 AC-WHO). The ABCDE check should be undertaken before commencing surgery (at the WHO surgical pause) and after each occasion the patient is moved. British Journal of Anaesthesia 2014 113, 549-559DOI: (10.1093/bja/aeu313) Copyright © 2014 The Author(s) Terms and Conditions