5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal.

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Presentation transcript:

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues†‡ T.M. Cook, 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, J.J. Pandit British Journal of Anaesthesia Volume 113, Issue 4, Pages 560-574 (October 2014) DOI: 10.1093/bja/aeu314 Copyright © 2014 The Author(s) Terms and Conditions

Fig 1 General anaesthesia most commonly involves no AAGA and there is no explicit recall or adverse psychological outcome. An accidental awareness event might lead to no recall, immediate recall, or delayed recall. Where there is no recall, the outcome from anaesthesia itself might be expected to be neutral. Recall of AAGA can lead to a neutral or adverse outcome. British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 2 Distribution of the cases by phase of anaesthesia (AAGA more common at induction>surgery>emergence) and by symptoms (by Michigan classification). British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 3 Distribution of the Michigan score by modified NPSA score (excluding unknowns). British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 4 Boxplots for modified NPSA score by Michigan score (n) with distress (blue) or without distress (green; D). For this and other boxplots, the horizontal line is the median, the edges of the box the 25th and 75th centiles, the error bars (where they can be calculated for the data) the 10th or 90th centiles, and the dots any outliers. Overall, the incidence of distress was 51%. British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 5 Main panel: distribution of perceived duration of experience; inset: cumulative distribution. The median duration was 180 [30–300 (3–10 800)] s (i.e. 3 min with an IQ range of 30 s to 5 min; the longest experience judged at 3 h). British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 6 (a) Boxplot for certain/probable and possible reports of duration of perceived AAGA by Michigan score: no distress (green bar) and distress (blue bar). Although the pooled durations are little meaningful, for all Michigan scores combined, the median duration for no distress was 60 [15–300 (3–10 800)] (outliers >4000 s not shown) and for distress was 180 [60–360 (5–3600)] s (NS). The vertical line within each box (generally obscured by the axis) is the median, the edges of the box the 25th and 75th centiles, the error bars the 90th centile (the 10th centile obscured by the axis), and dots are outliers. (b) Boxplot of relationship of perceived impact of AAGA by modified NPSA score. The solid bold line joins the medians of boxplots to give a visual impression of (modest) relationships. British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 7 (a) Boxplot showing relationship in certain/probable and possible AAGA reports between the distress at the time of AAGA (i.e. Michigan score with distress, blue bars, and no distress, green bars) and delay in reporting. (b) Boxplot showing relationship in certain/probable and possible reports between psychological impact at the time of the report (i.e. modified NPSA score) (blue bars) and delay in reporting. British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions

Fig 8 (a) AAGA experiences during sedation. Distribution of Michigan scores across the ‘phases' of sedation. Michigan 1, auditory sensations; 2, tactile sensations; 3, pain; 4, paralysis; 5, paralysis and pain. (b) Boxplot of the modified NPSA score by patient experience (Michigan scale). British Journal of Anaesthesia 2014 113, 560-574DOI: (10.1093/bja/aeu314) Copyright © 2014 The Author(s) Terms and Conditions