J J Pandit1, J Andrade2, D G Bogod3, J M Hitchman4, W R Jonker5, N Lucas6, J H Mackay7, A F Nimmo8, K O'Connor9, E P O'Sullivan10, R G Paul11, J H MacG Palmer12, F Plaat13, J J Radcliffe14, M R J Sury15, H E Torevell16, M Wang17, T M Cook18. 1. Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK jaideep.pandit@dpag.ox.ac.uk. 2. Department of Psychology, School of Psychology and Cognition Institute, Plymouth University, Plymouth, UK. 3. Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK. 4. Member Royal College of Anaesthetists' Lay Committee, London, UK. 5. Department of Anaesthesia, Intensive Care and Pain Medicine, Sligo Regional Hospital, Sligo, Ireland. 6. Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, UK. 7. Department of Anaesthesia, Papworth Hospital, Cambridge, UK. 8. Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK. 9. Bristol School of Anaesthesia, Bristol, UK. 10. Department of Anaesthesia, St James Hospital, Dublin, Ireland. 11. Adult Intensive Care Unit, Royal Brompton Hospital, London, UK. 12. Department of Anaesthesia, Salford Royal Hospital, Salford, UK. 13. Department of Anaesthesia, Imperial College NHS Trust, London, UK. 14. Department of Neuroanaesthesia, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. 15. Department of Anaesthesia, Great Ormond Street Hospital, London, UK. 16. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. 17. Department of Clinical Psychology, University of Leicester, Leicester, UK. 18. Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Abstract
BACKGROUND: Accidental awareness during general anaesthesia (AAGA) with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project (NAP5) was designed to investigate the reported incidence, predisposing factors, causality, and impact of accidental awareness. METHODS: A nationwide network of local co-ordinators across all the UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymized reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorized into main types by a multidisciplinary panel, using a formalized process of analysis. RESULTS: The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorization was also defined for each report. Patient experience and sequelae were categorized using current tools or modifications of such. CONCLUSIONS: The NAP5 methodology may be used to assess new reports of AAGA in a standardized manner, especially for the development of an ongoing database of case reporting. This paper is a shortened version describing the protocols, methods, and data analysis from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.
BACKGROUND: Accidental awareness during general anaesthesia (AAGA) with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project (NAP5) was designed to investigate the reported incidence, predisposing factors, causality, and impact of accidental awareness. METHODS: A nationwide network of local co-ordinators across all the UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymized reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorized into main types by a multidisciplinary panel, using a formalized process of analysis. RESULTS: The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorization was also defined for each report. Patient experience and sequelae were categorized using current tools or modifications of such. CONCLUSIONS: The NAP5 methodology may be used to assess new reports of AAGA in a standardized manner, especially for the development of an ongoing database of case reporting. This paper is a shortened version describing the protocols, methods, and data analysis from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.
Authors: Juliet Hounsome; Amanda Nicholson; Janette Greenhalgh; Tim M Cook; Andrew F Smith; Sharon R Lewis Journal: Cochrane Database Syst Rev Date: 2016-08-10