Never Ending Pursuit - Advancing Patient Safety, Satisfaction Throughout the Surgical Experience

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In recognition of National Patient Safety Week March 8-14 the American Society of Anesthesiologists and the Anesthesia Awareness Campaign, are working together to educate patients on the occurrence and treatment of anesthesia awareness.

Anesthesia awareness is an uncommon condition that occurs when surgical patients under general anesthesia can recall sounds, events, or even pain during their surgery. Incidences of awareness occur once or twice per thousand surgeries performed under general anesthesia.

Not all incidences of recall during medical procedures involving anesthesia are considered cases of awareness. Patients who receive sedation, local anesthesia, regional blocks, spinal or epidural anesthesia are expected to be somewhat awake or aware of their surroundings and have some recall of the procedure. In addition at the very end of a surgical procedure, the anesthetic is reduced so that patients can awaken and therefore, there may be some awareness during this period.

The risk for anesthesia awareness is higher for unstable patients or for patients undergoing high-risk surgeries such as trauma, cardiac surgery or emergency caesarean sections. In these high-risk cases, using a deep anesthetic may not be in the best interest for patient’s safety.

“Regardless of statistics, even one case of anesthesia awareness is too many. The ASA continues to study the occurrence of awareness to find effective ways to prevent the condition,” said Roger A. Moore, M.D., President of the American Society of Anesthesiologists. “The entire surgical team must be vigilant before during and after surgery to ensure the safety, comfort and recovery of each patient.”

Specific steps can be taken by physician and patient to reduce the risk of awareness. Patients and anesthesiologists should meet prior to surgery to discuss anesthesia options as well as the patient’s surgical, anesthetic and medication history. It may be helpful for patients to have a friend or family member advocate with them for this discussion. It is during this visit that patients should discuss any anxiety or concerns about their procedure with the anesthesiologist including possible awareness.

Following surgery, patients who believe they may have experienced anesthesia awareness are encouraged to contact their anesthesiologist regarding their experience. The first step in overcoming the adverse emotional consequences of an intra-operative awareness experience is acknowledgement that it may have occurred.

Seeking greater understanding why awareness occurs, ASA has sponsored the development of The Anesthesia Awareness Database, http://www.awaredb.org, a voluntary registry of patients who have experienced awareness.

The Anesthesia Awareness Database was developed to understand why anesthesia awareness occurs, to prevent future occurrences awareness and to help anesthesiologists and other healthcare professionals better understand and assist patients who experience awareness.

“Patients who believe they have experienced awareness should not only contact their physicians and the Anesthesia Awareness Campaign, but also register with the Anesthesia Awareness Database so their case can be studied and used to help understand why awareness occurs in some patients and help stop awareness from occurring,” said Carol Weihrer, founder of the Anesthesia Awareness Campaign, a non-profit patient advocacy organization dedicated to bringing awareness to awareness.

Anesthesiologists: Physicians providing the lifeline of modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

About the Anesthesia Awareness Campaign
The mission of the Anesthesia Awareness Campaign is “to prevent patients (even one) from experiencing anesthesia awareness and its consequences through education, prevention, and empowerment by replacing ignorance or fear with knowledge.” Now in its second decade, the nonprofit patient advocacy organization works individually with victims of anesthesia awareness, interfaces with professional anesthesia organizations, works to promote research into awareness, and tries to educate the public about how to prevent awareness from happening to them.

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The greatest utility of brain activity monitors is in avoiding the traditional routine of giving anesthesia in excess for fear of under-medicating - what I have referred to as the ‘art of the controlled overdose.’ Over-medication of patients under anesthesia has been shown to increase C-reactive proteins, markers of inflammatory response and be associated with postoperative cognitive dysfunction (POCD), both of which are astronomically greater risks to patients than awareness. Pulse oximetry became commercially available in 1984. I insisted my hospital get them a soon as they became available. Yet, the ASA took 8 years to decide pulse oximetry was good for all patients. The current generation of brain activity monitors became commercially available in 1996. I have yet to meet a patient who thought it was a bad idea for me to measure what I was trying to medicate - their brain. I have been using my brain activity monitor to improve my patients safety and satisfaction since 1997. My web site has a page with my publications that have resulted from this effort. There is also a page with patient testimonials worth visiting as well. Based on their history with pulse oximetry and current history with brain activity monitoring, the ASA is not where the public needs to look for patient satisfaction advocacy. Much like the AMA, the ASA is primarily a political organization charged with helping its members deal with reasonable reimbursement for services rendered to patients covered by third party payers like Medicare, Blue Shield/Blue Cross. This assessment is not a ‘flame,’ but a statement of fact some may find politically incorrect & objectionable, nonetheless it is an accurate representation of the ASA history.

posted by Barry L. Friedberg, M.D. on 03/09/2009 at 11:37 am -08:00

A patient should get enough information from doctor before being put under any possible risk. No amount of caution substitue a patient’s own decision on taking calcuted risk.

posted by andy press on 04/14/2009 at 12:30 pm -08:00