Monitoring for Intraoperative Awareness

AORN Journal,  Dec, 1998  by Sandra M. Ouellette,  Chrysanne Simpson

• E-mail
• Print
• Link

* faster emergence and recovery from general anesthesia,

* more cost-effective use of medications, and

* fewer undesirable intraoperative events.

So far, BIS is not available in most anesthesia departments. Until a reliable monitor for awareness is available for all patients, guidelines for prevention must be followed (Table 4). Currently, the most reliable indicator of adequate anesthesia available is patient movement. Unnecessary use of large amounts of muscle relaxants should be avoided. The acoustic environment should be controlled, and fixed doses of anesthetic agents should not be relied on to ensure adequate anesthesia. It is imperative, therefore, that all members of the surgical team insist on a respectful environment and thoughtful conversation.

Table 4

Premedicate with sedative or amnestic agents when appropriate.

Meticulously check anesthesia machine.

Use anesthetic agents with amnestic qualities.

Use adequate doses of analgesics.

Consider supplemental doses of induction medication if indicated.

Avoid routine use of muscle relaxants.

Do not rely solely on nitrous oxide with narcotics unless indicated.

Supplement balanced techniques as needed.

Reverse muscle relaxants before anesthetic is discontinued.

Minimize OR conversation.

NOTES

(1.) T Heier, P A Steen, "Awareness in anesthesiology: Incidence, consequences, and prevention," Acta Anaesthesiologica Scandinavica 40 (October 1996) 1073-1086.

(2.) J Abke et al, "Detection of inadequate anesthesia by EEG power and bispectral analysis," Anesthesiology 85 no 3A suppl (1996) A477.

(3.) S Muravchick, "Defining and measuring the anesthetic state," in The Anesthetic Plan: From Physiologic Principles to Clinical Strategies (St Louis: Mosby-Year Book, 1991) 31.

(4.) Ibid.

(5.) Ibid.

(6.) J P Payne, "Awareness and its medicolegal implications," British Journal of Anaesthesia 73 (July 1994) 38-45.

(7.) A Aitkenhead, "Awareness during anesthesia: When is an anesthetic not an anesthetic?" Canadian Journal of Anaesthesia 43 no 3 (1996) 206-211; P L Bailey, T H Stanley, "Con: The anesthesiologist is not liable if intraoperative recall occurs," Journal of Cardiothoracic and Vascular Anesthesia 7 (August 1993) 489-491; W H Liu et al, "Incidence of awareness with recall during general anaesthesia," Anaesthesia 46 (June 1991) 435-437; G A Osborne, R K Webb, W B Runciman, "An Australian incident monitoring study. Patient awareness during anaesthesia: An analysis of 2000 incident reports," Anaesthesia and Intensive Care 21 (October 1993) 653-654.

(8.) Bailey, Stanley, "Con: The anesthesiologist is not liable if intraoperative recall occurs," 489-491.

(9.) C T Mora et al, "The effects of anesthetic technique on the hemodynamic response and recovery profile in coronary revascularization patients," Anesthesia and Analgesia 81 (November 1995) 900-910.

(10.) N Moerman, B Bonke, J Oosting, "Awareness and recall during general anesthesia. Facts and feelings," Anesthesiology 79 (September 1993) 454-464.