Awareness in anaesthesia

Awareness in Anesthesia
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Abstract
Awareness in anesthesia is a phrase used by medics that refers to a condition that arises when a patient in surgery, and under general anesthesia, becomes aware of some or all procedures involving the surgery. Here, the patient passes through various situations which might end up in them getting posttraumatic disorder or even mental illness; for example, breathing problems, and even pains in some or whole of the body. General anesthesia refers to a numbing that affects the entire body and ordinarily causes loss of consciousness. However, recent studies indicate that intraoperative awareness is a very uncommon occurrence, which arises in only 0.1% to 0.2% of patients in recent years. The risk factors for anesthesia awareness include equipment failure or misuse, large anesthetic needs, and smaller anesthetic drugs. To avert this challenge, it essential to do a history and physical scrutiny, focusing on threat factors for pulmonary and cardiac complications and a determination of the patient’s functional capacity, are critical to any preoperative evaluation.
Keywords: Awareness, anesthetics, general anesthesia, risk factors
 

Introduction
Anesthesia refers to a situation in which someone does not feel pain, touch or heat generally because of drugs they have been given (mostly injection) before undergoing surgery (Ghoneim, 2010). During and after this surgical treatment, patients often experience different feelings.

From the research, 48% of the patients have breathing problems, 28% feel pains and a massive 48% also experience awareness report auditory recollection. Half of these patients experience mental distress, including an unknown number of patients with posttraumatic stress disorder. When this occurs, many patients find it hard to communicate or report it to the doctor. This awareness during general Anesthesia is detected by direct questioning, specifically or non-specifically. Several reports have developed about patients who have gone through anesthesia awareness. For example, Sidney L. Williams, who underwent anesthesia awareness during open heart surgery. Also, there is Jeanette Liska, a writer of books, i.e., silenced screams, surviving anesthetic awareness and many more; she describes how she experienced two hours of pain and fear during her surgery (Beyea, 2005). Carol Weihrer also experienced this horrific torture and begun an awareness campaign.
Intraoperative awareness is a very uncommon occurrence, which arises in only 0.1% to 0.2% of patients in recent years (Orser, Mazer, & Baker, 2007). Research findings point out that the actual preventive measures for anesthetic awareness cannot be advanced technologically since the incidences are inadequate to identify the casual and risk factors for this phenomenon (Ghoneim, 2000). Further research indicates that there is only 0.3% awareness incidence (Nunes, Porto, Miranda, De Andrade, & Carneiro, 2012). Going through full intraoperative awareness is likely to expose the patients to gigantic trauma. Some of these patients experience post-traumatic stress disorder, which leads to long-term consequences.
Challenges – current and in future practice
The leading challenge in intraoperative awareness is trauma. If not handled properly, trauma is likely to contribute to the loss of human life. Research indicates that trauma in patients undergoing emergency treatment is likely to have come from a penetrating injury or a blunt force. Trauma is one of the leading challenges in anesthesia awareness; it can cause death if not quickly handled. Anesthetic providers face a challenge when handling trauma patients who are taken into the operating room for emergency treatment since they might have been subjected to either blunt force or a penetrating injury (Ghoneim, 2007). Some of the challenges posed include airway management, unstable hemodynamics, extensive resuscitation needs in the setting of bleeding, and the constantly evolving intraoperative procedure. A doctor will, therefore, have to play an important duty of applying unique management practices to address each case so that the patient’s stability is guaranteed. The current and future practice in these cases that could help the patient in this state is the doctor (anesthesiologist) handling the special challenge caused by trauma through inducing or maintaining anesthesia. However, for this to be successful, there should be no harmful effect on blood pressure ensuring there is appropriate vascular access for resuscitation and observation.
Literature review
Studies conducted by Sebel et al. (2004) indicate that awareness during anesthesia is a global phenomenon. Awareness during anesthesia is approximated at 1 or 2 cases for every one thousand individuals without considering the geographic location or the anesthetic techniques used. For instance, it has been estimated that about twenty million anesthetics are given in the United States annually; therefore, this interprets the occurrence of about twenty-six thousand instances of intraoperative awareness every year. Research has pointed out that when anesthetics are administered in quantities that are not adequate to keep a patient unconscious, then awareness might be inevitable during surgical stimulation (Sebel et al., 2004). Therefore, for this to occur, there must have been equipment failure or misuse, large anesthetic needs, or smaller anesthetic drugs. These researchers conclude that awareness during anesthesia is something that can be avoided.
Research conducted by Beyea (2005) 0.1% to 0.2% of patients subjected to general anesthesia will experience awareness. Awareness is described by the presence of auditory awareness, pain, or difficulty breathing. A patient experiencing awareness may be aware of all or some of the happenings during an operation (Beyea, 2005). Despite the existence of anesthesia awareness, several strategies can be applied to prevent its occurrence. Some of the strategies include the application of premedication in association with amnesic medication, applying muscle paralysis when it is necessary, and regular maintenance of anesthesia machinery and the associated accessories (Beyea, 2005).
Studies conducted by Ghoneim (2010) indicate that intraoperative awareness is a rare phenomenon that is registered in about 0.1% to 0.2% of patients. Further, the researcher indicates that the causes of anesthesia awareness include increased anesthetic need, overly light anesthesia, and misuse or malfunction of the anesthetic equipment. However, the major cause of intraoperative awareness is overly light anesthesia since it contributes to about 87% of all the incidences of awareness (Ghoneim, 2010).
Strengths and limitations
Being in trauma as a patient who has been anesthetic aware is one of the things that can weaken a person and leave them in stress disorder for long. People even die because of this situation, but when the doctor takes into consideration and listens to the patient after reporting or even during surgery; trauma can’t become as big an issue to the patient. The above research also shades light to ethics and legal perspectives of awareness in anesthesia which helps resolve any legal battles when they occur after surgery.
However, a major limitation of the studies is that none was able to adequately describe the warning signs to point the possibility of awareness during anesthesia. Therefore, this is an area undergoing research and findings should be shared by experts soon.
Application of findings to current practices
The findings from past literature are applied today where general assessments on the status of patients are done before they are allowed to go through surgery. Their heart condition, the possibility of risk, medical history as well their condition before surgery helps determine what dosage of anesthesia is required to keep them in perfect position until surgery is complete while allowing them to come back alive without any complications or remaining still.
Recommendations on areas of improvement
A history and physical scrutiny, focusing on threat factors for pulmonary and cardiac complications and a determination of the patient’s functional capacity, are critical to any preoperative evaluation. Laboratory examinations should be ordered only when designated by the patient’s drug therapy, medical status, or the nature of the planned procedure and not on a predictable basis. Persons without connected medical problems may need little more than a quick medical review to ensure that their already condition does not negatively impact the surgery. Patients with comorbidity should be optimized for the procedure. Proper discussions with appropriate therapeutic services should be attained to advance the patient’s condition. These consultations with appropriate departments and medical experts should preferably not be done in a “last second” fashion but in advance of surgery to get accuracy and continuity of the patient’s condition.
Current Practice Guidelines
Preoperative clinics are done. Every patient should undergo a doctor anesthetist-led preoperative assessment, and every effort to enhance the situation of the patient should be adopted immediately.
A checklist is followed to ensure all processes are followed as follows:
Assessing the patient’s condition.
The patient has received relevant statistics on the anesthetic procedure, including risks.
Anesthetists should be aware of the problem of fatigue and less favorable outcome data during night duty and prolonged shifts.
Anesthetists must minimize the problem of fatigue as far as possible in the context in which they are working.
Employers must optimize rosters and working/resting conditions to minimize the risk of fatigued anesthetists.
Three levels should be used when setting the minimum standards for the available anesthetic equipment. The three levels should be mandatory, recommended, and possible.
Equipment should be handled following the set guidelines.
All equipment should be labeled and conform to ISO or other quality regulations.
Equipment should be tested according to a checklist at defined intervals. Anesthesia machines should be checked at least daily with smaller checks between cases.
There must be a backup strategy in the case of power cuts.
All activities in the operating theatre must then be systematically documented.
Anesthetic records should be kept in all cases.
All sections should have a systematic approach to anesthesia-related problems and use these data for quality improvement strategies in the department.
In the case of adverse outcome, the anesthetic contribution to those should be analyzed systematically in the department.

References
Beyea, S. C. (2005). Addressing the trauma of anesthesia awareness. AORN, 81(3), 603-606.
Ghoneim, M. (2010). Etiology and risk factors of intraoperative awareness. Cambridge University Press, 91-113.
Ghoneim, M. M. (2000). Awareness during anesthesia. Clinical Concepts and Commentary, 92, 597-602. Retrieved from http://anesthesiology.pubs.asahq.org/pdfaccess.ashx?url=/data/journals/jasa/931249/
Ghoneim, M. M. (2007). Incidence of and risk factors for awareness during anaesthesia. Best Practice & Research Clinical Anaesthesiology, 21(3), 327-343.
Nunes, R. R., Porto, V. C., Miranda, V. T., De Andrade, N. Q., & Carneiro, L. M. (2012). Risk factor for intraoperative awareness. Revista Brasileira de Anestesiologia, 62(3), 365-374.
Orser, B. A., Mazer, C. D., & Baker, A. J. (2007). Awareness during anesthesia. Canadian Medical Association, 185-188.
Sebel, P. S., Bowdle, T. A., Ghoneim, M. M., Rampil, I. J., Padilla, R. E., Gan, T. J., & Domino, K. B. (2004). The incidence of awareness during anesthesia: A multicenter United States study. International Anesthesia Research Society, 99, 833-839.