Anesthetic Awareness!?!!

Luella

Junior Member
10+ Year Member
Jun 14, 2006
8
0
    Just saw a documentary about this on the Discovery Health Channel...

    The incidence of this phenomenon has gone down since the intro of BIS in '96, but there are still a number of cases in which the paralytic works but the patient is still conscious. Usually, HR and BP go up so the anesthesiologist can correct the dose, but not always. Has anyone heard of a reported case recently?
     

    militarymd

    SDN Angel
    10+ Year Member
    15+ Year Member
    Dec 17, 2003
    5,886
    20
    1. Attending Physician
      Luella said:
      Just saw a documentary about this on the Discovery Health Channel...

      The incidence of this phenomenon has gone down since the intro of BIS in '96, but there are still a number of cases in which the paralytic works but the patient is still conscious. Usually, HR and BP go up so the anesthesiologist can correct the dose, but not always. Has anyone heard of a reported case recently?

      There are several studies looking at this.....reported incidence is supposedly 1 in 1000 anesthetics.....multiple centers have reported this rate.
       

      Luella

      Junior Member
      10+ Year Member
      Jun 14, 2006
      8
      0
        militarymd said:
        There are several studies looking at this.....reported incidence is supposedly 1 in 1000 anesthetics.....multiple centers have reported this rate.


        According to the documentary, the incidence has gone down to 1 in 10,000 with the use of BIS monitors.

        I was wondering if anyone actually knows (1st, 2nd or 3rd hand) of an occurance.
         
        About the Ads

        Gator05

        Resident
        7+ Year Member
        15+ Year Member
        Oct 18, 2001
        350
        1
        1. Resident [Any Field]
          Also data to show that of those occurrences of awareness, the usual clinical/BIS indicies of awareness fail for many. In other words, if you had it to do over again, you're not sure you could prevent the awareness.
           

          UTSouthwestern

          1K Member
          Moderator Emeritus
          7+ Year Member
          15+ Year Member
          Jul 5, 2003
          2,070
          23
          Dallas, TX
            Luella said:
            According to the documentary, the incidence has gone down to 1 in 10,000 with the use of BIS monitors.

            I was wondering if anyone actually knows (1st, 2nd or 3rd hand) of an occurance.

            Know of one where a resident never turned on the vaporizer in a thoracic case. Gave the patient narcotic, but didn't realize that the vaporizer wasn't on until an hour into the case. Patient had total recall of the initial incision and application of rib spreading devices.

            Faculty was furious with the resident, but I wonder why the faculty also didn't notice the vaporizer not being on.
             

            rn29306

            Drugs are bad, m'kay?
            10+ Year Member
            7+ Year Member
            Oct 30, 2004
            422
            3
            Dirty South
            1. Post Doc
              UTSouthwestern said:
              Know of one where a resident never turned on the vaporizer in a thoracic case. Gave the patient narcotic, but didn't realize that the vaporizer wasn't on until an hour into the case. Patient had total recall of the initial incision and application of rib spreading devices.

              Faculty was furious with the resident, but I wonder why the faculty also didn't notice the vaporizer not being on.


              Is there a space on everyone's charting on here for ET% of gas?
               

              militarymd

              SDN Angel
              10+ Year Member
              15+ Year Member
              Dec 17, 2003
              5,886
              20
              1. Attending Physician
                Luella said:
                According to the documentary, the incidence has gone down to 1 in 10,000 with the use of BIS monitors.

                I was wondering if anyone actually knows (1st, 2nd or 3rd hand) of an occurance.

                That is just unabashed, biased, advertising on the Aspect's part.
                 

                jwk

                CAA, ASA-PAC Contributor
                15+ Year Member
                Apr 30, 2004
                3,856
                1,293
                Atlanta, GA
                  DreamMachine said:
                  Yes. But most residents fall behind in charting. Charting is a secondary concern. The first concern being to pay attention to your patient.
                  Although the patient is always the primary, don't fool yourself into thinking charting isn't important. It's not "secondary". Crappy charting and a bad outcome will burn your ass.
                   

                  rn29306

                  Drugs are bad, m'kay?
                  10+ Year Member
                  7+ Year Member
                  Oct 30, 2004
                  422
                  3
                  Dirty South
                  1. Post Doc
                    DreamMachine said:
                    Yes. But most residents fall behind in charting. Charting is a secondary concern. The first concern being to pay attention to your patient.

                    Rib spreaders! Oh my god!


                    I do realize what is involved in a major thoracic case, esp at the start...
                    - getting the DLT in, auscultation, FO, turning / positioning, ax rolls, re-verifying DLT placement, lung down...I could go on and on.

                    Thanks for your clarification on the "patient comes first". The ET% was a question in general. I wanted to know if everyone's charting included this.

                    I honestly cannot imagine what having your ribs spread apart must feel like.
                     

                    jwk

                    CAA, ASA-PAC Contributor
                    15+ Year Member
                    Apr 30, 2004
                    3,856
                    1,293
                    Atlanta, GA
                      rn29306 said:
                      I do realize what is involved in a major thoracic case, esp at the start...
                      - getting the DLT in, auscultation, FO, turning / positioning, ax rolls, re-verifying DLT placement, lung down...I could go on and on.

                      Thanks for your clarification on the "patient comes first". The ET% was a question in general. I wanted to know if everyone's charting included this.

                      I honestly cannot imagine what having your ribs spread apart must feel like.
                      Our most recent revision of our record includes ET% agent.

                      As far as the incidence - the 1:1000 is far too common to really be believable. But it's Aspect Medical's favorite study to quote. At that rate, my facility would be having a case of anesthetic awareness every 10 days. It doesn't. And as was suggested in an issue of the ASA Newsletter a couple of years ago, if the incidence of anesthetic awareness is that high with the author of the study, the author needs to learn a different anesthetic technique.
                       

                      militarymd

                      SDN Angel
                      10+ Year Member
                      15+ Year Member
                      Dec 17, 2003
                      5,886
                      20
                      1. Attending Physician
                        jwk said:
                        Our most recent revision of our record includes ET% agent.

                        As far as the incidence - the 1:1000 is far too common to really be believable. But it's Aspect Medical's favorite study to quote. At that rate, my facility would be having a case of anesthetic awareness every 10 days. It doesn't. And as was suggested in an issue of the ASA Newsletter a couple of years ago, if the incidence of anesthetic awareness is that high with the author of the study, the author needs to learn a different anesthetic technique.

                        I don't recall the exact details of how "awareness" was defined.....I believe the way it was defined in the studies....1 to 2 :1000 is believeable.
                         

                        UTSouthwestern

                        1K Member
                        Moderator Emeritus
                        7+ Year Member
                        15+ Year Member
                        Jul 5, 2003
                        2,070
                        23
                        Dallas, TX
                          DreamMachine said:
                          They may not have felt much with the narcotics on board. It seems by the way UT Southwestern described it, they were just "aware." I may be wrong. Lawsuit, UT Southwestern?

                          I don't know if they felt much pain with the narcotics on board. I just know that the patient felt it and sued. I also know that the resident was a first class prick and wouldn't take "credit" for forgetting.

                          His chart showed an amnestic level of end tidal sevoflurane that was obviously never given. Great ammo for a prosecuting attorney unless he chose to lie his ass off in court.
                           
                          About the Ads
                          This thread is more than 15 years old.

                          Your message may be considered spam for the following reasons:

                          1. Your new thread title is very short, and likely is unhelpful.
                          2. Your reply is very short and likely does not add anything to the thread.
                          3. Your reply is very long and likely does not add anything to the thread.
                          4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
                          5. Your message is mostly quotes or spoilers.
                          6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
                          7. This thread is locked.