Luella

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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

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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.
 
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Luella

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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.
 

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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.
 

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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.
 

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rn29306

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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?
 

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militarymd

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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.
 
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Luella

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yeah, I suspect fuzzy math.
All articles I could find suggest more like a 1-2 per thou incidence.

Sometimes I forget to fact-check my television...
 

jwk

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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.
 

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militarymd said:
That is just unabashed, biased, advertising on the Aspect's part.
That's for sure.

And this "awareness" issue is not new news.
 

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rn29306

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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

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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.
 

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militarymd

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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.
 

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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.