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dc.contributor.authorCook, TM
dc.contributor.authorAndrade, J
dc.contributor.authorBogod, DG
dc.contributor.authorHitchman, JM
dc.contributor.authorJonker, WR
dc.contributor.authorLucas, N
dc.contributor.authorMackay, JH
dc.contributor.authorNimmo, AF
dc.contributor.authorO'Connor, K
dc.contributor.authorO'Sullivan, EP
dc.contributor.authorPaul, RG
dc.contributor.authorPalmer, JHM
dc.contributor.authorPlaat, F
dc.contributor.authorRadcliffe, JJ
dc.contributor.authorSury, MRJ
dc.contributor.authorTorevell, HE
dc.contributor.authorWang, M
dc.contributor.authorHainsworth, J
dc.contributor.authorPandit, JJ

<jats:title>Summary</jats:title><jats:p>The 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients’ experiences ranged from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for &lt; 5 min, yet 51% of patients (95% CI 43–60%) experienced distress and 41% (95% CI 33–50%) suffered longer‐term adverse effect. Distress and longer‐term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's <jats:italic>interpretation</jats:italic> of what is happening at the time of the awareness seemed central to later impact; explanation and reassurance during suspected accidental awareness during general anaesthesia or at the time of report seemed beneficial. Quality of care before the event was judged good in 26%, poor in 39% and mixed in 31%. Three quarters of cases of accidental awareness during general anaesthesia (75%) were judged preventable. In 12% of cases of accidental awareness during general anaesthesia, care was judged good and the episode not preventable. The contributory and human factors in the genesis of the majority of cases of accidental awareness during general anaesthesia included medication, patient and education/training. The findings have implications for national guidance, institutional organisation and individual practice. The incidence of ‘accidental awareness’ during sedation (~1:15 000) was similar to that during general anaesthesia (~1:19 000). The project raises significant issues about information giving and consent for both sedation and anaesthesia. We propose a novel approach to describing sedation from the patient's perspective which could be used in communication and consent. Eight (6%) of the patients had resorted to legal action (12, 11%, to formal complaint) at the time of reporting. The 5th National Audit Project methodology provides a standardised template that might usefully inform the investigation of claims or serious incidents related to accidental awareness during general anaesthesia.</jats:p>

dc.subjectAnesthesia, General
dc.subjectDeep Sedation
dc.subjectIntraoperative Awareness
dc.subjectMedical Audit
dc.subjectStress Disorders, Post-Traumatic
dc.titleThe 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues
plymouth.organisational-group/Plymouth/Admin Group - REF
plymouth.organisational-group/Plymouth/Admin Group - REF/REF Admin Group - FoH
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/School of Psychology
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA04 Psychology, Psychiatry and Neuroscience
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA04 Psychology, Psychiatry and Neuroscience/UoA04 REF peer reviewers
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)
plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)/Cognition
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Plymouth Institute of Health and Care Research (PIHR)
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.rights.embargoperiodNo embargo
rioxxterms.typeJournal Article/Review

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