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dc.contributor.authorPandit, JJ
dc.contributor.authorAndrade, Jackie
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, JHMG
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.authorCook, TM
dc.contributor.authorArmstrong, J
dc.contributor.authorBird, J
dc.contributor.authorEddy, A
dc.contributor.authorHarrop-Griffiths, W
dc.contributor.authorLove, N
dc.contributor.authorMahajan, R
dc.contributor.authorMallick, A
dc.contributor.authorBarker, I
dc.contributor.authorKirkpatrick, A
dc.contributor.authorMolodynski, J
dc.contributor.authorPoonnusamy, K
dc.contributor.authorMoonesinghe, R
dc.contributor.authorWeatherill, D
dc.contributor.authorSmith, D
dc.contributor.authorHumphrey, M
dc.contributor.authorCasserly, M
dc.contributor.authorDrake, S
dc.contributor.authorRangasami, J
dc.date.accessioned2016-12-22T12:35:17Z
dc.date.available2016-12-22T12:35:17Z
dc.date.issued2014-10
dc.identifier.issn0007-0912
dc.identifier.issn1471-6771
dc.identifier.urihttp://hdl.handle.net/10026.1/8160
dc.description.abstract

We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

dc.format.extent549-559
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoeng
dc.publisherElsevier BV
dc.subjectaccidental awareness
dc.subjectawareness
dc.subjectNational Audit Project
dc.title5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors
dc.typejournal-article
dc.typeJournal Article
dc.typeResearch Support, Non-U.S. Gov't
plymouth.author-urlhttps://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000343087400007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008
plymouth.issue4
plymouth.volume113
plymouth.publication-statusPublished
plymouth.journalBritish Journal of Anaesthesia
dc.identifier.doi10.1093/bja/aeu313
plymouth.organisational-group/Plymouth
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)
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dc.publisher.placeEngland
dc.identifier.eissn1471-6771
dc.rights.embargoperiodNo embargo
rioxxterms.versionofrecord10.1093/bja/aeu313
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
plymouth.oa-locationhttp://bja.oxfordjournals.org/content/113/4/549.long


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