Patient perspectives on intraoperative awareness with explicit recall: report from a North American anaesthesia awareness registry

• Published in: British journal of anaesthesia : BJA Vol. 115; no. suppl_1; pp. i114 - i121
• Main Authors: Kent, C.D., Posner, K.L., Mashour, G.A., Mincer, S.L., Bruchas, R.R., Harvey, A.E., Domino, K.B.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2015; Oxford University Press
• Subjects: Adolescent; Adult; anaesthesia, general; Female; Humans; intraoperative awareness; Intraoperative Awareness - epidemiology; Male; Mental Recall; Middle Aged; patient preference; patient satisfaction; Registries; patient preference; patient satisfaction; anaesthesia, general; intraoperative awareness; registries
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aev211

Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended awareness from the patient’s perspective with an emphasis on their experiences and healthcare provider responses.
English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses.
Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%).
Data from this registry confirm the serious impact of anaesthesia awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers.