Beware the Boojum: the NAP5 audit of accidental awareness during intended general anaesthesia

The role and limitations of EEG‐based depth of anaesthesia monitoring in theatres and intensive care

“…More recently, the 5th National Audit Project (NAP5) demonstrated an overall incidence of ~1:19,000 anaesthetics . The disparity between results and methodologies used has been extensively discussed, with Avidan and Sleigh commenting in an editorial that NAP5 ‘was reliant on sampling from the population of all GA survivors from 1946 to the present, who had not previously reported any intra‐operative recall, and who had also chanced to be exposed to the investigation team’ . Importantly, the associated NAP5 Activity Survey reported that only 2.8% of all general anaesthetics involved depth of anaesthesia (DOA) monitoring in the UK .…”

Awareness in cardiothoracic anaesthetic practice - where now after NAP5?

“…The estimated incidence of spontaneous reports of awareness in the UK in the NAP5 study was 1:15 000 in the baseline survey and 1:19 000 in the main study , remarkably less than in the formal studies with a Brice interview . The possible reasons for this have been addressed elsewhere , and it is important to stress that NAP5 does not provide a definitive incidence of unintended awareness during cardiothoracic anaesthesia. The NAP5 project received five or four spontaneous reports of unintended awareness during cardiac anaesthesia, depending on whether one reads Chapter 11 or Chapter 14, and four reports during thoracic anaesthesia (Table ).…”

Tramadol - the Marmite™drug

“…The estimated incidence of spontaneous reports of awareness in the UK in the NAP5 study was 1:15 000 in the baseline survey [26] and 1:19 000 in the main study [5], remarkably less than in the formal studies with a Brice interview [2,16]. The possible reasons for this have been addressed elsewhere [27,28], and it is important to stress that NAP5 does not provide a definitive incidence of unintended awareness during cardiothoracic anaesthesia. The NAP5 project received five or four spontaneous reports of unintended awareness during cardiac anaesthesia, depending on whether one reads Chapter 11 or Chapter 14, and four reports during thoracic anaesthesia (Table 2).…”