The State of UK anaesthesia: a survey of National Health Service activity in 2013

Sury, Michael R. J.; Palmer, James; Cook, Tim; Pandit, J J

doi:10.1093/bja/aeu292

Cited by 148 publications

(142 citation statements)

References 11 publications

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“…For the analysis of risk factors, we compared the relative frequencies of features in AAGA reports with the frequency of those in the NAP5 activity survey [5].…”

Section: Methodsmentioning

confidence: 99%

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The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. 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% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. 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; neuromuscular blockade; 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, most 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 neuromuscular blockade. 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 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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“…For the analysis of risk factors, we compared the relative frequencies of features in AAGA reports with the frequency of those in the NAP5 activity survey [5].…”

Section: Methodsmentioning

confidence: 99%

“…Two of its stated aims included estimating an incidence of reports of AAGA and determining risk factors. The methodology is described in an accompanying paper [4] and together with its activity survey [5], makes NAP5 the largest and most comprehensive study on AAGA and its risk factors ever undertaken.…”

Section: Introductionmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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“…Overviews of the project have been described in part elsewhere [23][24][25][26][27][28]. The NAP5 project was approved by the National Information Governance Board in England and Wales, and Patient Advisory Groups in Scotland and Northern Ireland.…”

Section: Methodsmentioning

confidence: 99%

“…The UK and Irish baseline [24,26] and activity [27,28] surveys have been published in full and details will not be repeated here.…”

Section: Methodsmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data

et al. 2014

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SummaryAccidental awareness during general anaesthesia with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project was designed to investigate the reported incidence, predisposing factors, causality and impact of accidental awareness. A nationwide network of local co-ordinators across all UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymised reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorised into main types by a multidisciplinary panel, using a formalised process of analysis. The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorisation was also defined for each report. Patient experience and sequelae were categorised using current tools or modifications of such. The 5th National Audit Project methodology may be used to assess new reports of accidental awareness during general anaesthesia in a standardised manner, especially for the develop-1078

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“…Similarly, the denominator (total number of general anaesthetics) is unclear from the NAP5 results. It is indirectly inferred (with an undisclosed percentage error) from the activity surveys [6,7], and is further complicated by the fact that almost a quarter of the cases (35/141) actually occurred before the study commenced, but had not been previously reported to a health professional. In essence, the investigators were sampling from the population of all general anaesthesia 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.…”

Section: Essential Findingsmentioning

confidence: 99%

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

Avidan

Sleigh

2014

Anaesthesia

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The State of UK anaesthesia: a survey of National Health Service activity in 2013

Abstract: Anaesthesia in the UK is currently predominantly a consultant-delivered service. The low mortality rate supports the safety of UK anaesthetic care. The survey data should be valuable for planning and monitoring anaesthesia services.

Cited by 148 publications

References 11 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data

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

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