Awareness under anaesthesia: The role of the perioperative nurse

Dawn Bull,Paula Foran

doi:10.26550/2209-1092.1184

Abstract

Intra-operative awareness is very rare yet represents a serious complication of general anaesthesia. The ongoing consequences of such an event may cause significant distress and long-term effects such as insomnia, depression, anxiety and post-traumatic stress disorder (PTSD). To provide safer anaesthesia, it is critical to identify contributing factors related to both the patient and the anaesthesia to prevent intra-operative awareness in at-risk patients. It is also vital to provide education to Post Anaesthesia Care Unit (PACU) nurses and surgical ward nurses about the appropriate way to manage a situation when a patient reports intra-operative awareness following anaesthesia. General anaesthesia with neuromuscular blockade is still considered the highest risk factor for intra-operative awareness. Depth of anaesthesia monitoring has come under the spotlight to try and address this complication; however, there is yet to be a device or technique that provides 100 per cent accuracy in measuring depth of anaesthesia. It is the collective responsibility of all perioperative staff to identify patients at high risk of intra-operative awareness, manage the intra-operative complexities and offer support and expert counselling post-operatively when intra-operative awareness is reported.

Highlights

Intra-operative awareness is defined as ‘post-operative recall of events during the period of general anaesthesia’.1,(p.115) It is a distressing complication of anaesthesia where patients have reported paralysis, hearing intra-operative conversations, feeling surgical manipulations and sometimes pain, with associated feelings of being helpless and afraid.[2]The fear of intra-operative awareness is second only to that of postoperative nausea and vomiting.[3]
Despite the low incidence of intraoperative awareness, it is still an area of particular concern for clinicians working in anaesthesia due to the potentially harmful and long-lasting effects on patients
The perioperative nurse plays an important role throughout all aspects of the patient’s perioperative journey in helping to advocate for use of detection monitoring and manage instances of intra-operative awareness that may be reported in the Post Anaesthesia Care Unit (PACU)

Summary

Introduction

Intra-operative awareness is defined as ‘post-operative recall of events during the period of general anaesthesia’.1,(p.115) It is a distressing complication of anaesthesia where patients have reported paralysis, hearing intra-operative conversations, feeling surgical manipulations and sometimes pain, with associated feelings of being helpless and afraid.[2]The fear of intra-operative awareness is second only to that of postoperative nausea and vomiting.[3]. Following extensive reading on this subject, three themes emerged: risk factors for adult patients, depth of anaesthesia monitoring and detection of post-operative awareness.

Results

Conclusion