Prevention of Awareness During Surgery

Prevention of Awareness During Surgery

The ultimate goals of anesthesia professional are always to protect the life of the patient and to make the patient as comfortable as possible. The primary purpose of maintenance of anesthesia is to ensure the adequacy of anesthesia so as to prevent awareness during surgery. Intraoperative awareness occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and subsequently has recall of these events. Recall after surgery under general anesthesia can be a psychological disaster from which the victim may take months to recover (post-traumatic stress disorder), which can lead to long lasting effects such as night mares, tremors, insomnia, fear of death even suicidal attempt.

Recall is always linked to a general anesthetic technique which has employed muscle relaxation and artificial ventilation. It may occur at any time: during induction (intubation of the trachea); during maintenance; and during emergence.

Awareness may arise from several causes:

• Clinical fault (misjudged anesthesia requirement or failure to balance anesthesia)
• Technical fault (the anesthesia system does not deliver the required mixture)
• Poor intraoperative monitoring of the patient
• Mixture of the above

Clinical observation as discussed in maintenance of anesthesia with intravenous drugs remains the mainstay of the diagnosis of impending or actual awareness.

Prevention include administering sufficient dose of hypnosis, avoiding unnecessary use of muscle relaxants, continuous monitoring of depth of anesthesia and maintain balanced anesthesia to the level of surgical or diagnostic procedures. If it is happened, the anesthetist should not ignore, rather should council the patient, and also should apology