Anaes Vivas · Depth of anaesthesia & awareness
Accidental awareness — communication and clinical viva
A communication/clinical viva on the management of a reported case of accidental awareness under general anaesthesia: believing the patient, the Brice interview, the explanation and apology, the record review, psychological follow-up, and the incident report.
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Target exams
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Prompt
A 40-year-old patient on the surgical ward, two hours after an emergency laparotomy under total intravenous anaesthesia, tells the nurse they heard voices and 'couldn't move or breathe' during the operation. You are the anaesthetist. Take me through your immediate and subsequent management.
Stimulus
A 40-year-old patient on the surgical ward, two hours after an emergency laparotomy under total intravenous anaesthesia, tells the nurse they heard voices and 'couldn't move or breathe' during the operation. You are the anaesthetist. Take me through your immediate and subsequent management[1][2].
References6ShowHide
- [1]Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth, 2014.PMID 25204697
- [2]Cook TM, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth, 2014.PMID 25204696
- [3]Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data. Br J Anaesth, 2014.PMID 25204695
- [4]Myles PS, Leslie K, McNeil J, Forbes A, Chan MT Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet, 2004.PMID 15172773
- [5]Avidan MS, Jacobsohn E, Glick D, et al. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med, 2011.PMID 21848460
- [6]Messner M, Beese U, Romstöck J, et al. The bispectral index declines during neuromuscular block in fully awake persons. Anesth Analg, 2003.PMID 12873942