Anaes Vivas · Depth of anaesthesia & awareness
Accidental awareness under general anaesthesia — Viva
Clinical viva on accidental awareness: the NAP5 incidence and risk gradient, the paralysed-but-aware mechanism, prevention, and the believe-and-follow-up response to a report.
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Target exams
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Prompt
A woman reports hearing voices and being unable to move during an emergency caesarean under general anaesthesia. Discuss what happened, the risk factors, and what you do now and next time.
Viva Stems
- What happened here, and why is the caesarean patient at particular risk?
- Quote the NAP5 incidence figures an examiner expects.
- Name the NAP5 risk factors — and the factors that were not risks.
- Why is neuromuscular blockade central to this case?
- How do you prevent awareness in a paralysed, high-risk patient?
- What does the BIS-versus-end-tidal trial evidence show?
- She is in front of you now reporting this. What do you do?
- What are the common exam pitfalls on this topic?
References3ShowHide
- [1]Pandit JJ, 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, 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]Avidan MS, et al. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med, 2011.PMID 21848460