Awarness During Anesthesia- PPT -josh Flashcards Preview

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Flashcards in Awarness During Anesthesia- PPT -josh Deck (37):
1

What is " the state of being conscious; awareness of one's own existence, sensation, thoughts, surroundings, etc"

 

Consciousness

 

2

What is " having knowledge,conscious, cognizant"

Awarness

3

what % of Pt's are concerned that they would not be asleep during their surgery

> 50%

4

For the anesthetists, _____ under anesthesia rancks second only to death as a "dreaded" complication

awareness

5

Which sx's have the highest incidence of awareness during anesthesia?

Trauma (11-43%)

OB (c/s)- 11.8%-1968 / 0.9% 1991

Cardiac 1977 5.8% / 0.3% 1998

General 1.2% 1960 / 0.11-0.16% 2000

 

6

what are the 5 most common pt perceptions of awareness

  1. Sounds and conversations 89-100%
  2. Sensation of paralysis 85%
  3. Anxiety and panic
  4. helplessness and powerless
  5. pain 39%

7

What are 3 of the least common pt perceptions of awareness?

  1. Visual perceptions
  2. Intubation or tube
  3. Feeling the oporation w/o pain

8

what are the 2 main after-effects of awareness during general anesthesia?

  • mental after-effects
  • Medico-legal After-effects

9

the cause of the mental after-effects of awareness can be caused by 37% of pt's being responded to by healthcare professionals in what 3 ways r/t thier reports of awareness

  • Disbelief
  • Ignorance
  • Anger

10

14% of pt's w/ awareness were told that their awareness was what?

  • just a bad dream
  • All in your imagination
  • Were medicated or hallucinating
  • had a 7th sense

11

what are some of the after-effects of surgical awareness

  • Sleep disturbances (fear of falling asleep)
  • Repetitive nightmares (54%)
  • Anxiety and panic (55%)
  • Depression
  • Flashbacks
  • Avoidance of medical care
  • Preoccupation of death
  • PTSD (14.3% to 22%)

12

what are the medico-legal after-effects of awareness?

very large compensations

13

what are risk factors for awareness?

  • No volatile used
  • Female
  • OB/GYN procedure
  • Opioid only
  • Muscle relaxants

14

what are main causes/factors of awareness?

  1. Light anesthesia
  2. malchine malfunction or misuse of tech
  3. Increased anesthestic requirements

15

 main causes/factors of awareness

what are the causes of light anesthesia

 

  • N2O/opioid/relaxant anesthesia
  • Myocardial depression
  • hypovolemia
  • C-section
  • Difficult intubation
  • Premature d/c of anesthestic

16

 main causes/factors of awareness

what are causes of machine malfunction or misuse

  • Failure to check equip
  • Vaporizer and circuit leaks
  • IV infusion errors
  • Accidental adm of muscle relaxant to awake pt

17

 main causes/factors of awareness

what are causes of increased anesthestic requirement?

  • Varibility of anesthestic requirement for IV agent
  • chronic ETOH, opoid, and cocaine abuse

18

what are 10 ways to prevent awareness?

  1. Amnestic premeds
  2. Vigilance w/ equip and monitoring
  3. Minimize complete Neuromuscular blockade
  4. Supplement N2O/opioid anesthesia w/ volatile anesthesia
  5. Maintain 0.8-1.0 MAC of a potent VAA itself
  6. Administer adequate dose of induction drug
  7. Obtain informed consent for high risk pt's
  8. Mask auditory input
  9. Provide education
  10. Monitor for awareness

19

what is the best way to detect awareness?

  • Structured postoperative interview

20

what are 5 great questions to ask during your potop awareness interview questioning

  1. What is the last thing you remember b4 going to sleep for the operation?
  2. what is teh first thing you remember after waking up after the operation?
  3. Do you remember anything between?
  4. Did you have any dreams?
  5. What was the most unpleasant thing you remember from your operation and anesthesia?

21

what are some clinical signs of awareness (AKA light anesthesia) and unreliable

  • Sympathetic activities:
  • Increased HR
  • Increased BP
  • sweating
  • pupillary dilation
  • Lacrimation

22

 main causes/factors of awareness

what are some ways to monitor for awareness?

  • ISOLATED FOREARM TECH
  • EEG
  • BIS
    AEP

IFT: the isolated forearm technique was originally described by Tunstall in obstetric anaesthesia. A tourniquet is applied to the patient's upper arm and inflated above systolic blood pressure, before the administration of muscle relaxants. Movement of the arm, either spontaneously or to command, indicated wakefulness, although not necessarily explicit awareness. At 15 - 20 minutes the anaesthetist lets the tourniquet down, and may then reinflate it if further muscle relaxant is required. Some would argue that response to command during surgery is a late sign when attempting to prevent awareness; however, not all patients responding have any recall.

23

what are 5 ways to manage a pt w/awareness

  1. Detailed interview w/ pt
    • Verify pt's account
    • Sympathize
    • Try to explain what happened
    • reassure about non-repetition
    • Apologize
    • Offer psychological support
  2. Record interview
  3. Informs pt's surgeon, RN, and hospitals lawyer
  4. Visit pt daily during hospital stay and keep in contact by telephone
  5. Don't delay referral to a psychologist or psychiatrist

24

Conclusions:

Incidence of awareness in GA is ___%

0.1-0.2%

25

Conclusions:

What is the incidence of awareness in cardiac sx

0.3%

26

Conclusions:

lower dose of anesthestics are associated w/ ______ incidence of intra-op awareness;

higher

27

Conclusions:

Standard physiologic monitoring is not reliable, such as AEP or BIS; however ______ signs are much more unreliable

Clinical

28

Conclusions:

the Psychiatric after-effect of awareness renages from no effect to _____

 

 

PTSD

29

Conclusions:

There is no evidence that any kind of ________ would affect the incidence of awareness

 

  • premedication

30

Conclusions:

if prolonged laryngoscopy is required, one should not forget to add more  ______ or ______

Induction agent

or

inhalation agent

31

Conclusions:

in a critical hemodynamic situation, ____ instead of General anesthestics may be aceptable

BZD

32

Conclusions:

to prevent awareness _____ should be used as sparingly as possible

NMBs

33

Conclusions:

if a pt has a hx of awareness under GA, it would be wise to use a _____

monitor

34

Conclusions:

if the pt has suffered from awareness, ________ consultation and _________ is recommended

  1. psychiatric
  2. Follow-up

35

Conclusions:

Just a fun fact....

most of her conclusions were not in the main slides.. odd

36

Another odd fact......

Wearing headphones for just an hour will increase the bacteria in your ear by 700 times


 

37

one more for good luck

A duck's quack doesn't echo, and no one knows why