5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

被引：296

作者：

Pandit, J. J. ^{[1
]}

Andrade, J. ^{[2
,3
]}

Bogod, D. G. ^{[4
]}

Hitchman, J. M.

Jonker, W. R. ^{[5
]}

Lucas, N. ^{[6
]}

Mackay, J. H. ^{[7
]}

Nimmo, A. F. ^{[8
]}

O'Connor, K. ^{[9
]}

O'Sullivan, E. P. ^{[10
]}

Paul, R. G. ^{[11
]}

Palmer, J. H. M. G. ^{[12
]}

Plaat, F. ^{[13
]}

Radcliffe, J. J. ^{[14
]}

Sury, M. R. J. ^{[15
]}

Torevell, H. E. ^{[16
]}

Wang, M. ^{[17
]}

Hainsworth, J. ^{[18
]}

Cook, T. M. ^{[19
]}

机构：

[1] Oxford Univ Hosp NHS Trust, Nuffield Dept Anaesthet, Oxford, England

[2] Univ Plymouth, Sch Psychol, Dept Psychol, Plymouth PL4 8AA, Devon, England

[3] Univ Plymouth, Cognit Inst, Plymouth PL4 8AA, Devon, England

[4] Nottingham Univ Hosp NHS Trust, Dept Anaesthesia, Nottingham, England

[5] Sligo Reg Hosp, Dept Anaesthesia Intens Care & Pain Med, Sligo, Ireland

[6] Northwick Pk Hosp & Clin Res Ctr, Dept Anaesthesia, Harrow HA1 3UJ, Middx, England

[7] Papworth Hosp, Dept Anaesthesia, Cambridge CB3 8RE, England

[8] Royal Infirm Edinburgh NHS Trust, Dept Anaesthesia, Edinburgh, Midlothian, Scotland

[9] Bristol Sch Anaesthesia, Bristol, Avon, England

[10] St James Hosp, Dept Anaesthesia, Dublin 8, Ireland

[11] Royal Brompton Hosp, Adult Intens Care Unit, London SW3 6LY, England

[12] Salford Royal Hosp, Dept Anaesthesia, Salford, Lancs, England

[13] Imperial Coll NHS Trust, Dept Anaesthesia, London, England

[14] Natl Hosp Neurol & Neurosurg, Dept Neuroanaesthesia, London, England

[15] Great Ormond St Hosp NHS Fdn Trust, Dept Anaesthesia, London, England

[16] Bradford Teaching Hosp NHS Fdn Trust, Bradford, W Yorkshire, England

[17] Univ Leicester, Leicester, Leics, England

[18] Leicestershire Partnership NHS Trust, Leicester, Leics, England

[19] Royal United Hosp, Dept Anaesthesia & Intens Care Med, Bath BA1 3NG, Avon, England

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2014年 / 113卷 / 04期

基金：

英国惠康基金;

关键词：

accidental awareness; awareness; National Audit Project; NEUROMUSCULAR BLOCKING-DRUGS; ISOLATED FOREARM TECHNIQUE; INTRAOPERATIVE AWARENESS; AIRWAY MANAGEMENT; MASK VENTILATION; BASE-LINE; RECALL; CLAIMS; UK; DYSANAESTHESIA;

D O I：

10.1093/bja/aeu313

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was similar to 1:19 600 anaesthetics (95% confidence interval 1:16 700-23 450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was similar to 1:8200 (1:7030-9700), and without, it was similar to 1:135 900 (1:78 600-299 000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was similar to 1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included:use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included:female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5-the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

引用

页码：549 / 559

页数：11

共 13 条

[1] The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors
Pandit, J. J.
Andrade, J.
Bogod, D. G.
Hitchman, J. M.
Jonker, W. R.
Lucas, N.
Mackay, J. H.
Nimmo, A. F.
O'Connor, K.
O'Sullivan, E. P.
Paul, R. G.
Palmer, J. H. MacG.
Plaat, F.
Radcliffe, J. J.
Sury, M. R. J.
Torevell, H. E.
Wang, M.
Hainsworth, J.
Cook, T. M.
[J]. ANAESTHESIA, 2014, 69 (10) : 1089 - 1101
[2] 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data
Pandit, J. J.
Andrade, J.
Bogod, D. G.
Hitchman, J. M.
Jonker, W. R.
Lucas, N.
Mackay, J. H.
Nimmo, A. F.
O'Connor, K.
O'Sullivan, E. P.
Paul, R. G.
Palmer, J. H. MacG
Plaat, F.
Radcliffe, J. J.
Sury, M. R. J.
Torevell, H. E.
Wang, M.
Cook, T. M.
[J]. BRITISH JOURNAL OF ANAESTHESIA, 2014, 113 (04) : 540 - 548
[3] The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data
Pandit, J. J.
Andrade, J.
Bogod, D. G.
Hitchman, J. M.
Jonker, W. R.
Lucas, N.
Mackay, J. H.
Nimmo, A. F.
O'Connor, K.
O'Sullivan, E. P.
Paul, R. G.
Palmer, J. H. MacG.
Plaat, F.
Radcliffe, J. J.
Sury, M. R. J.
Torevell, H. E.
Wang, M.
Cook, T. M.
[J]. ANAESTHESIA, 2014, 69 (10) : 1078 - 1088
[4] 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues
Cook, T. M.
Andrade, J.
Bogod, D. G.
Hitchman, J. M.
Jonker, W. R.
Lucas, N.
Mackay, J. H.
Nimmo, A. F.
O'Connor, K.
O'Sullivan, E. P.
Paul, R. G.
Palmer, J. H. M. G.
Plaat, F.
Radcliffe, J. J.
Sury, M. R. J.
Torevell, H. E.
Wang, M.
Hainsworth, J.
Pandit, J. J.
[J]. BRITISH JOURNAL OF ANAESTHESIA, 2014, 113 (04) : 560 - 574
[5] The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues
Cook, T. M.
Andrade, J.
Bogod, D. G.
Hitchman, J. M.
Jonker, W. R.
Lucas, N.
Mackay, J. H.
Nimmo, A. F.
O'Connor, K.
O'Sullivan, E. P.
Paul, R. G.
Palmer, J. H. MacG.
Plaat, F.
Radcliffe, J. J.
Sury, M. R. J.
Torevell, H. E.
Wang, M.
Hainsworth, J.
Pandit, J. J.
[J]. ANAESTHESIA, 2014, 69 (10) : 1102 - 1116
[6] Beware the Boojum: the NAP5 audit of accidental awareness during intended general anaesthesia
Avidan, M. S.
Sleigh, J. W.
[J]. ANAESTHESIA, 2014, 69 (10) : 1065 - 1068
[7] A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK
Pandit, J. J.
Cook, T. M.
Jonker, W. R.
O'Sullivan, E.
[J]. BRITISH JOURNAL OF ANAESTHESIA, 2013, 110 (04) : 501 - 509
[8] A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK
Pandit, J. J.
Cook, T. M.
Jonker, W. R.
O'Sullivan, E.
[J]. ANAESTHESIA, 2013, 68 (04) : 343 - 353
[9] Awareness during anaesthesia: NAP5 report released in UK
[J]. Reactions Weekly, 2014, 1519 (1) : 10 - 10
[10] Awareness with Recall After Neuromuscular Blockade—Lessons on Anesthetic Awareness from the UK and Ireland National Audit Project 5 (NAP5)
Alastair F. Nimmo
[J]. Current Anesthesiology Reports, 2020, 10 : 488 - 500

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