Awareness with Recall After Neuromuscular Blockade-Lessons on Anesthetic Awareness from the UK and Ireland National Audit Project 5 (NAP5)

Purpose of Review This review will summarize the current understanding of awareness with recall (AWR) after general anesthesia and draw ten lessons on its prevention and management from the largest study of AWR, the UK and Ireland National Audit Project 5 (NAP5). Recent Findings The results of NAP5 were published in 2014 and resulted in practice guidance on the prevention and management of AWR, "The NAP5 Handbook" which was published in 2019. NAP5 also led to the Guidelines for the Safe Practice of Total Intravenous Anaesthesia (TIVA) which were produced by the Association of Anaesthetists and the Society for Intravenous Anaesthesia (SIVA) and published in 2019. Summary Awareness with recall (AWR) after general anesthesia usually occurs when a neuromuscular blocking drug is given. The principal problem would be better described as awareness with recall after neuromuscular blockade (ARNB). Attempts to avoid or detect AWR should focus on preventing or detecting situations in which a neuromuscular blocking drug is acting but inadequate hypnotic anesthetic drug is given.