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NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 & AAGA Mike.

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Presentation on theme: "NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 & AAGA Mike."— Presentation transcript:

1 NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 The 5th National Audit Project ■ ■ ■ ■ ■ NAP5 & AAGA Mike Sury APA Linkman Meeting 2014

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4 AAGA is recall of an experience Is it from – Direct questioning? – Spontaneous reporting?

5 The incidence of AAGA in adults 0.1 - 0.2%, mainly related to paralysis 15% get PTSD Avidan et al. 2008 Avidan et al. 2011 Myles et al. 2004 Sandin et al. 2000 Sebel et al. 2004 Wennervirta et al. 2002

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7 NAP5 Spontaneous reports – First reports only A procedure managed by an anaesthetist – In and out of theatres – the patent complains

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9 How many reports? Of 300 reports – 141 were class A or B A = certain B = probable C = sedation D = ICU E = unassessable F = unlikely G = other SO = statement only

10 Classification: experience NAP5 The 5th National Audit Project ■ ■ ■ ■ ■

11 NAP5 activity survey Denominator Important details – Who – What – Which – When

12 Intended Conscious level (LOC) GA2,766,60076.9% Sedation (of any level) 308,8008.6% Awake523,10014.5%

13 Main procedure

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15 Intended LOC

16 2.8m GA cases per year (overall incidence of AAGA reports = 1:20,000)

17 Incidence: depends on circumstances NAP5 The 5th National Audit Project ■ ■ ■ ■ ■

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20 Vignettes: Unassessable or Statement Only

21 ? Missing reports If 0.74% is the true rate of AAGA, there should be approximately 3,700 children per year in the UK with recall of events during general anaesthesia.

22 NAP5 Executive Summary The largest AAGA study ever undertaken Of 300 reports – 141 classified as “certain/probable” or “possible” AAGA Wide range of experiences/sensations 50% reported distress linked to paralysis. – psychological sequelae pronounced and long lasting in 41% NAP5 The 5th National Audit Project

23 Common/Important situations Induction Transfer Emergence Cardiovascular collapse Syringe swops TIVA

24 Induction 50% of reports Causative/contributory factors were: – thiopental – obesity, – rapid sequence induction (RSI), – prolonged airway management

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27 drug omission on transfer (‘Mind the gap’)

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29 Emergence 18% almost all experienced distressing residual paralysis from unmonitored blockade

30 Cardiovascular instability Do not turn anaesthesia off Except…………

31 Accidental paralysis from drug error 10% of reports identical effects. “organisational factors” NAP5 The 5th National Audit Project

32 TIVA Transfers to ICU/Radiology poor & non-standard techniques ? monitoring NAP5 The 5th National Audit Project

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34 Preventable? 2/3 were – Or were they? 7% had no obvious explanation

35 Minimising the psychological consequences of AAGA Before – “if you waken you might not be able to move ………. this is reversible, I will look after you …..” – Reconfirm intended conscious level During – Reassure the patient if you think they are awake

36 Managing AAGA: suggested pathway NAP5 The 5th National Audit Project ■ ■ ■ ■ ■

37 NAP5: Recommendations N = 64 TIVA and EEG – both need training with pragmatic protocols SOPs (Who checklist, what to say to patients, how to manage AAGA) NAP5 The 5th National Audit Project


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