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12th Mar 2013

New survey reports low rate of patient awareness during anaesthesia

The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) today (12 March) publish initial findings from a major study which looked at how many patients experienced accidental awareness during general anaesthesia.

The survey asked all senior anaesthetists in NHS hospitals in the UK (more than 80% of whom replied) to report how many cases of accidental awareness during general anaesthesia they encountered in 2011. There are three million general anaesthetics administered each year. Study findings are published in Anaesthesia, and The British Journal of Anaesthesia, the peer-reviewed journals of the AAGBI, and RCoA respectively.

Previous reports have suggested a surprisingly high incidence of awareness of about one in 500 general anaesthetics. The current report found it to be much less common in the UK with one episode known to anaesthetists in every 15,000 general anaesthetics. The report also reports very low use of brain monitoring technology: with only 2% of anaesthetists routinely using it.

The survey is part of a major study called the Fifth National Audit Project (NAP5) taking place over three years. NAP5 is thought to be the largest study of its kind ever conducted and is funded entirely by the profession.

Professor Jaideep Pandit, Consultant Anaesthetist in Oxford and lead author, said: "Anaesthesia is a medical speciality very much focussed on safety and patient experience. We identified accidental awareness during anaesthesia as something which concerns patients and the profession. The profession is therefore undertaking this major study so that we can better understand the problem and work to reduce the likelihood of it happening to patients.

"We are particularly interested in patient experiences of awareness. Although we know that some patients do suffer distress after these episodes, our survey has found that the vast majority of episodes are brief and do not cause pain or distress.

"Our study will continue to explore the reasons for the differences between our figures and previous reports. Anaesthesia in the UK is administered only by trained doctors and is a consultant-led service. Whether this - or other factors such as differences in patient sensitivity to anaesthetic drugs or different detection rates influence the reported numbers - is something we will be studying in the rest of the project."

Professor Tim Cook, co-author and a Consultant Anaesthetist in Bath said: "Risks to patients undergoing general anaesthesia are very small and have decreased considerably in the last decades. Anaesthesia doctors in the UK undergo the same level of training as surgeons and physicians. Of the three million general anaesthetics administered in the NHS each year, only a very small number of patients experience awareness during anaesthesia, with the majority of these occurring before surgery starts or after it finishes.

"While our findings are generally reassuring for patients and doctors alike, we recognise that there is still more work to be done. We are spending the next year studying as many of the cases as possible to learn more from patients' experiences. It is hoped that the findings included in the final report, due out early 2014, will increase our understanding of accidental awareness during general anaesthesia so that the anaesthetic profession can further increase safety for patients.

"Anaesthetists have always put patients first and will continue to do so. This study, which comes just after the publication of the Francis report, shows that anaesthetists are clearly listening to patients and have acted positively to address a major patient concern."

Notes to editors
We have several expert spokespeople available for interview. Please contact Martin Spencer, AAGBI Marketing and Communications Manager, 020 7631 8854/07825 299549 or nap5@nap5.org or Simon Scott, RCoA Media Adviser, 07730 989 692.

The interim report Accidental Awareness during General Anaesthesia in the UK and Ireland: the 5th National Audit Project (NAP5) - a partnership between the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland is due to be published at 03.00am on Tuesday 12 March at: http://onlinelibrary.wiley.com/doi/10.1111/anae.2013.68.issue-4/issuetoc and at 07.05am at: http://bja.oxfordjournals.org/content/early/recent It is published in Anaesthesia and the British Journal of Anaesthesia respectively.

Patients who experience accidental awareness can remember events taking place just before or during their surgery. In many cases, the patient remembers only noise or touch. However, a smaller number describe feeling unpleasant sensations such as a feeling of suffocation, inability to move or even pain of surgery.

The project is the largest study of awareness during anaesthesia ever performed. Over three years, the project is collecting data (between 1 June 2012 and 31 May 2013) from approximately 3 million general anaesthetics. It is endorsed by all four Chief Medical Officers in the UK and is also supported by the College of Anaesthetists of Ireland. As with previous National Audit Projects, NAP5 has the support and involvement of every NHS hospital in the UK, as well as all hospitals in the Republic of Ireland. The project is led by Professor Jaideep Pandit and the final report is due to be published in the early part of 2014.

As well as recording the number of such cases the researchers will examine each case in depth. Local NAP5 Coordinators in each UK hospital are actively seeking to identify all cases reported within this one-year period. Each case is then analysed in detail by an expert panel of anaesthetist and psychologists so that as much can be learned as possible. Once the study is complete, all the results of NAP5 will be published on the NAP website http://www.nationalauditprojects.org.uk/NAP5_home

The Royal College of Anaesthetists is the professional body responsible for the specialty throughout the UK. It ensures the quality of patient care through the maintenance of standards in anaesthesia, critical care and pain medicine. To find out more about the RCoA, please visit http://www.rcoa.ac.uk.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) is the professional representative membership body for over 10,500 anaesthetists in the UK and Ireland. The AAGBI promotes patient care and safety. It advances anaesthesia through education, publications, research and international work. To find out more about the work of the AAGBI, visit www.aagbi.org.

12 March 2013

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