Anesthesia Awareness .


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Anesthesia Awareness. PACU presentation 5/14/08 -S. Zaghi MD. Definition. Definition of Anesthesia: Anesthesia is a state in which the patient feels no pain. This may range from blocking the sensation of one small part of the body to total unconsciousness.
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Anesthesia Awareness PACU presentation 5/14/08 - S. Zaghi MD

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Definition of Anesthesia: Anesthesia is a state in which the patient feels no agony. This may go from obstructing the vibe of one little part of the body to aggregate obviousness. Meaning of Anesthesia Awareness: "unintended intra-agent awareness" happens amid general anesthesia, when a patient has not had enough broad soporific or pain relieving to anticipate cognizance.

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Definition Components of Anesthesia Unconsciousness Amnesia Anesthesia +/ - Muscle Relaxation Analgesia

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Definition How is Anesthesia "measured" Classically done by measuring centralizations of breathed in sedative specialists like: sevoflorane, desflorane.

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Definition Basic Concept of MAC Defn: MAC = Miniumum Alveolar Concentration of breathed in operator where at 1MAC, half of targets don\'t move to surgical boost. Macintosh for Iso: 1.1 MAC for Sevo: 2.2 MAC for Des: 6.6

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Definition Advanced comprehension of MAC qualities are added substance Addition of N2O oxide Use of opiates, benzodiazepines, and so on.. Macintosh qualities are understanding particular Age ETOH intense Hypothermia Pregnancy Drugs Hyponatremia 1 1.3

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MAC Aware .3 MAC – focus at which half of patients lose cognizance Bell Curve – half is clearly insufficient! Mindfulness .3 .7

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Importance Patient Experience

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Importance Clip of AWAKE

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Importance Increase in patient support

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Importance No motivation to utilize screens that are not compelling… Cost $$ 360 million in BIS test cost/yr

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Incidence .1 - .2% of all patients experiencing general anesthesia. 21 million patients have GETA, Calculated 20-40K/yr encounter Even be higher in kids Incidence computed for patients who got general anesthesia. local anesthesia (ie epidural) does not mean mindfulness

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Risk Factors Risk Factors Routine utilization of immobile people (twofold frequency from .1% to .18%) TIVA Light anesthesia for purpose of turnover Hemodynamic insecurity Procedures: Obstetric/Cardiac/Trauma Patient Age H.o of troublesome aviation route Limited heart hold H.o of substance misuse (perpetual ETOH, anxiolytics, cocaine) .

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Experiences What is experienced: Audio (48%) Not having the capacity to breath (48%) Pain (30%) from the ET tube to serious torment from entry point

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Etiologies Class 1 : pt particular changed increment in expression of analgesic receptors Class 2 : understanding can\'t endure sedative Class 3 : pt. hemodynamics are covered: Class 4 : analgesic conveyance disappointment

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Detection Hemodynamic Typical pointers of physiologic and engine reaction, for example, hypertension, heart rate, or development, lacrimation, Movement conceal by the utilization of immobile specialists to accomplish important muscle unwinding.

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Detection BIS screen Processed EEG from a solitary frontal anode, into a numerical unit less esteem. Values range from 0 – 100, and speak to nonattendance of cerebrum movement to alert state Usually go for numbers 40-60 for surgical anesthesia and point in diminishing mindfulness. BIS <40 speak to a profound mesmerizing state.

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Outcomes PTSD (30%) "most noticeably bad experience of my life" versus uncomfortable Unable to discover why a few people the experience prompts PTSD others less so. May recollect these occasions in the PACU, on the floor or even once they are released.

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Treatment Reassurance Honest examination with the patient about the danger variables of mindfulness Why mindfulness happened, and probability of reoccurrence. Pt ought to educate future anesthesiologist that has had mindfulness Some patients ought to be alluded for mental assessment and treatment/guiding ASADatabase of mindfulness AwarenessDB.org (http://depts.washington.edu/awaredb/)

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Prevention Premedication with versed (amenstic) if expect light anesthesia Ensure patient is snoozing preceding intubation (fitting measurements) Ensure incessant machine checks and fxn Watch examinations in the OR When giving beta blockers or antiHTN – stress over concealing mindfulness Avoid loss of motion unless required.

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B-UnAware study plan 2000 "high hazard" patients, randomized to ETAG versus BIS 40-60; both ETAG and BIS values PC recorded at 1sec interims for later correlation. Avidan MS, et al. Anesthesia mindfulness and the Bispectral Index. The New England Journal of Medicine 358, (11), 1097-1108: 2008.

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B-UnAware "High Risk" Major Criteria: long haul utilization of Narcotics/ETOH/cocaine/EF <40% h.o Anesthesia mindfulness, h.o troublesome intubation ASA 4 or 5 Aortic Stenosis/open heart surgery/ESLung Disease/Minor Criteria perioperative utilization of BBlockers COPD, BMI >30 tobacco 2packs/day

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B-UnAware Questionnaires where audited by blinded commentators for specificity for intraoperative occasions. On the off chance that two of three where in understanding however another was not, then a fourth master was brought into to assess. At that point taking into account occasions, master requested that recognize when in typical intraoperative course the mindfulness could have happened( to thus distinguish BIS or ETAG concentration]

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B-Unaware Results 90% (1754)of enlisted patients finished whole convention. 4 patients had unequivocal mindfulness, 2 in the BIS gathering and 2 in the ETAG bunch. General frequency of .2% 5 patients had conceivable mindfulness – in many cases reviewed in stand out meeting point, regularly the third most distal meeting date. 4 BIS and 1ETAG general rate of .6%, Of the 1754 patients who did not have mindfulness 55% (964) of them had BIS values that where managed more than 60 75% (1315) of them had ETAG that where more than .7

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B-UnAware Experiences

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B-UnAware Experience Definite Possible Notice how the Turquoise line (BIS) reliably in extent, yet mindfulness still happened

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