ASA press release - Point, Counterpoint, Common Ground

CHICAGO
March 31, 2006
PRNewswire

If you are facing the prospect of surgery, the American Society of Anesthesiologists (ASA) wants you to be well-informed³ about what you may encounter before, during and after the operation. 

1.) In the United States, pre-surgery communication consists of a very brief interview with an anesthesia provider unknown to the patient, while the patient is lying on a gurney in a skimpy hospital gown, understandably nervous about impending surgery, and in a sedated state (if they are lucky).

2.) Are patients who desire the use of brain activity monitoring empowered when the ASA does not even require a monitor in every hospital, much less every operating room?

3.)  Informed consent minutes prior to surgery seldom mentions the possibility of awareness.

     In-depth communication⁴ is a key component in reducing anxiety prior to surgery. As a patient, you should discuss with your anesthesiologist your medical history, prior experiences with anesthesia and your⁵ anesthesia plan.

4.) "In-depth communication" requires unhurried communication, which is not efficient use of time when an OR and surgeon and staff will be ready at a certain time.  I doubt that many patients feel they are given the opportunity for "in-depth" communication. 

5.) How much input does the patient actually have or know to ask for in "your plan?" 

     In return, patients will be reassured to know that anesthesiologists have all of the education, tools⁷ and information to provide state-of-the-art⁸ care.

6 If you are concerned about awareness and want to have the latest patient-safety technology used, but no monitors are available, that particular concerns will be ignored. 

a.) It is the duty of every patient to follow this requirement to the letter.  Hold back nothing! 

7.) except the assurance of the presence and use of a clinically proven effective brain activity monitor 

8.) In its "Practice Advisory of October 2006, the ASA does not require or even suggest the availability of state-of-the-art brain activity monitors, and if such state-of-the-art equipment should be available, the Practice Advisory leaves the use of such equipment up to the individual discretion of each anesthesiologist.

"The prospect of undergoing anesthesia and surgery can be unsettling for patients. We believe that the combination of patient communication and ongoing physician education⁹ can help alleviate some of this anxiety," said ASA President Orin F. Guidry, M.D.

9.) As far as physician education into the seriousness of anesthesia awareness for those who undergo it and the need to treat awareness victims with compassion, validation, apology, and attempts to prevent long-term sequelae, there is a lot of educating yet to be done (especially in the older generations of anesthesia providers).

     As part of ASA's on-going effort to provide its member physicians with critical patient safety guidance and information, its latest practice advisory tackles the uncommon phenomenon of "patient awareness"^b, ¹⁰ during general anesthesia (sometimes called "anesthesia awareness").¹¹ 

b.) Thank you for putting "awareness" back into awareness

10.) instead of clinging to the "euphemism" used in the Practice Advisory:  unintended intraoperative patient recall! 

11.) SOMETIMES???  Almost every media, including television, cable, newspapers, magazines, journals, websites (i.e., WebMD), other organizations (like JCAHO in their Sentinel Event Alert Issue 32) uses the term anesthesia awareness to describe this problem.

     Unintended awareness under general anesthesia is a rare¹² event in which a patient may regain consciousness and have recall of events during surgery. The advisory documents that awareness occurs in 1 to 2 cases per 1,000 surgeries performed under general anesthesia. Episodes of awareness may include hearing sounds and feeling sensations or pain and are more likely to occur in patients whose condition is unstable or during surgery for emergencies or trauma.c

     Although some awareness cases may be brief and insignificant, others may be much more significant or traumatic for the patient. Some episodes of awareness are not preventable, including cases in which the patient's health or injury requires lighter anesthesia to keep the patient safe. (Awareness is not an issue for patients who undergo procedures with moderate sedation, regional or local anesthesia, as these patients are expected to be aware during some or all of the procedure.) More information is available for patients on ASA's Web site at htp://www.asahq.org/patientEducation/
Awarenessbrochure.pdf .

     The Practice Advisory makes several recommendations to assist decision-making for patient care with the goal of reducing awareness. These recommendations are summarized in four major areas: preoperative evaluation of the patient's risk for awareness, use of equipment checklists, monitoring depth of anesthesia and drug selection. The advisory states that patients should be monitored with clinical techniques and conventional monitors such as electrocardiograms, vital signs and gas analyzers. Newer devices called "brain function monitors" may also be used at the discretion of the individual anesthesiologist. The Practice Advisory also recommends that anesthesiologists should continue to treat any patient who reports awareness with compassion and respect, and refer them for counseling as appropriate.

     He added that publication of this advisory further supports ASA's commitment to leadership in patient safety and in understanding and implementing the use of the latest proven technologies and techniques that advance the society's patient safety goals. "ASA has been educating its members about awareness for more than a decade through its NEWSLETTER and educational meetings. The advisory builds on this tradition and the Society's longstanding focus on patient safety," explained Dr. Guidry. "My view is that one case of preventable awareness is one case too many. NOW THIS IS REALLY PROGRESS!!  THANK YOU, DR. GUIDRY! This advisory will help our members move closer to this goal."

     Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 40,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.