Part of a speech delivered at MAA5, and international meeting in Hull, England, June 2004
From the Anesthesia Awareness Campaign, Inc.
February 3, 2004 *
* These suggestions, written February 3, 2004, closely resemble the suggestions in the Joint Commission on the Accreditation of Healthcare Organizations’ (JCAHO) Sentinel Event Alert #32 on Anesthesia Awareness, issued October 6, 2004.
Make time to speak to patients about their questions about anesthesia before surgery. Consider awareness a risk factor that should be disclosed; one no scarier than death, which is always discussed.
Remember that under the current system (at least in the US), a patient is expected to put their life in the hands of someone they’ve never met in an anesthesia provider; unlike a surgeon.
When patient movement occurs, please impress upon your peers and students to consider that their patient just may be trying to communicate awareness to you before more paralytic drug is automatically administered without an equal amount of sedation.
During surgery, talk to your patient by name, assuring them that you are there for them.
Consider teaching surgeons that completely debilitating amounts of paralytic neuro-blocking drugs are probably not necessary, and may allow more cases of awareness to slip through.Make that post-op visit to the PACU and the hospital room for inpatients. It is not always done! Refer any awareness victims you happen to have to this campaign or some other research organization so a means of prevention can be found’ and a better means of treating the life-changing trauma can be given.
If a claim of awareness is made, insist that everyone take that claim seriously and handle it with care. Push for the development and use of protocols for such incidents.
Make sure all patients and their families get immediate professional psychological help.
Please consider or reconsider using available brain activity monitoring technology. I know the ASA claims it is not yet 100% accurate nor peer vetted by their organization, but it is better than nothing. And the FDA has endorsed it. Obviously, action has to be taken outside the aegis of the ASA or the issue will never be "peer vetted." Brain activity monitoring must become as routine as pulse oximetry within the next five years. consider or reconsider using available brain activity monitoring technology. I know the ASA claims it is not yet 100% accurate nor peer vetted by their organization, but it is better than nothing. And the FDA has endorsed it. So far the ASA committee to peer vet and take a stand on monitoring as not even met since October 14, 2003! There is nothing on the agenda about monitoring for the October 2004 general meeting. Obviously, action has to be taken outside the aegis of the ASA or the issue will never be "peer vetted." Brain activity monitoring must become as routine as pulse oximetry within the next five years.
Consider or reconsider using available brain activity monitoring technology. I know the ASA claims it is not yet 100% accurate nor peer vetted by their organization, but it is better than nothing.Because, you see, most of your future patients don’t
realize how important you are to the
rest of their lives!
Now, let me take the liberty of giving you a question to consider: In many specialties, such as psychiatry, doctors are themselves required to undergo the treatment they will be giving. I feel it would be invaluable training for every anesthesia provider to experience paralyzation with awareness. How do you feel about that? Are you willing to undergo it? Do you think you would ever forget it? Should it be a required part of anesthesia training?