This is the current release of the guideline.

A summary of the Practice Advisory is presented below.

Preoperative Evaluation

• Review patient medical records for potential risk factors
  • Substance use or abuse
  • Previous episode of intraoperative awareness
  • History of difficult intubation or anticipated difficult intubation
  • Chronic pain patients using high doses of opioids
  • American Society of Anesthesiologists (ASA) physical status IV or V
  • Limited hemodynamic reserve
• Interview patient
  • Assess level of anxiety
  • Obtain information regarding previous experiences with anesthesia
• Determine other potential risk factors
  • Cardiac surgery
  • Cesarean delivery
  • Trauma surgery
  • Emergency surgery
  • Reduced anesthetic doses in the presence of paralysis
  • Planned use of muscle relaxants during the maintenance phase of general anesthesia
  • Planned use of nitrous oxide-opioid anesthesia
• Patients whom the individual clinician considers to be at substantially increased risk of intraoperative awareness should be informed of the possibility of intraoperative awareness when circumstances permit

Preinduction Phase of Anesthesia

• Adhere to a checklist protocol for anesthesia machines and equipment to assure that the desired anesthetic drugs and doses will be delivered
• Verify the proper functioning of intravenous access, infusion pumps, and their connections, including the presence of appropriate back-flow check valves
• The decision to administer a benzodiazepine prophylactically should be made on a case-by-case basis for selected patients (e.g., patients requiring smaller dosages of anesthetics)

Intraoperative Monitoring

• Use multiple modalities to monitor depth of anesthesia
  • Clinical techniques (i.e., checking for purposeful or reflex movement)
    • Neuromuscular blocking drugs may mask purposeful or reflex movement
  • Conventional monitoring systems (e.g., electrocardiogram, blood pressure, heart rate, end-tidal anesthetic analyzer, capnography)
  • Brain function monitoring
    • Not routinely indicated for general anesthesia patients
    • The decision to use a brain function monitor should be made on a case-by-case basis by the individual practitioner for selected patients (e.g., light anesthesia)

Intraoperative and Postoperative Management

• The decision to administer a benzodiazepine intraoperatively after a patient unexpectedly becomes conscious should be made on a case-by-case basis
• Speak with patients who report recall of intraoperative events to obtain details of the event and to discuss possible reasons for its occurrence
• A questionnaire or structured interview may be used to obtain a detailed account of the patient's experience
• Once an episode of intraoperative awareness has been reported, an occurrence report regarding the event should be completed for the purpose of quality management
• Offer counseling or psychological support to those patients who report an episode of intraoperative awareness

None provided

The type of evidence supporting the recommendations is not specifically stated.

The advisory statements contained in this document represent a distillation of the current spectrum of clinical opinion and literature-based findings.

Not applicable: The guideline was not adapted from another source.

2006 Apr

American Society of Anesthesiologists - Medical Specialty Society

American Society of Anesthesiologists

Task Force on Intraoperative Awareness

Task Force Members: Jeffrey L. Apfelbaum, M.D. (Chair), Chicago, Illinois; James F. Arens, M.D., Houston, Texas; Daniel J. Cole, M.D., Phoenix, Arizona; Richard T. Connis, Ph.D., Woodinville, Washington; Karen B. Domino, M.D., Seattle, Washington; John C. Drummond, M.D., San Diego, California; Cor J. Kalkman, M.D., Ph.D., Utrecht, The Netherlands; Ronald D. Miller, M.D., San Francisco, California; David G. Nickinovich, Ph.D., Bellevue, Washington; Michael M. Todd, M.D., Iowa City, Iowa

Two of the 10 members of the Task Force disclosed receipt of funds from or a financial interest in a company developing or manufacturing brain function monitors; these companies have a direct financial interest in the expanded use of such monitors. Task Force members may also have received funds from or have a financial interest in other companies, such as developers or manufacturers of anesthetics that may be indirectly affected by the expanded use of brain function monitors. The Task Force did not request for its members to disclose such interests because they were deemed too remote and speculative to present conflicts of interest.

Fifty-four percent of the consultants disclosed receipt of funds from or a financial interest in a company developing or manufacturing brain function monitors. Consultants also may have received funds from or have a financial interest in other companies that may be indirectly affected by the use of brain function monitors. The Task Force did not request for its consultants to disclose such interests because they were deemed too remote and speculative to present conflicts of interest.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on May 19, 2006. The information was verified by the guideline developer on May 24, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.