Anesthesia Awareness.ppt

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. Definition of Anesthesia Awareness: unintended intra-operative awareness occurs during general anesthesia, when a patient has not had enough general anesthetic or analgesic to prevent consciousness. Definition Components of Anesthesia Definition How is Anesthesia “measured” Classically done by measuring concentrations of inhaled anesthetic agents like: sevoflorane, desflorane. Definition Basic Concept of MAC Defn: MAC = Miniumum Alveolar Concentration of inhaled agent where at 1MAC, 50% of targets do not move to surgical stimulus. MAC for Iso: 1.1 MAC for Sevo: 2.2 MAC for Des: 6.6 Definition Advanced understanding of MAC MAC values are additive Addition of N2O oxide Use of narcotics, benzodiazepines, etc.. MAC values are patient specific Age ETOH acute Hypothermia Pregnancy Drugs Hyponatremia MAC Aware .3 MAC – concentration at which 50% of patients lose consciousness Bell Curve – 50% is obviously not enough! Importance Patient Experience Importance Clip of AWAKE Importance Increase in patient advocacy Importance No reason to use monitors that are not effective… Cost $$ 360 million in BIS probe cost/yr Incidence .1 -.2% of all patients undergoing general anesthesia. 21 million patients have GETA, Calculated 20-40K/yr experience Even be higher in children Incidence calculated for patients who received general anesthesia. regional anesthesia (ie epidural) does not count for awareness Risk Factors Risk Factors Routine use of paralytics (double incidence from .1% to .18%) TIVA Light anesthesia for sake of turnover Hemodynamic instability Procedures: Obstetric / Cardiac / Trauma Patient Age H.o of difficult airway Limited cardiac reserve H.o of substance abuse (chronic ETOH, anxiolytics, cocaine) . Exp