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KEY WORDS Anaesthesia, General anaesthetic, Anaesthetic awareness, Patient care
Awareness during general anaesthesia is a potentially traumatising risk of any general anaesthetic, which can have lasting effects on the patients who experience it. This article assesses the issues and causes of anaesthetic awareness, together with the current status of research being conducted into its prevention, and the effect of market forces and litigation.
Introduction
'Patients rightfully expect that they will have no memory of their surgery when it is performed under general anaesthesia' (Leslie & Myles 2001).
The above quote clearly states what patients should be able to expect from a general anaesthetic, and yet for an unfortunate number of patients this is not true. The phenomenon of anaesthetic awareness has been a thorn in the side of anaesthetics, with the difficulties of measuring the depth of anaesthesia, the patient's own individual condition and the advance of anaesthetic pharmaceuticals. The author felt that this topic was relevant to the modern healthcare practitioner, both qualified and in training, as it is their duty of care to protect the patient from harm. The risk of awareness during anaesthesia is a real threat to the patient's well being. It may also not be completely avoidable, as will be shown later, but the risk can be reduced and managed in the patient's favour.
The author found during preliminary research that there is very little textbook material available on this subject. However, a paragraph relating the high risk factors appears in Kumar (2002). This lack of available literature gave the topic an air of mystery, which continued until a journal search was carried out. The journals supplied a number of articles and editorials that came from all view points in this subject. Furthermore, articles found were dated from 1998 to 2004, meaning that they were still current, therefore relevant to this literature search. Additionally, the majority of articles came from peer reviewed journals and therefore were a strong source of information. A number of online journals and websites were used, though the author acknowledges the potential limitations and weaknesses of these forms of gathering information. However, they remain extremely useful for seeing the information available to everyone.
As will be shown, the notion of anaesthetic depth tends to...