Feature


JAP  Volume 7 Issue 1


Risk factors for awareness during general


anaesthesia Awareness is a dreadful complication of general anaesthesia particularly when muscle relaxants are used. The patient may not forget this most horrible experience for the rest of his/her life and the litigation costs could be in the millions. We have worked out a few acronyms which could be of some help to avoid recall during anaesthesia. Remember “RECALL I NOT”


R Regional anaesthesia will avoid the risk of awareness altogether


E Emergency surgical patients are at risk C Cardiac surgical procedures going on CPB carry risk of awareness CPR during cardiac arrest is a special situation the patient may recall


A Alarms should be activated and BIS monitor considered L Long surgical procedures under TIVA are at risk (Chinese and Spanish studies)


L Litigation costs could be huge I Intensive care patients are sedated only and need to be anaesthetised during interventions e.g. tracheostomies and insertion of chest drains


N Neurosurgical patients must be warned that at some stage the surgeon would like to wake him/her up in the middle of a procedure and be re-anaesthetised


O Obstetric surgery like LSCS under GA carries risk of awareness T Traumatic stress could have long term consequences


Care of patients in post-anaesthetic recovery room Anaesthetists are responsible for the immediate care of their


patients in PACU. The following are a few tips on dealing with patients in the recovery room. Remember “RECOVERED”.


R Recovery position of patient is important after ENT and airway anaesthesia Re-activate basic alarms in PACU Respiratory observations for rate and depth Remove secretions and debris from mouth and airway


E Emergence from GA should be smooth and non-violent C Comfortable and pain-free patient Cardio-stable patient


O Obstructed airway should be avoided at every cost O 2


to give if SpO2 is low Obese patients should be observed for sleep apnoea


V Vomiting could result in aspiration pneumonitis and delays discharge from PACU


E Environment in PACU should be calm and quiet R Re-warm the patient if hypothermic Retention of urine is a hidden cause of distress


E Encourage patient to sit up if appropriate D Drugs prescribed, signed and dated Document any events and discharge from PACU when appropriate


Non-anaesthetic causes of Vomiting PONV is not uncommon after anaesthesia and surgery. However,


it’s not always the anaesthetist to be blamed. The following are the non-anaesthetic causes of vomiting. Simply remember the word “VOMITING”.


V Vestibular disturbances O Obstetric causes e.g. morning sickness M Medicine e.g. cytotoxics, digoxin Metabolic e.g. uraemia, DKA, raised Ca+


I Infection such as influenza virus, E-B virus and cytomegalovirus T Travel sickness I Ingestion of excessive alcohol N Neurological disorder e.g. raised ICP G Gastro-intestinal obstruction


Sher’s scoring for prediction of PONV You might have heard about the four markers for the prediction of


PONV i.e smoking status, female gender, previous PONV and the use of opiates. We have added another marker, which is site/type of operation (ref. ENIGMA study).We have remodified this scoring and made it simple. It is called Sher’s Simplified Scoring for the prediction of sickness in surgical patients. Remember “5Ss”


S Smoking status i.e.non-smokers S Sex i.e. female gender S Sickness (previous PONV)


+1 +1 +1


S Side effects (sickness) of opiates +1 S Site/type of surgery


+1


Based on this scoring, patients are assigned a risk of developing PONV. Remember that SS stands for sickness scoring and this has not been validated. • Low risk


• Medium risk • High risk


(SS 0-1) (SS 2-3)


(SS > 3-5) www.japractice.com 19


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