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Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 December;68(12):905-10

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Should disclosure of the danger of awareness during general anesthesia be a part of preanesthesia consent?

Gurman G. M., Weksler N., Schily M.

Division of Anesthesiology Ben Gurion University of the Negev Faculty of Health Sciences and Soroka Medical Center, Beer Sheva, Israel


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Aware­ness dur­ing anes­the­sia (AGA) is ­known as an intra­op­er­a­tive inci­dent ­which ­could ­lead to a ­series of unto­ward ­effects, ­among ­them symp­toms com­pat­ible ­with the post­trau­mat­ic ­stress syn­drome (­PTSS). Inci­dence of AGA rang­es ­between 0.1% and 0.7%, ­most of the ­reports indi­cat­ing a 0.2% ­rate of all gen­er­al anes­the­sias. Nev­er­the­less, ­some ­patients are con­sid­ered to be in a high­er ­than usu­al ­risk for devel­op­ing ­this inci­dent. The ­list of AGA ­high-­risk sit­u­a­tions ­include cae­sar­ian sec­tion, ­open ­heart sur­gi­cal pro­ce­dures, ­marked obes­ity, ­major trau­ma ­with hemo­dy­nam­ic instabil­ity and chron­ic use of ­drugs, alco­hol or tobac­co smok­ing. The usu­al pre­an­es­the­tic ­informed con­sent ­does not men­tion AGA ­among the pos­sible unde­sired ­effects of gen­er­al anes­the­sia, nei­ther in ­Israel nor in oth­er ­parts of the ­world. ­This ­paper ris­es the ques­tion of the indi­ca­tion to dis­cuss the AGA mat­ter, as ­part of the ­informed con­sent, ­with any ­patient who is ­prone devel­op it in a sig­nif­i­cant high­er per­cent­age ­than the gen­er­al pop­u­la­tion. The top­ic can be dis­cussed by the pri­mary ­care phy­si­cian or by the sur­geon, but ­this rep­re­sents the obvi­ous ­task of the anes­the­sio­lo­gist dur­ing his/her ­first con­tact ­with the ­patient ­before anes­the­sia and sur­gery. It is the ­authors ­belief ­that a preoper­a­tive dis­cus­sion on AGA ­might sub­stan­tial­ly ­reduce the mag­ni­tude of reper­cus­sions of AGA ­among ­high-­risk ­patients to devel­op ­this anes­thet­ic com­pli­ca­tion.

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