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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

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

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


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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