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JCAHO issues recommendations to address "anesthesia awareness"

Nurse Leader Weekly, October 11, 2004

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The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) urged healthcare professionals to take steps to reduce "anesthesia awareness," or instances when patients under general anesthesia become cognizant of some or all events during a surgery or procedure.

In its October 6 Sentinel Event Alert, the JCAHO also recommended that efforts be made to reduce the impact on patients when these episodes do occur.

Anesthesia awareness most commonly occurs during a cardiac, obstetric, or major trauma surgery where general anesthetics are provided in smaller doses to avoid significant side effects, the JCAHO said. And due to the routine use of neuromuscular blocking agents, or paralytics, the patient is unable to communicate when these events occur.

The JCAHO pointed out that although studies show that instances of anesthesia awareness occur in only one to two cases in every 1,000 general anesthetics administered, the experience is traumatic for those patients who do become aware.

As a result, it offers the following recommendations:

1. Develop and implement an anesthesia awareness policy that addresses the following:
* Education of clinical staff about anesthesia awareness and how to manage patients who have experienced it
* Identification of high-risk patients, and discussion with them, before surgery, of the potential for anesthesia awareness.
* Application of available anesthesia monitoring techniques, including the timely maintenance of anesthesia equipment.
* Appropriate postoperative follow-up of all patients who have undergone general anesthesia, including children.
* Identification, management, and, if appropriate, referral of patients who have experienced awareness.

2. Assure access to counseling or other support for patients who are experiencing post-traumatic stress syndrome or other mental distress.

Source: JCAHO Sentinel Event Alert, Issue 32 (October 6, 2004)

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