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Anaesth Intensive Care. 2017 Jul;45(4):441-447.

Awareness during general anaesthesia in the first 4,000 incidents reported to webAIRS.

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Honorary Professorial Fellow, Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, and Department of Pharmacology and Therapeutics, University of Melbourne; Honorary Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria.
Anaesthetist, Department of Anaesthesia, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Queensland.
Data Analyst, Research Fellow, Anaesthesia and Peri-operative Services, Royal Brisbane and Women's Hospital; Griffith University, The University of Queensland, Brisbane, Queensland.
Research Fellow, Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Professor of Anaesthesiology, University of Auckland, Specialist Anaesthetist, Auckland City Hospital, Auckland, New Zealand.


The aim of this study was to analyse the incidents related to awareness during general anaesthesia in the first 4,000 cases reported to webAIRS-an anaesthetic incident reporting system established in Australia and New Zealand in 2009. Included incidents were those in which the reporter selected "neurological" as the main category and "awareness/dreaming/nightmares" as a subcategory, those where the narrative report included the word "awareness" and those identified by the authors as possibly relevant to awareness. Sixty-one awareness-related incidents were analysed: 16 were classified as "awareness", 31 were classified as "no awareness but increased risk of awareness" and 14 were classified as "no awareness and no increased risk of awareness". Among 47 incidents in the former two categories, 42 (89%) were associated with low anaesthetic delivery and 24 (51%) were associated with signs of intraoperative wakefulness. Memory of intraoperative events caused significant ongoing distress for five of the 16 awareness patients. Patients continue to be put at risk of awareness by a range of well-described errors (such as syringe swaps) but also by some new errors related to recently introduced anaesthetic equipment, such as electronic anaesthesia workstations.


anaesthesia, awareness, conscious recall

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