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Waking up during surgery: Low-cost prevention?

Michael Avidan, George Mashour and David Glick highlight the serious issue of awareness during anaesthesia in a recent review published by F1000 Medicine Reports.

Consciousness during general anaesthesia is an extremely distressing condition leading to post-operative psychological trauma and contributes towards patients' fear of surgery. Dr Avidan, a member of Faculty of 1000 Medicine and a leading authority on Anaesthesia and Pain Management, writes that intra-operative awareness with subsequent recall is surprisingly common, affecting around 1 in 500 surgical cases. These appear to be mostly preventable.

There are currently a number of candidate awareness monitors available to anaesthesiologists and theatre staff, but attention has focussed on the bispectral index (BIS) monitor, which is used widely in operating rooms and intensive care units around the world. However, it is not clear that the reduction in awareness reported with BIS monitors is attributable predominantly to the technology itself. Controversially, recent research suggests that previous cases of awareness with explicit recall might have been prevented by implementing a simple 'increased vigilance' protocol. Such a protocol would cost less and be less prone to machine malfunction.

Large, prospective randomized trials are currently underway to evaluate effective awareness monitoring technologies, with the aim of ultimately improving intra-operative patient care. Avidan says, "Cost effective interventions that increase vigilance should be implemented to decrease the likelihood of this complication."

1 Dr Michael S Avidan, Faculty Member for F1000 Medicine is a global authority on Anaesthesia & Pain Management, and Associate Professor of Anaesthesiology and Surgery, and Division Chief, CT Anaesthesiology & CT Intensive Care at Washington University in St Louis

2 The full text of this F1000 Medicine Reports article is available at

3 Please name F1000 Medicine Reports and Faculty of 1000 Medicine in any story you write. If you are writing for the web, please link to the website (details below).

4 The F1000 Medicine Reports journal (ISSN 1757-5931), publishes short commentaries by expert clinicians focussing on the most important studies identified by Faculty of 1000 Medicine that are likely to change clinical practice. The commentaries summarise the implications of important new research findings for clinicians

5 Faculty of 1000 Medicine,, is a unique online service that helps you stay informed of high impact articles and access the opinions of global leaders in medicine. Our distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.

6 Please contact Kathleen Wets, Director of Sales & Marketing, for a complimentary journalist subscription to Faculty of 1000 (which includes F1000 Medicine Reports).

Kathleen Wets | EurekAlert!
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