Changing understanding and practice in anaesthesia

Developing strategies for the prevention and management of accidental awareness during general anaesthesia.

Surgical patients often worry that they will wake up during their operation. In fact, accidental awareness during general anaesthesia, or AAGA, is poorly understood because it is very rare. Jackie Andrade led the psychological component of the world’s largest study on AAGA, set up by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland to understand the causes and consequences of AAGA and develop strategies for its prevention and management. The project showed that AAGA can cause lasting psychological harm, and that this harm can be reduced and even prevented through good communication and psychological management. The project also discovered a very strong association between using drugs to paralyse patients for surgery and reports of AAGA.

This research has raised anaesthetists’ awareness of the serious psychological consequences of AAGA, and trainee anaesthetists must now study the findings and implications of the research in order to qualify. The research has changed how the risk of AAGA is described to patients, for example through a new patient leaflet on ‘Risks Associated with your Anaesthetic’. Based on the project’s findings, the Association of Anaesthetists published a new set of standards in 2015 for monitoring anaesthetic delivery and paralysis. These standards aim to ensure that each patient receives sufficient anaesthetic and that paralysing drugs have worn off before they regain consciousness. In 2019, the Royal College of Anaesthetists published key clinical recommendations from the project, including advice on communicating with patients, using paralysing drugs safely, and psychologically supporting patients who report AAGA.