Patient characteristics, anaesthetic workload and techniques in the UK : an analysis from the 7th National Audit Project ( NAP7 ) activity survey

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Methods for the detection of carelessly invalid responses in survey data

Paul G Curran (2016)

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Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments.

T M Cook, N Woodall, J. Harper … (2011)

The Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society (NAP4) was designed to identify and study serious airway complications occurring during anaesthesia, in intensive care unit (ICU) and the emergency department (ED). Reports of major complications of airway management (death, brain damage, emergency surgical airway, unanticipated ICU admission, prolonged ICU stay) were collected from all National Health Service hospitals over a period of 1 yr. An expert panel reviewed inclusion criteria, outcome, and airway management. A total of 184 events met inclusion criteria: 36 in ICU and 15 in the ED. In ICU, 61% of events led to death or persistent neurological injury, and 31% in the ED. Airway events in ICU and the ED were more likely than those during anaesthesia to occur out-of-hours, be managed by doctors with less anaesthetic experience and lead to permanent harm. Failure to use capnography contributed to 74% of cases of death or persistent neurological injury. At least one in four major airway events in a hospital are likely to occur in ICU or the ED. The outcome of these events is particularly adverse. Analysis of the cases has identified repeated gaps in care that include: poor identification of at-risk patients, poor or incomplete planning, inadequate provision of skilled staff and equipment to manage these events successfully, delayed recognition of events, and failed rescue due to lack of or failure of interpretation of capnography. The project findings suggest avoidable deaths due to airway complications occur in ICU and the ED.

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5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors.

J Pandit, J. Andrade, D G Bogod … (2014)

We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

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A. D. Kane: (View ORCID Profile)

J. Soar: (View ORCID Profile)

R. A. Armstrong: (View ORCID Profile)

E. Kursumovic: (View ORCID Profile)

M. T. Davies: (View ORCID Profile)

L. Cortes: (View ORCID Profile)

C. Taylor: (View ORCID Profile)

I. K. Moppett: (View ORCID Profile)

S. Agarwal: (View ORCID Profile)

J. Cordingley: (View ORCID Profile)

S. J. Finney: (View ORCID Profile)

G. Kunst: (View ORCID Profile)

D. N. Lucas: (View ORCID Profile)

R. Mouton: (View ORCID Profile)

J. P. Nolan: (View ORCID Profile)

V. J. Pappachan: (View ORCID Profile)

B. R. Scholefield: (View ORCID Profile)

J. H. Smith: (View ORCID Profile)

T. M. Cook: (View ORCID Profile)

Journal

Title: Anaesthesia

Abbreviated Title: Anaesthesia

Publisher: Wiley

ISSN (Print): 0003-2409

ISSN (Electronic): 1365-2044

Publication date (Electronic): March 2023

Affiliations

[1 ]Royal College of Anaesthetists Red Lion Square UK

[2 ]Department of Anaesthesia James Cook University Hospital, South Tees NHS Foundation Trust Middlesbrough UK

[3 ]Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital Bristol UK

[4 ]Department of Anaesthesia Severn Deanery Bristol UK

[5 ]Department of Anaesthesia and Intensive Care Medicine Royal United Hospitals Bath NHS Foundation Trust Bath UK

[6 ]Department of Critical Care and Anaesthesia North West Anglia NHS Trust UK

[7 ]University Hospitals Bristol and Weston NHS Foundation Trust UK

[8 ]University of Nottingham UK

[9 ]Department of Anaesthesia Manchester University Hospitals Foundation Trust Manchester UK

[10 ]Department of Critical Care and Anaesthesia Barts Health NHS Trust UK

[11 ]Department of Cardiovascular Anaesthesia Kings College London UK

[12 ]Department of Anaesthesia London North West University Healthcare NHS Trust UK

[13 ]Department of Anaesthesia North Bristol NHS Trust Bristol UK

[14 ]Resuscitation Medicine, Warwick Clinical Trials Unit University of Warwick Coventry UK

[15 ]Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine University Hospital Southampton NHS Foundation Trust Southampton UK

[16 ]Department of Anaesthesia Imperial College Healthcare NHS Trust London UK

[17 ]Institute of Inflammation and Ageing University of Birmingham UK

[18 ]Department of Anaesthesia Great Ormond Street Hospital London UK

[19 ]Department of Anaesthesia University College London Hospitals London UK

[20 ]University of Bristol UK

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DOI: 10.1111/anae.15989

PubMed ID: 36857758

SO-VID: b299303b-2e59-4cda-acf6-a2c9eccb3a9c

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http://doi.wiley.com/10.1002/tdm_license_1.1

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Patient characteristics, anaesthetic workload and techniques in the UK : an analysis from the 7th National Audit Project ( NAP7 ) activity survey

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Most cited references 23

Methods for the detection of carelessly invalid responses in survey data

Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments.

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors.

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