Background and aims Accidental awareness during general anaesthesia (AAGA) refers to explicit recall of sensory perceptions during general anaesthesia. NAP 5 estimated incidence of 1:19000 with incidence of 1:8000 on use of neuromuscular blockade and recommended the use of depth of anaesthesia (DoA) monitoring in high risk patients for AAGA, which is endorsed by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) TIVA guidelines2. We audited the use of DoA monitoring in patients who had TIVA with neuromuscular blockade who are considered high risk for AAGA.
Methods We conducted the prospective audit for 2 months about the use of DoA monitoring (entropy in our hospital) in patients who had TIVA with neuromuscular blockade. Data collected from electronic database on type of surgery, use of DoA monitoring, timing of commencing monitoring (on induction or in theatre) and lowest entropy value.
Results We included 67 cases in this audit over 2-month period who had TIVA with neuromuscular blockade. TIVA was mainly used orthopaedic cases (27%), urology (25%) and gynaecology (25%) surgeries. Entropy was used in only 30% of cases and in majority (65%) of cases commenced in operating theatre. We observed lowest entropy value was 2 in few cases, which is too deep anaesthesia.
Conclusions TIVA with neuromuscular blockade is considered high risk for AAGA. Our results showed that we need to improve in the use of depth of anaesthesia monitoring in high risk cases and recommended to commence monitoring in anaesthetic room on induction. We aim to re-audit the practice in few months time.
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