Table 1.

Recommendations of the Practice Advisory for Intraoperative Awareness and Brain Function Monitoring (Apfclbaum JL et al, 2006)¹⁰

Preoperative evaluation

Review patient medical records for risk factors like: –Substance abuse or use –Previous history of intraoperative awareness –History of difficult intubation –Chronic pain patients using high doses of opioids –ASA IV/V –Limited haemodynamic reserve

Interview patient –Obtain history regarding previous experience with anaesthetics

Determine other potential risk factors –Cardiac surgery –Caesarean section –Trauma surgery –Emergency surgery –Decreased anaesthetic doses in the presence of paralysis –Planned use of muscle relaxants during general anaesthesia –Planned use of nitrous oxide- opioid anaesthesia

Patients at high risk should be informed of the possibility of intraoperative awareness when circumstances permit.

Pre-induction phase of anaesthesia

Adhere to checklist protocol for checking of anaesthesia machine and equipment Check proper functioning of intravenous access, infusion pumps, connections and backflow valves. Decision to administer benzodiazepines prophylactically should be made on a case to case basis. Intra-operative monitoring Use multiple modalities to monitor depth of anaesthesia – Clinical techniques (e.g. purposeful or reflex movement) – Conventional monitoring systems (e.g. ECG, BP, EtCO2 etc.) – Brain function monitoring not routinely indicated for all general anaesthesia cases and should be used for selected patients (e.g. light anaesthesia)

Postoperative Management

Interview patient following the adverse event and offer counselling/ psychological support. Initiate occurrence report for quality management.