Accidental Awareness During Anesthesia Is Rare.

Accidental Awareness During Anesthesia Is Rare.

A Very few surgical patients experience accidental awareness while under general anesthesia.

The survey of the senior anesthetists at National Health Service hospitals in the United Kingdom about cases of accidental awareness during general anesthesia encountered in 2011.

Previous research has suggested a high rate of accidental awareness, occurring in about one in 500 patients.

But this study found that the rate was one in 15,000.

The researchers also found that only about 2 % of anesthetists routinely use brain-monitoring equipment to keep tabs on patients during surgery.

The findings, published in the journals Anesthesia and The British Journal of Anaesthesia, appeared online March 12.

"Anesthesia is a medical specialty very much focused on safety and patient experience," study lead author Jaideep Pandit, a consultant anesthetist in Oxford, said in an Anesthesia news release. "We identified accidental awareness during anesthesia as something which concerns patients and the profession. The profession is therefore undertaking this major study so that we can better understand the problem and work to reduce the likelihood of it happening to patients."

"We are particularly interested in patient experiences of awareness," Pandit added. "Although we know that some patients do suffer distress after these episodes, our survey has found that the vast majority of episodes are brief and do not cause pain or distress."

The researchers plan to investigate why their findings are so different from the results of previous studies.

"Risks to patients undergoing general anesthesia are very small and have decreased considerably in the last decades," study co-author Tim Cook, a consultant anesthetist in Bath, said in the news release. "Of the 3 million general anesthetics administered in [National Health Services hospitals] each year, only a very small number of patients experience awareness during anesthesia, with the majority of these occurring before surgery starts or after it finishes."

"While our findings are generally reassuring for patients and doctors alike, we recognize that there is still more work to be done," Cook said. "We are spending the next year studying as many of the cases as possible to learn more from patients' experiences."

THE ANAESTHETIC MANAGEMENT OF THE OBESE CHILDREN Alisher Agzamov, A.M. Al Qattan, Asmahan Al Mulla, A. Y. Dubikaitis Department of Anaesthesiology & ICU, Al Sabah Hospital, Kuwait City, Kuwait More than 42 million children under 5 years of age are overweight across the world. In Asia, in Middle East and in the Gulf region, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident. The definition of childhood obesity has not been standardized in the past, making studies difficult to compare. In spite of this, the increase in the incidence of childhood obesity is evident and has now reached epidemic proportions. Obese children experience few of the medical complications seen in obese adults. 1. Respiratory System is most affected, the degree of which is determined by the level of obesity. 2. A considerable amount of information on the anaesthetic management of the obese adult, but a very little has been written concerning the obese child. 3. There is less pathology in the obese child when compared with the adult but some evidence shows a higher likelihood of a critical incident occurring when anaesthetizing such children. 4. We need to be as worried about anaesthetizing the obese child as we are for the obese adult. This concern should increase with increasing body mass index. Anaesthesia consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.

THE ANAESTHETIC MANAGEMENT OF THE OBESE CHILDREN

Alisher Agzamov, A.M. Al Qattan, Asmahan Al Mulla, A. Y. Dubikaitis

Department of Anaesthesiology & ICU, Al Sabah Hospital, Kuwait City, Kuwait

More than 42 million children under 5 years of age are overweight across the world.

In Asia, in Middle East and in the Gulf region, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident.

The definition of childhood obesity has not been standardized in the past, making studies difficult to compare. In spite of this, the increase in the incidence of childhood obesity is evident and has now reached epidemic proportions.

Obese children experience few of the medical complications seen in obese adults.

1. Respiratory System is most affected, the degree of which is determined by the level of obesity.

2. A considerable amount of information on the anaesthetic management of the obese adult, but a very little has been written concerning the obese child.

3. There is less pathology in the obese child when compared with the adult but some evidence shows a higher likelihood of a critical incident occurring when anaesthetizing such children.

4. We need to be as worried about anaesthetizing the obese child as we are for the obese adult.

This concern should increase with increasing body mass index. Anaesthesia consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.

The tougher guidelines on research conduct. Dr. Alisher Agzamov MD PhD

The tougher guidelines on research conduct. Dr. Alisher Agzamov MD phD

Geoff Watts. Research Councils UK issues tougher guidelines on research conduct. BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1565 (Published 8 March 2013)

Cite this as: BMJ 2013;346:f1565

Research Councils UK has issued more explicit guidelines on the conduct that it expects from holders of its members’ research grants.¹ 

Unlike the document it replaces, published in 2009, it also outlines the likely penalties facing individuals and institutions that knowingly break the rules.

“We want to be seen to be tougher, but there’s a balance to be struck,” said Dr Tony Peatfield, director of corporate affairs at the Medical Research Council. “The more you threaten sticks rather than carrots, the greater the temptation for institutions to bury stuff. I think we’ve got the right balance.”

In the case of proven research misconduct the report lists the sanctions that might be applied. For the individuals concerned the research councils would reserve the right to withdraw funding and disallow future applications for grants for any fixed period of time, or even indefinitely. A researcher’s institution might also be required to return all the money awarded to the individual.

Research Councils UK is the strategic partnership of all seven of the country’s research councils. The new guidelines are now in line with a set of recommendations already laid out in a 2012 concordat on research conduct organised by Universities UK and approved by most of the country’s main funding bodies.

The new guidance sets standards of good research practice and also defines unacceptable research conduct. It explains how alleged misconduct should be reported and investigated and clarifies the responsibilities of the research councils, as opposed to research institutions, in fostering high standards.

The report emphasises the importance, where relevant, of clear procedures for obtaining ethical approval for intended work; seeking the informed consent of subjects; and ensuring that all staff are aware of these procedures.

“Peer reviewers,” it says, “must declare any conflicts of interest, including professional, personal or commercial conflicts, and must not take advantage of any information received as a result of their peer reviewing role.”

Commenting on what it considers to be unacceptable research conduct, the report says, “The spectrum of inappropriate behaviour is wide, ranging from minor misdemeanours which may happen occasionally and inadvertently, to significant acts of misappropriation or fabrication.”

Unacceptable conduct includes the creation of false data, the inappropriate manipulation of data and images, plagiarism, and misrepresentation. The last of these covers the suppression of relevant findings and/or data, the undisclosed duplication of published reports, the failure to declare material interests, false claims about qualifications and/or experience, and inappropriate claims to authorship.

The report suggests that any preliminary investigation of suspected misconduct should be carried out informally, and outlines how this might be done. If the suspicion is substantiated, it describes how a more formal procedure should be conducted.

Notes: Cite this as: BMJ 2013;346:f1565

References

1.    Research Councils UK. RCUK policy and guidelines on governance of good research conduct. www.rcuk.ac.uk/documents/reviews/grc/RCUKPolicyandGuidelinesonGovernanceofGoodResearchPracticeFebruary2013.pdf