Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Awareness is a rare but in some cases severe complication of general anesthesia. In clinical practice vegetative signs such as sweating, lacrimation, tachycardia and hypertension are used to assess the anesthetic depth. Awareness however may also occur without any of these signs. ⋯ A similar reduction of the incidence was reached in studies using protocols based on concentrations of volatile anesthetics. Other systems to monitor anesthetic depth have been developed, but their influence on awareness has not yet been investigated sufficiently. Further studies are needed to clarify their impact concerning the incidence of awareness.
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In general there are 3 significant malpractice risks for anaesthesiologists: insufficient supervision especially in case of patients, who have a known awareness risk, technical mistakes in the preparation or controlling of anaesthesia and no or insufficient therapeutic reaction if awareness has occurred. As long as awareness cannot be avoided during anaesthesia this risk should be explained to the patient. ⋯ In all cases the claims have been dismissed. There is no Federal Court decision dealing with informed consent in case of awareness.
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Awareness is a rare but typical complication during general anesthesia, with a reported incidence of 0.1- 0.2% to 1% (high risk patients) in adults and probably much higher in children with 0.2 -1.2%. Awareness is defined as consciousness during general anesthesia with explicit (conscious) recall of memories. ⋯ Recommendations of the German Society of Anesthesiologists have been developed according to the ASA Task Force for intraoperative awareness and brain function monitoring. The article focuses on risk factors and sequelae of awareness, explains the options for detection of intraoperative wakefulness and postoperative memories and makes recommendations for prevention and handling of awareness.