NAP5: Accidental Awareness during General Anaesthesia in the UK and Ireland

NAP5 Overview

NAP5 examined the topic of Accidental Awareness during General Anaesthesia (AAGA), selected after an open call for proposals, peer review and shortlisting. NAP5 was jointly funded by the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists.

The project had also, for the first time, expanded the NAPs into Ireland with the support of the College of Anaesthetists in Ireland.

Key questions for NAP5 were:

  • How many patients (in a defined national population) spontaneously report AAGA?
  • How do these patients present: when, to whom and how?
  • To what extent can risk factors be identified (including but not limited to those suggested in
    the literature)?
  • What do patient stories tell us about patients' experiences and expectations soon after an episode of AAGA (and do these change with time)?
  • Is specific depth of anaesthesia monitoring used and does it alter incidence of AAGA?

Key aims for NAP5 were:

  • To develop strategies for prevention of AAGA.
  • To identify an optimal process for managing cases of explicit awareness.
  • To acquire further knowledge of AAGA that can be used by anaesthetists when informing patients and consenting for anaesthesia.

What were the findings?

NAP5 received more than 400 contacts from individuals wishing to report cases of AAGA. Delay in reporting ranged from none to up to 62 years after the event.

The estimated incidence of patient reports of AAGA was ~1:19,000 anaesthetics. However, this incidence varied considerably in different settings.

There was a wide range of patient experiences and a wide range of psychological consequences (from none to life-changing).

Most reports were short in duration, the vast majority lasting <5 minutes. Longer-term psychological effects were identified in approximately half of patients reporting AAGA.

NAP5 Launch

Click here for launch videos and presentations, filmed at the NAP5 Report Launch held at the Royal Society of Medicine in 2014.

NAP5 created resources that provide information for patients, their families or their carers. We hope it is helpful to any patient worried about experiencing accidental awareness during anaesthesia, or to patients who have had this experience.

Meet the NAP5 team

Prof Jaideep Pandit

NAP5 Clinical Lead

Prof Tim Cook

RCoA Director of the National Audit Projects

We thank the members of the NAP5 Steering Panel for their hard work and wise advice throughout this project:

  • Prof J Andrade
  • Dr J Armstrong
  • Dr D Bogod
  • Ms S Drake
  • Dr W Harrop-Griffiths
  • Mr J Hitchman
  • Dr W Jonker
  • Dr N Lucas
  • Dr J MacKay
  • Prof R Mahajan
  • Dr A Nimmo
  • Dr K O'Connor
  • Prof E O'Sullivan
  • Dr J Palmer
  • Dr R Paul
  • Dr F Plaat
  • Dr J Radcliffe
  • Dr M Sury
  • Ms H Torevell
  • Prof M Wang
  • Mrs M Bell

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