One of the most common fears surgeons hear from patients who are about to enter surgery is that they will experience a severe complication with anesthesia and won’t wake up.
While exceedingly rare, these types of complications can happen. Alternatively, there is a risk that they will wake up and experience some level of consciousness during surgery. For surgeons, it is shocking and distressing to have a patient describe some part of the procedure or recall that they felt discomfort or pain during the surgery. These impressions can remain with the patient for long periods of time and cause significant emotional distress.
Estimates show that among 20 million anesthetics administered, 26,000 incidents of a patient experiencing some level of awareness during surgery—such as pain, auditory perceptions, the sensation of the endotracheal tube, or dreaming during surgery—occur in the US each year.1
These errors with anesthesia can have long-term impacts on patients, well past the initial postoperative period. After experiencing awareness during surgery, patients reported significant postoperative distress related to feeling unable to communicate, unsafe, terrified, abandoned, and betrayed, resulting in many patients developing post-traumatic stress disorder.2
Not only can these events cause long-term emotional harm for patients, but they also can result in a mental toll on the surgeon. One study found a strong connection between reported major medical errors and degree of burnout, mental quality of life, and depression for surgeons.3 These findings suggest that preventing anesthesia-related errors is in the interest of patients and surgeons.
The Preanesthesia Assessment
Anesthesia-related events can happen if the correct precautions aren’t taken prior to surgery. Surgeons and anesthesiologists must work together to ensure these “never events” never happen.
Surgeons and anesthesiologists have tools at their disposal to prevent these kinds of errors. Preanesthesia assessments allow the surgery team to identify perioperative risks as well as implement interventions to mitigate them. Preanesthesia assessments, conducted by an individual qualified to administer anesthesia, provide an opportunity to build rapport between the anesthetist and patient, while reducing patient anxiety about the procedure.4
Elements of a Preanesthesia Assessment
A thorough preanesthesia assessment is critical to reducing risks associated with anesthesia and developing an anesthesia plan.
While required by The Joint Commission, the preanesthesia assessment is an underutilized tool. In 2022, The Joint Commission found that approximately one-in-five hospitals surveyed were not in compliance with this requirement, either missing elements of a preanesthesia assessment or not performing an assessment at all.5 Surgical teams should have the proper policies and procedures in place to ensure the assessment occurs according to requirements.
According to the American Society of Anesthesiologists (ASA), a preanesthesia assessment should involve:6
- Reviewing the patient’s medical history, including anesthesia, drug and allergy history, and a physical examination
- Formally assessing anesthesia risks and identifying potential problems, particularly those that may suggest complications or contraindications to the planned procedure
- Collecting additional preanesthesia data or information, such as stress tests or other specialist consultations
- Discussing risks and benefits of anesthesia
- Obtaining informed consent
- Developing a plan for the patient’s anesthesia care, including the discussion and potential use of an amnestic agent
A proper preanesthesia assessment should be conducted within 48 hours of the day of surgery. The ASA provides additional guidance on preanesthesia assessments and how they differ from a general preoperative assessment as well as example scenarios on its website.
After the Preanesthesia Assessment
Surgeons should discuss the findings of a preanesthesia assessment with the anesthesiologist and potentially other specialists to determine impacts to the surgery plan. Surgeons may have to modify their plans to ensure the patient is safe and the procedure is in the patient’s best interest.
If an error occurs, whether related to anesthesia or another part of the surgery, best practice for surgeons is to have an immediate conversation with the patient and his or her family about what happened and how it was resolved. These conversations are undoubtedly challenging, but they are necessary to foster trust between surgeons and patients.
