Nearly two-thirds of patients who experienced intraoperative awareness suffered from post-traumatic stress disorder 5 years after their surgeries, according to researchers who followed up with patients in Australia, New Zealand and Hong Kong.

"Long-term psychological follow-up should be offered to patients who report awareness regardless of their early postoperative psychological state," suggest the researchers, who published their findings in the March issue of Anesthesia & Analgesia.

The research team surveyed patients who'd experienced awareness during a clinical trial of 2.463 surgical patients designed to study the efficacy of bispectral monitoring. Seven of the 13 patients who'd experienced awareness were still alive, and 5 of them reported symptoms of PTSD, according to the article.

It's not certain, however, that anesthesia awareness caused the PTSD in each case, writes George Mashour, MD, PhD, of the University of Michigan Medical School in an accompanying editorial. The patients in the trial were undergoing potentially stressful high-risk surgeries and may have suffered from other illness-related factors. "Medical events, such as myocardial infarction, can be associated with PTSD," he writes.

Regardless, concludes Dr. Mashour, the high rate of PTSD "reinforces the need for preventing intraoperative awareness."

Kent Steinriede

The airway complication risks associated with the use of propofol during advanced endoscopic procedures are lower when trained professionals deliver the sedative and monitor patients, say researchers.

For a study appearing in the February issue of Clinical Gastroenterology and Hepatology, physicians at Washington University in St. Louis, Mo., observed the incidence of airway modifications in 799 patients who were administered propofol by a CRNA before endoscopic ultrasound, endoscopic retrograde cholangiopancreatography and small-bowel enteroscopy.

Airway modifications were needed 14.4% of the time, including 97 chin lifts to improve upper airway patency, 29 modified facemask ventilations to deliver higher flows of oxygen and 28 nasal tube insertions to prevent the tongue from blocking airflow. Hypoxemia was the most commonly reported adverse event, occurring in 12.8% of procedures, but no patients required bag-mask ventilation or endotracheal intubation.

Sreeni Jonnalagadda, MD, FASGE, the study's lead author, says the patients at highest risk - the morbidly obese and those with an ASA class of 3 or higher - should be managed by providers trained in advanced airway interventions, but if sedation is maintained at conscious sedation level, lesser degrees of training may be sufficient.

Still, he notes, "We feel that the person administering propofol needs to be trained well enough that [she] can recognize and rescue patients who develop laryngospasm, hypoxemia and hypotension. In my opinion, providers cannot transition from standard conscious sedation to propofol sedation without additional training."

Daniel Cook

A study examining the frequency and causes of wrong-site injections in pain management procedures recommends strict use of the Universal Protocol in order to reduce the incidence of such errors.

Noting the lack of clinical literature on the topic, researchers reviewed 2 years' worth of quality improvement records from 3 private practices, 4 teaching hospitals and 3 military treatment facilities for the study, which appeared in the March issue of the journal Anesthesiology.

Out of 48,941 cases, they found 52.4% were at risk of committing wrong-site errors and 13 involved such an error (an incidence rate of 0.027%). Root cause analyses showed that in the 13 error-stricken cases, only 1 of the surgical teams completely followed the Joint Commission's Universal Protocol to prevent such errors. In 9 of the cases, there was more than 1 diversion from the protocol. And in 7 of the cases, the patient was aware that a wrong-site error was occurring.

Adapting the protocol's site marking, time out and verification steps to interventional pain management procedures and vigilantly employing them to every case can go a long way toward eliminating such errors, the researchers conclude.

David Bernard

Food. Money. Gift cards. Paid time off. When your staff go above and beyond the call of duty, as a manager you want to reward them for their efforts. Tell us what your preferred employee recognition strategy is in this week's poll question. We'll report the results in this space next week.

Last week, 227 respondents told us their average room turnover times. Here's the breakdown: