Intraoperative Awareness
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Intraoperative Awareness
Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory, it is also possible for the victim to have awareness with explicit recall, where victims can remember the events related to their surgery (intraoperative awareness with explicit recall). Intraoperative awareness with explicit recall is an infrequent condition with potentially devastating psychological consequences. While it has gained popular recognition in media, research shows that it only occurs at an incidence rate of 0.1-0.2%. Patients report a variety of experiences ranging from vague, dreamlike states to being fully awake, immobilized, and in pain from the surgery. This is usually caused by the delivery of inadequate anesthetics rela ...
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General Anaesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. A variety of General anesthetic, drugs may be administered, with the overall goal of achieving unconsciousness, amnesia, analgesia, loss of reflexes of the autonomic nervous system, and in some cases paralysis of ske ...
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General Anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. A variety of drugs may be administered, with the overall goal of achieving unconsciousness, amnesia, analgesia, loss of reflexes of the autonomic nervous system, and in some cases paralysis of skeletal muscles. The ...
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Medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and relies on the science of pharmacology for continual advancement and on pharmacy for appropriate management. Drugs are classified in multiple ways. One of the key divisions is by level of control, which distinguishes prescription drugs (those that a pharmacist dispenses only on the order of a physician, physician assistant, or qualified nurse) from over-the-counter drugs (those that consumers can order for themselves). Another key distinction is between traditional small molecule drugs, usually derived from chemical synthesis, and biopharmaceuticals, which include recombinant proteins, vaccines, blood products used therapeutically (such as IVIG), gene therapy, monoclonal antibodies and cell therapy (for instance, stem cell therapies) ...
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Gas Cylinder
A gas cylinder is a pressure vessel for storage and containment of gases at above atmospheric pressure. High-pressure gas cylinders are also called ''bottles''. Inside the cylinder the stored contents may be in a state of compressed gas, vapor over liquid, supercritical fluid, or dissolved in a substrate material, depending on the physical characteristics of the contents. A typical gas cylinder design is elongated, standing upright on a flattened bottom end, with the valve and fitting at the top for connecting to the receiving apparatus. The term ''cylinder'' in this context is not to be confused with ''tank'', the latter being an open-top or vented container that stores liquids under gravity, though the term scuba tank is commonly used to refer to a cylinder used for breathing gas supply to an underwater breathing apparatus. Nomenclature In the United States, "bottled gas" typically refers to liquefied petroleum gas. "Bottled gas" is sometimes used in medical supply, espe ...
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Nitrous Oxide
Nitrous oxide (dinitrogen oxide or dinitrogen monoxide), commonly known as laughing gas, nitrous, or nos, is a chemical compound, an oxide of nitrogen with the formula . At room temperature, it is a colourless non-flammable gas, and has a slightly sweet scent and taste. At elevated temperatures, nitrous oxide is a powerful oxidiser similar to molecular oxygen. Nitrous oxide has significant medical uses, especially in surgery and dentistry, for its anaesthetic and pain-reducing effects. Its colloquial name, "laughing gas", coined by Humphry Davy, is due to the euphoric effects upon inhaling it, a property that has led to its recreational use as a dissociative anaesthetic. It is on the World Health Organization's List of Essential Medicines. It is also used as an oxidiser in rocket propellants, and in motor racing to increase the power output of engines. Nitrous oxide's atmospheric concentration reached 333 parts per billion (ppb) in 2020, increasing at a rate of abo ...
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Bispectral Index
Bispectral index (BIS) is one of several technologies used to monitor depth of anesthesia. BIS monitors are used to supplement Guedel's classification system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral index during general anesthesia in adults (and children over 1 year old) allows the anesthetist to adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in a more rapid emergence from anesthesia. Use of the BIS monitor could reduce the incidence of intraoperative awareness during anaesthesia. The exact details of the algorithm used to create the BIS index have not been disclosed by the company that developed it. BIS cannot be used as the sole monitor of anaesthesia, as it is affected by several other factors, including the anaesthetic drugs used (BIS is relatively insensitive to agents such as ketamine and nitrous oxide), and muscle movement or artefact from surgical equipment. BIS is used as an adjunct t ...
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American Society Of Anesthesiologists
The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians organized to raise the standards of the medical practice of anesthesiology and to improve patient care. As of 2021, the organization included more than 55,000 national and international members and has more than 100 full-time employees. History Anesthesiology's roots date back to the mid-19th century. On March 30, 1842, Crawford Long, M.D. administered the first ether anesthetic for surgery and operated to remove a tumor from a patient's neck. After the surgery, the patient revealed that he felt nothing and was not aware the surgery was over until he awoke. This was the start of a specialty critical to modern medicine, anesthesiology. In 1905, nine physicians (from Long Island, N.Y.) organized the first professional anesthesia society. In 1911, the Society expanded to 23 members and became the New York Society of Anesthetists. Over the next 25 years, involvement in ...
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Volatile Anesthetic
An inhalational anesthetic is a chemical compound possessing general anesthetic properties that can be delivered via inhalation. They are administered through a face mask, laryngeal mask airway or tracheal tube connected to an anesthetic vaporiser and an anesthetic delivery system. Agents of significant contemporary clinical interest include volatile anesthetic agents such as isoflurane, sevoflurane and desflurane, as well as certain anesthetic gases such as nitrous oxide and xenon. List of inhalational anaesthetic agents Currently-used agents * Desflurane * Isoflurane * Nitrous oxide * Sevoflurane * Xenon Previously-used agents Although some of these are still used in clinical practice and in research, the following anaesthetic agents are primarily of historical interest in developed countries: * Acetylene * Chloroethane (ethyl chloride) * Chloroform * Cryofluorane * Cyclopropane * Diethyl ether * Divinyl ether * Enflurane * Ethylene * Fluroxene * Halothane (still widely ...
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Anaesthetic Vaporiser
An anesthetic vaporizer (American English) or anaesthetic vaporiser (British English) is a device generally attached to an anesthetic machine which delivers a given concentration of a volatile anesthetic agent. It works by controlling the vaporization of anesthetic agents from liquid, and then accurately controlling the concentration in which these are added to the fresh gas flow. The design of these devices takes account of varying: ambient temperature, fresh gas flow, and agent vapor pressure. Modern vaporizers There are generally two types of vaporizers: plenum and drawover. Both have distinct advantages and disadvantages. The ''dual-circuit gas-vapor blender'' is a third type of vaporizer used exclusively for the agent desflurane. Plenum vaporizers The plenum vaporizer is driven by positive pressure from the anesthetic machine, and is usually mounted on the machine. The performance of the vaporizer does not change regardless of whether the patient is breathing spontaneous ...
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Anesthetic Machine
An anaesthetic machine (British English) or anesthesia machine (American English) is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining anaesthesia. The machine is commonly used together with a mechanical ventilator, breathing system, suction equipment, and patient monitoring devices; strictly speaking, the term "anaesthetic machine" refers only to the component which generates the gas flow, but modern machines usually integrate all these devices into one combined freestanding unit, which is colloquially referred to as the "anaesthetic machine" for the sake of simplicity. In the developed world, the most frequent type in use is the continuous-flow anaesthetic machine or "Boyle's machine", which is designed to provide an accurate supply of medical gases mixed with an accurate concentration of anaesthetic vapour, and to deliver this continuously to the patient at a safe pre ...
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Hypotension
Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the diastolic blood pressure (the bottom number), which are the maximum and minimum blood pressures, respectively. A systolic blood pressure of less than 90 millimeters of mercury (mmHg) or diastolic of less than 60 mmHg is generally considered to be hypotension. Different numbers apply to children. However, in practice, blood pressure is considered too low only if noticeable symptoms are present. Symptoms include dizziness or lightheadedness, confusion, feeling tired, weakness, headache, blurred vision, nausea, neck or back pain, an irregular heartbeat or feeling that the heart is skipping beats or fluttering, or fainting. Hypotension is the opposite of hypertension, which is high blood pressure. It is best understood as a physiological st ...
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