Anaesthesia Awareness - Case Study Example

Anaesthesia Awareness Name: Institution: Anaesthesia Awareness Awareness under anaesthesia presents devastating experiences to a patient especially when pain is involved and may trigger anxiety. Anaesthesia awareness refers to a situation in which anaesthesia administered to a patient undergoing surgery fails to achieve complete or the desired insensibility leading to complete recollection accompanied by pain or vague recollection without pain (Cork, 2006). Awareness during anaesthesia often triggers anxiety during or after operation leading to intolerable pain, result into coma and in some cases even death. The common effect of anaethesia awareness includes post-traumatic stress disorder, usually accompanied symptoms such as insomnia, fear associated with flashbacks to the operation process, recurring anxiety and the fear of hospitals (Hudetz & Hemmings Jr, 2012). The event results from anaesthesia equipment failure, inadequate dose, and failure by the health providers to adhere to the recommended anaesthesia awareness-prevention practices. However, the greatest challenge in preventing awareness during anaesthesia revolves the limitation in determining the right level of unconsciousness. In order to achieve the right level of anaesthesia, anaesthetic nurses are expected to try to balance the hypnotic effects of anaesthetic agents against the possible arousal that may be triggered by the surgical process (Andrede, 2007). As such, anaesthesia awareness remains a major issue a major professional issue especially for the anaesthetic nurses and surgeons. While on clinical placement in preoperative preparation room, the issue of anaesthesia manifested in one of the patient undergoing appendectomy. The event presented prominent ethical and legal consideration related to professional practice as discussed in the subsequent sections. Case Scenario Patient X had been scheduled for appendicectomy and as a student on clinical practice in the hospital, I happened to be part of the team preparing the patient for the operation. Patient X is 55 years old, weight 80kg, and diagnosed with Type 2 diabetes. The patient was advised regarding the procedure as well as sedative agent to be administered and allowed to sign a formal informed consent form as required in pre-operative operation. The appropriate equipment such as a positive-pressure oxygen delivery system and monitoring apparatus were also positioned appropriately in the operation room. The patient was administered with an introduction dose 80mg/kg followed by 20 mg/kg every 4 minutes intravenous methohexital dose necessary to produce with deep sedation throughout the operation process. However, an error took place leading to failure to administer the maintenance dose every 4 minutes. As a result, the patient started to gain consciousness during the operation, a phenomenon that caused anxiety within the operations room. However, the operation went on since the patient’s response was minimal and later transferred to the recovery ward. Everything else was conducted well until the wound healed and the patient was discharged. The patient’s family reported that the patient had developed post-traumatic stress disorder accompanied symptoms such as insomnia, fear associated with flashbacks to the operation process and recurring anxiety. The family members later got information that the patient had gained some consciousness during the operation and neither the family members nor the patient was informed about the situation. Ethical, Professional, and Legal Issues Prominent in the Scenario The major ethical issue revolves around the failure to disclosure important information to the health of the patient to the family members or the patient about what conspired in the process of the surgery. Healthcare practitioners are mandated to discuss important information about the health of the patient either with the patient if in a competent condition or with the close family members (Smart, Ververis & Hivey, 2003). It is clear that the information withheld by the health providers would have been of benefit in planning the postoperative care. Disclosure of information about the incidence of anaesthesia awareness would have played a critical role in preparing the patient to live beyond the surgery room experiences as well as prevention of the posttraumatic distress symptoms reported by the family members (Simini, 2000). Health providers have an obligation to do everything within their means to ensure that the patient benefits from their actions and safeguarding the patient from potential but avoidable suffering because of complication associated with their interventions. The principle of integrity and totality demands consideration of the well-being of the whole person in making patient care plan and this could be easily applied in this case. The issues of the possible effects of the anaesthesia awareness on the wellbeing of the patient should have been taken into account in planning for the postoperative care to prevent effects such as the posttraumatic stress disorder (American Association of Nurse Anesthetists, 2013). The actions in the scenario contradicts the ethical principle of beneficence in which health providers are expected to do everything with positive impact on the patient’s health under any given circumstance. In this case, the anaesthesia nurses should have responded appropriately to ensure that the patient does not capture the events of the operation, which have devastating effect on the recovery of the patient. The legal issue arise from the scenario revolve around negligence as indicated by failure by the nurses involved in the operation to inform the patient or family members about intra-operative experience. The nurses not only failed to inform the patient or the family members about the event in the operation room but also failed to initiate or recommend psychiatric help to assist the patient to overcome problems that could have been triggered by the awareness. Despite nurses knowing the potential health risks that could be emanate from the patient’s experience chose to ignore such details in the postoperative care plan. This could be treated in a court of law as negligence on the part of the health providers to provide comprehensive care to patient leading to development of posttraumatic disorder (Lang, 2013). The issue of medical professional liability emerges in this scenario of the omissions of health care providers that resulted in the suffering of the patient (Kent & Domino, 2007). For instance, anaesthetic nurses made key omission in the process of the operation such as failure to effective monitor the patient for possible awareness, failure determine the appropriate anaesthesia depth necessary to keep the patient unconscious throughout the operation and failure to inform family members about the patient’s experiences in the operation and the possible effects. The patient or the family members through their legal representative can lay claims for damages based on separate theories of negligence against the surgeons and the preoperative preparation nurses and healthcare entities (Lang, 2013). In this case, the legal argument during litigation may revolve around deviation from standard of care in the operation unit. The anaesthetic nurses owe a duty of care to the patient to conform to the standards of care aimed at ensuring quality and safety during the provision of care. On the other hand, several professional issues related to nurse competency in delivering patient care arise from the scenario including failure to adhere to standard procedures in operative room. Nurse anesthesia standard practices require nurses to formulate a patient specific plan for anaesthesia and to implement the care plan as well as make adjustments based on the patient’s response to the anesthetic agents (Bejjani, Lequeux, Schmartz, Engelman, & Barvais, 2009). Nurses are required to continuously monitor assess the patient’s response to throughout the surgical process to optimize the patient’s physiologic condition. The competency of the health providers involved in the discussed case scenario faced the test following failure to determine the patient’s anesthesia depth and the error in administering the maintenance dose (Sandlin, 2006). Such incompetence resulted in the patient gaining awareness during the operation with subsequent negative implication on his postoperative psychological condition. The nurses also failed in the obligation to accurately document all the information related to the anesthesia administration and sedation in the patient’s medical record. This was evinced by lack of knowledge amongst the family members about the anesthesia awareness event that occurred in the surgery room. Accurate documentation of all the information related to the anesthesia administration and patient’s response would have paved way for the initiation of psychiatric intervention to safeguard the patient from posttraumatic disorder, fear, and anxiety (Daundere & Schwender, 2000). The nurses failed to ensure that before transferring the patient from the preoperative preparation to the surgical the patient’s safety and depth of the anesthetic agent was sufficient to avoid the patient becoming aware during the operation. The health providers involved in the case breached the obligation to observe standard safety precautions by committing errors and failing to initiate a psychological help intervention to ensure the awareness condition does not affect the patient’s psychological health in later days (American Association of Nurse Anesthetists, 2013). Breach of standards practices and procedures arises as a major professional competency issue in the case of patient X. Competence in the entire anesthesia administration and in the postoperative period would have prevented the ordeal the patient was going through after the operation. The nurses particularly failed in determining the appropriate anesthesia depth to guarantee that the patient does not become aware in the process of the operation, monitoring the patient’s response keenly and ability to apply a flexible patient care plan (Voss, 2007). All these failures represent significant incompetency on the part of nurse anesthesia in ensuring the patient’s sedation is kept within limits that prevent possibilities of awareness during the operation and its consequences on the patient. Recommendation In order to avoid potential legal actions from the different perspectives of medical professional liability as well as negative effects on the patient’s psychology, nurse anesthetists must focus on effective monitoring of the patient’s slightest awareness and initiate psychological interventions (Sneyd & Mathews, 2008). Since patients have the potential to record some of the events before the general anesthesia and during the operation, it would be recommended to initiate psychological help in the postoperative care. This would play a crucial role in helping the patient to cope with the preoperative and during the operation events beyond the wound recovery. Psychological help should be made a key aspect of postoperative care to avert complications associated with the slightest awareness during the operation such as posttraumatic stress, fear, insomnia, and anxiety. The next recommendation in dealing with the professional issues identified would be ensuring strict adherence to the standard nurse anesthesia practices throughout the entire patient care process. Continuous monitoring of the patient as one the measures in preventing anesthesia awareness and consequent effects can be enhanced through application of advanced monitoring technology such as the bispectral index electroencephalographic (Osborne, Bacon & Helps, 2005). Adherence to the standard practices can be bolstered through nurse education programs on anesthesia and provision of such standards in all preoperative, operative, and postoperative rooms as guidance for all parties involved in the provision of the care. Conclusion Although limited research has been done on the issue of anesthesia awareness, the ordeal under by patients following the event remains a major quality and safety issue in the contemporary health care facilities. The described scenario presents prominent ethical, legal and professional issues such negligence, concealing of importance information from patients and family members and failure to adhere to professional standards of practice in anesthesia. The issue of anesthesia awareness is preventable and can avoided through proper evaluation of the patient for potential risk factors, adherence to professional standards of practice in anesthesia, effective continuous monitoring of the patient and mandatory psychological help for the patients in the postoperative care. References American Association of Nurse Anesthetists. (2013). Standards for nurse anesthesia practice. Retrieved from http://www.aana.com/resources2/professionalpractice/Documents/PPM%20Standards%20for%20Nurse%20Anesthesia%20Practice.pdf Andrede, J. (2007). Unconscious memory formation during anaesthesia. Best Practice & Research Clinical Anaesthesiology 21 (3), 385-401. Bejjani, G., Lequeux, P., Schmartz, D., Engelman, E & Barvais, L. (2009). No evidence of memory processing during propofol-remifentanil target-controlled infusion anesthesia with bispectral index monitoring in cardiac surgery. Journal Of Cardiothoracic And Vascular Anesthesia 23(2), 175-181. Cork, R. (2006). Awareness under anesthesia. Journal of PeriAnesthesia Nursing 21(4), 288- 290. Daunderer, M & Schwender, D. (2000). Awareness during general anaesthesia: Extent of the problem and approaches to prevention. CNS Drugs 14 (4), 172-190. Hudetz, A & Hemmings Jr, H. (2012). Anaesthesia awareness: 3 years of progress. British Journal of Anaesthesia 108 (2), 180-182. Kent, C & Domino, K. (2007). Awareness: Practice, standards, and the law. Best Practice & Research Clinical Anaesthesiology, 21(3), 369-383. Lang, J. (2013). Awakening. The Atlantic Monthly. Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=95ae56de-936a-4ddc-9681-7dc770222f33%40sessionmgr111&vid=1&hid=118 Osborne, G., Bacon, A & Helps, R. (2005). Crisis management during anaesthesia: Awareness and anaesthesia. Quality Safe Health Care, 14 (16), 1-6. Sandlin, D. (2006). Anesthesia awareness. Journal of PeriAnesthesia Nursing 21(2), 135-137. Simini, B. (2000). 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