Joint Commission Issues Alert on Patient Awareness Under Anesthesia

OAKBROOK TERRACE, Ill. -- Tens of thousands of patients undergoing surgery each year experience the helplessness of being partially awake while under general anesthesia during surgery, but being unable to communicate their distress to caregivers.  Better understanding among healthcare professionals of this frightening phenomenon could reduce the risk of these events and assure appropriate support for patients when they do occur, according to an Alert issued today by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).


The phenomenon of anesthesia awareness affects an estimated 20,000 to 40,000 patients each year.  While that figure represents only one to two cases in every 1,000 general anesthetics administered, the experience is traumatic for those patients who do become aware.  Patients undergoing cardiac, obstetric and major trauma surgeries are at proportionately higher risk for anesthesia awareness, according to the Joint Commissions Sentinel Event Alert patient safety newsletter.


Anesthesia awareness is under-recognized and under-treated in health care organizations, says Dennis S. OLeary, MD, president of the Joint Commission.  The Joint Commission understands that anesthesia professionals must balance the psychological risks of anesthesia awareness against the physiological risks of excessive anesthesia.  This Alert is intended to help health care organizations address this problem in an open and constructive fashion.  


The Joint Commission Alert to more than 15,000 healthcare organizations nationwide is designed to provide practical advice to health care organization leaders and health care professionals to help prevent or, when it occurs, manage anesthesia awareness.  The specific recommendations set forth in the Alert include:

1) Develop and implement an anesthesia awareness policy that addresses the following:

           Education of clinical staff about anesthesia awareness and how to manage patients who have experienced awareness.

           Identification of patients at proportionately higher risk for an awareness experience, and discussion with such patients, before surgery, of the potential for anesthesia awareness.

           The effective application of available anesthesia monitoring techniques, including the timely maintenance of anesthesia equipment.

           Appropriate post-operative follow-up of all patients who have undergone general anesthesia, including children.

           The identification, management and, if appropriate, referral of patients who have experienced awareness.


2) Assure access to necessary counseling or other support for patients who are experiencing post-traumatic stress syndrome or other mental distress.

The Alert on anesthesia awareness is the latest in a series of periodic Alerts issued by the Joint Commission.  The content for most but not all of these Alerts is drawn from the Joint Commissions Sentinel Event Database, one of the nations most comprehensive voluntary reporting systems for adverse events in healthcare.  Previous Alerts have addressed wrong-site surgery, deadly medication mix-ups, healthcare-acquired infections, patient suicides, infant abductions, and fatal falls among the elderly. This Database identifies the common underlying causes of sentinel events and provides an informed basis for the Joint Commission to warn facilities about dangers and share solutions for preventing these occurrences.  The complete list and text of past issues of Sentinel Event Alert can be found on the Joint Commission website at


Source: Joint Commission on Accreditation of Healthcare