title: 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data.
abstract: BACKGROUND
  Accidental awareness during general anaesthesia (AAGA) with recall is a potentially distressing complication of general anaesthesia that can lead to psychological harm. The 5th National Audit Project (NAP5) was designed to investigate the reported incidence, predisposing factors, causality, and impact of accidental awareness.
  
  
  METHODS
  A nationwide network of local co-ordinators across all the UK and Irish public hospitals reported all new patient reports of accidental awareness to a central database, using a system of monthly anonymized reporting over a calendar year. The database collected the details of the reported event, anaesthetic and surgical technique, and any sequelae. These reports were categorized into main types by a multidisciplinary panel, using a formalized process of analysis.
  
  
  RESULTS
  The main categories of accidental awareness were: certain or probable; possible; during sedation; on or from the intensive care unit; could not be determined; unlikely; drug errors; and statement only. The degree of evidence to support the categorization was also defined for each report. Patient experience and sequelae were categorized using current tools or modifications of such.
  
  
  CONCLUSIONS
  The NAP5 methodology may be used to assess new reports of AAGA in a standardized manner, especially for the development of an ongoing database of case reporting. This paper is a shortened version describing the protocols, methods, and data analysis from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK jaideep.pandit@dpag.ox.ac.uk.
authors.forename: J J
authors.initials: JJ
authors.lastname: Pandit
authors.affiliation: Department of Psychology, School of Psychology and Cognition Institute, Plymouth University, Plymouth, UK.
authors.forename: J
authors.initials: J
authors.lastname: Andrade
authors.affiliation: Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Bogod
authors.affiliation: Member Royal College of Anaesthetists' Lay Committee, London, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Hitchman
authors.affiliation: Department of Anaesthesia, Intensive Care and Pain Medicine, Sligo Regional Hospital, Sligo, Ireland.
authors.forename: W R
authors.initials: WR
authors.lastname: Jonker
authors.affiliation: Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, UK.
authors.forename: N
authors.initials: N
authors.lastname: Lucas
authors.affiliation: Department of Anaesthesia, Papworth Hospital, Cambridge, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Mackay
authors.affiliation: Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: A F
authors.initials: AF
authors.lastname: Nimmo
authors.affiliation: Bristol School of Anaesthesia, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: O'Connor
authors.affiliation: Department of Anaesthesia, St James Hospital, Dublin, Ireland.
authors.forename: E P
authors.initials: EP
authors.lastname: O'Sullivan
authors.affiliation: Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Paul
authors.affiliation: Department of Anaesthesia, Salford Royal Hospital, Salford, UK.
authors.forename: J H MacG
authors.initials: JH
authors.lastname: Palmer
authors.affiliation: Department of Anaesthesia, Imperial College NHS Trust, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Plaat
authors.affiliation: Department of Neuroanaesthesia, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Radcliffe
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
authors.forename: M R J
authors.initials: MR
authors.lastname: Sury
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Torevell
authors.affiliation: Department of Clinical Psychology, University of Leicester, Leicester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Cook
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D003071:Cognition / Q000502:physiology; D003625:Data Collection / Q000379:methods; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D058926:Intraoperative Awareness / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D007431:Intraoperative Complications / Q000209:etiology; D007494:Ireland / Q000453:epidemiology; D019300:Medical Errors / Q000706:statistics & numerical data; D019148:Neuromuscular Blockade / Q000009:adverse effects; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: AAGA; awareness; consciousness; mechanisms