Guidelines for Complications of Cancer Treatment Vol VIII Part B

disorder) may occur after an episode of intraoperativeawareness, and affected patients may remain severely disabledfor extended periods of time. Surgeries for cancer due to theircomplexities associated with massive blood loss,haemodyanamic instability and sharing of airway or difficultairway may have episodes of lighter planes of anaesthesiamaking awareness possible.Practice Advisory for Intraoperative Awareness and BrainFunction MonitoringA Report by the American Society of Anesthesiologists TaskForce on Intraoperative Awareness Anesthesiology 2006;104:847–64Definition- Intraoperative awareness occurs when a patientbecomes conscious during a procedure performed undergeneral anesthesia and subsequently has recall of these events.For the purpose of this Advisory, recall is limited to explicitmemory and does not include the time before generalanesthesia is fully induced or the time of emergence fromgeneral anesthesia, when arousal and return of consciousnessare intended. Dreaming is not considered intraoperativeawareness.Preoperative Evaluation- An evaluation should include, ifpossible, a review of a patient’s medical records for previousoccurrences of awareness or other potential risk factors, apatient interview to assess level of anxiety or previousexperiences with anesthesia, and a physical examination.Potential risk factors to consider for patients undergoinggeneral anesthesia include substance use or abuse (e.g.,opioids, benzodiazepines, cocaine), a history of awareness, ahistory of difficult intubation or anticipated difficult intubation,chronic pain patients using high doses of opioids, cardiacsurgery, cesarean delivery, trauma and emergency surgery,69