Attitudes of anaesthetists to awareness and depth of anaesthesia monitoring in the UK

Background and objective: Awareness with postoperative recall of intraoperative events is a rare but serious complication of general anaesthesia. This survey investigated the attitude of anaesthetists in the UK to awareness and depth of anaesthesia monitoring. Methods: Questionnaires were sent to 4927 consultant anaesthetists in 285 hospitals in the UK in September 2004. The responses were recorded in an electronic database, summarized and compared with the results of studies performed in Australia and the USA. Results: The response rate was 44%. When judged against published awareness rates, anaesthetists underestimated the incidence of awareness in their own practice (median 1 : 5000). One-third of respondents have dealt with patients who have experienced intraoperative recall. The majority of anaesthetists perceived awareness as a minor problem on an 11-point scale (modal score 2, median score 3, IQR 2-5). Eighty-six percent of anaesthetists considered clinical signs unreliable but 91% felt that measurement of end-tidal anaesthetic agent concentration reduces the likelihood of awareness. The majority of anaesthetists would use a monitor at least some of the time if one was available to them. Overall, the attitudes of anaesthetists in the UK, USA and Australia are remarkably similar. Conclusions: Anaesthetists tend not to view awareness as a serious problem. Although most accept that clinical signs are unreliable indicators of awareness, few believe that monitors of anaesthetic depth should be used for routine cases.