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Related Concept Videos

General Anesthesia: Overview01:24

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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
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The concept of subconscious awareness refers to the processing of information below the level of conscious thought, which significantly influences both behaviors and decisions. It is also known as waking subconscious awareness. This complex level of cognition operates without the direct awareness of the individual, facilitating rapid and simultaneous handling of multiple information streams.
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Inhalational Anesthetics: Overview01:20

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Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Updated: Mar 23, 2026

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Awareness during anesthesia: a closed claims analysis.

K B Domino1, K L Posner, R A Caplan

  • 1Department of Anesthesiology, University of Washington School of Medicine, and the Virginia Mason Medical Center, Seattle 98195, USA. kdomino@u.washington.edu

Anesthesiology
|April 14, 1999
PubMed
Summary
This summary is machine-generated.

Intraoperative awareness during general anesthesia, including awake paralysis and recall, is linked to professional liability. Substandard care in labeling and administration caused awake paralysis, while specific anesthetic techniques increased recall risk.

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Area of Science:

  • Anesthesiology
  • Medical Malpractice Law
  • Patient Safety

Background:

  • Intraoperative awareness during general anesthesia can cause significant psychological distress and post-traumatic stress disorder.
  • This study investigates the role of intraoperative awareness in anesthesia-related professional liability claims.

Purpose of the Study:

  • To analyze cases of intraoperative awareness from the American Society of Anesthesiologists Closed Claims Project database.
  • To identify factors contributing to professional liability in anesthesia due to awareness events.

Main Methods:

  • Reviewed malpractice claims from the Closed Claims Project database focusing on intraoperative awareness.
  • Identified causation patterns and standards of care for awareness claims.
  • Used logistic regression to determine patient and anesthetic factors associated with recall during general anesthesia.

Main Results:

  • Awareness claims constituted 1.9% of all claims, with 18 for awake paralysis and 61 for recall.
  • Awake paralysis claims predominantly involved errors in labeling and administration (94% substandard care).
  • Recall during general anesthesia was more frequent in women and associated with nitrous-narcotic-relaxant techniques without volatile anesthetics.

Conclusions:

  • Labeling deficiencies and lack of vigilance were primary causes of awake paralysis.
  • Women and specific anesthetic combinations (nitrous-narcotic-relaxant) were linked to higher rates of recall during general anesthesia.