Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review
General anesthesia should induce unconsciousness and provide amnesia. Intraoperative awareness (IOA) is the unexpected awakening of the patient during general anesthesia, which also implies failure of anesthesia. Inadequate concentration of anesthetic drugs due to malfunction or error in the Anesthe...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1566185/full |
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| author | Qisheng Chen Qisheng Chen Shixuan Peng Shixuan Peng Shixuan Peng Wenjun Luo Shuzhai Li Zhiming Zhang |
| author_facet | Qisheng Chen Qisheng Chen Shixuan Peng Shixuan Peng Shixuan Peng Wenjun Luo Shuzhai Li Zhiming Zhang |
| author_sort | Qisheng Chen |
| collection | DOAJ |
| description | General anesthesia should induce unconsciousness and provide amnesia. Intraoperative awareness (IOA) is the unexpected awakening of the patient during general anesthesia, which also implies failure of anesthesia. Inadequate concentration of anesthetic drugs due to malfunction or error in the Anesthetic Drug Delivery Systems (ADDS) is a common cause of IOA. This review explores the risk factors for IOA associated with ADDS, focusing on issues in intravenous systems like infusion pump malfunctions, lack of carrier fluid, unrecognized venous access blockades, intraoperative dosing errors, and syringe swaps, as well as problems in inhalation systems such as anesthetic vaporizer malfunctions, insufficient carrier or fresh gas flow, and breathing circuit leaks. To tackle the unique challenges of ADDS in relation to IOA, the review discusses and emphasizes comprehensive 3E prevention strategies: (1) Enhancing training and education (such as check-listing of anesthetic delivery systems preoperatively, conducting effective communication, optimizing drug combinations, and avoiding intraoperative anesthetic medication errors); (2) Employing more monitoring intraoperatively (such as monitoring anesthetic concentration, monitoring depth of anesthesia, monitoring vital signs, and monitoring neuromuscular function); and (3) Encouraging incident reporting and audit practices. The future of ADDS may involve AI-assisted and AI-supervised management to further reduce the risk of IOA. However, more research is needed to eliminate IOA. |
| format | Article |
| id | doaj-art-33609b316cfd4d3b91d3fbc33cfc55d6 |
| institution | OA Journals |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-33609b316cfd4d3b91d3fbc33cfc55d62025-08-20T02:35:51ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-06-011610.3389/fphar.2025.15661851566185Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative reviewQisheng Chen0Qisheng Chen1Shixuan Peng2Shixuan Peng3Shixuan Peng4Wenjun Luo5Shuzhai Li6Zhiming Zhang7Department of Anesthesiology, The First People's Hospital of Chenzhou, The First Affiliated Clinical College, University of Xiangnan, Chenzhou, Hunan, ChinaDepartment of Pharmacology, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), Xiangtan, Hunan, ChinaDepartment of Anesthesiology, The First People's Hospital of Chenzhou, The First Affiliated Clinical College, University of Xiangnan, Chenzhou, Hunan, ChinaDepartment of Oncology, Graduate Collaborative Training Base of The First People’s Hospital of Xiangtan City, Hengyang Medical School, University of South China, Hengyang, Hunan, ChinaDepartment of Oncology, The First People’s Hospital of Xiangtan City, Xiangtan, Hunan, ChinaDepartment of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, ChinaDepartment of Anesthesiology, The First People's Hospital of Chenzhou, The First Affiliated Clinical College, University of Xiangnan, Chenzhou, Hunan, ChinaDepartment of Anesthesiology, The First People's Hospital of Chenzhou, The First Affiliated Clinical College, University of Xiangnan, Chenzhou, Hunan, ChinaGeneral anesthesia should induce unconsciousness and provide amnesia. Intraoperative awareness (IOA) is the unexpected awakening of the patient during general anesthesia, which also implies failure of anesthesia. Inadequate concentration of anesthetic drugs due to malfunction or error in the Anesthetic Drug Delivery Systems (ADDS) is a common cause of IOA. This review explores the risk factors for IOA associated with ADDS, focusing on issues in intravenous systems like infusion pump malfunctions, lack of carrier fluid, unrecognized venous access blockades, intraoperative dosing errors, and syringe swaps, as well as problems in inhalation systems such as anesthetic vaporizer malfunctions, insufficient carrier or fresh gas flow, and breathing circuit leaks. To tackle the unique challenges of ADDS in relation to IOA, the review discusses and emphasizes comprehensive 3E prevention strategies: (1) Enhancing training and education (such as check-listing of anesthetic delivery systems preoperatively, conducting effective communication, optimizing drug combinations, and avoiding intraoperative anesthetic medication errors); (2) Employing more monitoring intraoperatively (such as monitoring anesthetic concentration, monitoring depth of anesthesia, monitoring vital signs, and monitoring neuromuscular function); and (3) Encouraging incident reporting and audit practices. The future of ADDS may involve AI-assisted and AI-supervised management to further reduce the risk of IOA. However, more research is needed to eliminate IOA.https://www.frontiersin.org/articles/10.3389/fphar.2025.1566185/fullintraoperative awarenessgeneral anesthesiadrug delivery system errorsequipment safetypreventive strategies |
| spellingShingle | Qisheng Chen Qisheng Chen Shixuan Peng Shixuan Peng Shixuan Peng Wenjun Luo Shuzhai Li Zhiming Zhang Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review Frontiers in Pharmacology intraoperative awareness general anesthesia drug delivery system errors equipment safety preventive strategies |
| title | Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review |
| title_full | Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review |
| title_fullStr | Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review |
| title_full_unstemmed | Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review |
| title_short | Preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems: a narrative review |
| title_sort | preventive strategies for reducing intraoperative awareness due to errors in anesthetic drug delivery systems a narrative review |
| topic | intraoperative awareness general anesthesia drug delivery system errors equipment safety preventive strategies |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1566185/full |
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