David Royston and Felicia Cox from the Harefield Hospital, Middlesex, UK, outline how patients scheduled for surgical procedures continue to express concerns about their safety, outcome, and comfort. All medical interventions carry risks, the authors comment, but the patient often considers anaesthesia as the intervention with the greatest risk. Many still worry that they will not wake up after their surgery, or that they will be awake during the operation. The article highlights how patients' awareness during surgery is rare-in around 0.2% of operations excluding obstetric and cardiac surgery.
The article discusses how there have been 'slow but steady' improvements in reported pain after surgery; around 2% fewer patients per year have reported postoperative moderate to severe pain over the past 30 years, associated with increased use of patient-controlled analgesia and epidural analgesia.
David Royston comments: "Challenges to improve the comfort of patients continue, especially with regard to the almost universal problems of nausea, vomiting, and pain after surgery. A newer concern is that patients will develop some degree of mental impairment that may delay return to a full work and social lifestyle for days and weeks. Developments in technology, education, and training have had a major effect on anaesthetic practice, so that anaesthesia is increasingly regarded as safe for the patient."
See also Commentary (p 1598)
Contact: Dr David Royston, Consultant in Cardiothoracic Anaesthesia, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK;
Lancet 2003; 362: 1598, 1648-58