Christopher D Kent

University of Washington Seattle, Seattle, Washington, United States

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Publications (16)21.8 Total impact

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    ABSTRACT: Awareness during general anaesthesia is a source of concern for patients and anaesthetists, with potential for psychological and medicolegal sequelae. We used a registry to evaluate unintended awareness from the patient's perspective with an emphasis on their experiences and healthcare provider responses. English-speaking subjects self-reported explicit recall of events during anaesthesia to the Anesthesia Awareness Registry of the ASA, completed a survey, and submitted copies of medical records. Anaesthesia awareness was defined as explicit recall of events during induction or maintenance of general anaesthesia. Patient experiences, satisfaction, and desired practitioner responses to explicit recall were based on survey responses. Most of the 68 respondents meeting inclusion criteria (75%) were dissatisfied with the manner in which their concerns were addressed by their healthcare providers, and many reported long-term harm. Half (51%) of respondents reported that neither the anaesthesia provider nor surgeon expressed concern about their experience. Few were offered an apology (10%) or referral for counseling (15%). Patient preferences for responses after an awareness episode included validation of their experience (37%), an explanation (28%), and discussion or follow-up to the episode (26%). Data from this registry confirm the serious impact of anaesthesia awareness for some patients, and suggest that patients need more systematic responses and follow-up by healthcare providers. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email:
    BJA British Journal of Anaesthesia 07/2015; 115 Suppl 1(suppl 1):i114-i121. DOI:10.1093/bja/aev211 · 4.85 Impact Factor
  • Julia Metzner · Christopher Kent ·

    01/2014; DOI:10.2147/AA.S53280
  • Laurent Bollag · Christopher Kent · Megan Sherman ·

  • Survey of Anesthesiology 08/2013; 57(4):192-193. DOI:10.1097/01.SA.0000431228.86571.a8
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    ABSTRACT: Background: Superiority of the modified Brice interview over quality assurance techniques in detecting intraoperative awareness with explicit recall has not been demonstrated definitively. Methods: We studied a single patient cohort to compare the detection of definite awareness using a single modified Brice interview (postoperative day 28-30) versus quality assurance data (postoperative day 1). Results: The incidence of awareness based on the modified Brice interview was 19 per 18,847 or 0.1%. Fewer awareness cases (incidence 0.02%) were detected by the quality assurance approach (P < 0.0001). Conclusion: The modified Brice interview is the preferred modality for assessing intraoperative awareness with explicit recall.
    Anesthesia and analgesia 03/2013; 116(4). DOI:10.1213/ANE.0b013e318281e9ad · 3.47 Impact Factor
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    C D Kent · G A Mashour · N A Metzger · K L Posner · K B Domino ·
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    ABSTRACT: Background: Anaesthetic awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. Methods: The Registry recruited subjects who self-identified as having had anaesthetic awareness. Inclusion criteria were a patient-reported awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. Results: Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. Conclusions: Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
    BJA British Journal of Anaesthesia 11/2012; 110(3). DOI:10.1093/bja/aes386 · 4.85 Impact Factor
  • Julia Metzner · Christopher D Kent ·
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    ABSTRACT: PURPOSE OF REVIEW: To summarize the currently available data on malpractice claims related to ambulatory anesthesia and provide an insight into the emerging patterns of anesthesia liability in this practice setting. RECENT FINDINGS: At present, studies are mixed about how the continued growth of outpatient surgery will impact liability for anesthesiologists. Data derived from the ASA Closed Claims Project suggests that malpractice claims for major damaging events are less common in the outpatient settings than in inpatient settings. Correspondingly, the payment amounts for outpatient claims are significantly lower than those for inpatients. Nevertheless, nondisabling adverse events are common and involve respiratory, cardiac, equipment-related, and drug errors. In addition, the vast majority of injuries in outpatient claims was the result of substandard care and judged preventable by better monitoring. Although major incidents leading to malpractice suits are less, new liability exposure may be on the horizon, due to the changing landscape of ambulatory practice that permits care for sicker patients who require more complex surgeries. The areas of potential concern include postoperative discharge criteria, care for the obstructive sleep apnea patient, and the choice of anesthetic techniques such as neuraxial blocks and monitored anesthesia care. SUMMARY: With steady increase in outpatient surgery, anesthesiologists are confronted with new areas of liability. More data are needed to identify these risks and reduce exposure to malpractice claims.
    Current opinion in anaesthesiology 11/2012; DOI:10.1097/ACO.0b013e3283592f90 · 1.98 Impact Factor
  • Robin R Bruchas · Christopher D Kent · Hilary D Wilson · Karen B Domino ·
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    ABSTRACT: Awareness during general anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of awareness during general anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an anesthesia awareness experience exists. The incidence of anesthesia awareness ranges from 0.1 to 0.2% (e.g., 1-2/1000 patients). Increased recognition of awareness during general anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.
    Journal of Clinical Psychology in Medical Settings 04/2011; 18(3):257-67. DOI:10.1007/s10880-011-9233-8 · 1.49 Impact Factor
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    Laurent Bollag · Christopher Kent · Philippe Richebé · Ruth Landau ·
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    ABSTRACT: We report the peripartum management of a 30-year-old wheelchair-bound nullipara woman with spinal muscular atrophy (SMA) type II, including severe restrictive lung disease and Harrington rods. At 38 weeks gestation, she was admitted for an induction of labor with neuraxial analgesia, but she subsequently had to be delivered via cesarean section under general anesthesia. We describe the anesthetic implications of SMA on labor and delivery management and review the available literature. © 2011 Bollag et al, publisher and licensee Dove Medical Press Ltd.
    Local and Regional Anesthesia 04/2011; 4(1):15-20. DOI:10.2147/LRA.S17089
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    Lorri A Lee · Karen L Posner · Christopher D Kent · Karen B Domino ·

    International anesthesiology clinics 01/2011; 49(3):56-67. DOI:10.1097/AIA.0b013e31821a0294
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    Christopher D Kent · Laurent Bollag ·
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    ABSTRACT: Regional anesthesia and analgesia have been associated with improved analgesia, decreased postoperative nausea and vomiting, and increased patient satisfaction for many types of surgical procedures. In obstetric anesthesia care, it has also been associated with improved maternal mortality and major morbidity. The majority of neurological adverse events following regional anesthesia administration result in temporary sensory symptoms; long-term or permanent disabling motor and sensory problems are very rare. Infection and hemorrhagic complications, particularly with neuraxial blocks, can cause neurological adverse events. More commonly, however, there are no associated secondary factors and some combination of needle trauma, intraneural injection, and/or local anesthetic toxicity may be associated, but their individual contributions to any event are difficult to define.
    Local and Regional Anesthesia 10/2010; 3(1):115-23. DOI:10.2147/LRA.S8177
  • Christopher D Kent · Karen B Domino ·
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    ABSTRACT: The present review article provides a summary of the recent literature evaluating the technology for monitoring depth of anesthesia and patient outcomes associated with its use. The tentative and controversial findings of a 2006 study suggesting a correlation of mortality with lower intraoperative bispectral index scores were reproduced in a more recent study, but the correlation could be accounted for by controlling for patient comorbidities, particularly malignancy. In a large trial involving patients at high risk for awareness, general anesthesia with volatile agents guided by bispectral index monitoring was associated with a low incidence of awareness, but no more so than the use of alarms for limits on volatile agent concentration. Studies comparing both emerging and more established brain function monitors suggest that, in spite of their different algorithms for processing and filtering electromyographic signal, many monitors are affected by the use of neuromuscular blocking agents. Recent evidence is consistent with previous studies that describe a nonlinear model for the dose-response of EEG parameters to increasing concentration of anesthetic agents with a dosing plateau response over a clinically relevant dose range. The goal of precisely dosed general anesthesia guided by brain monitoring remains elusive.
    Current opinion in anaesthesiology 09/2009; 22(6):782-7. DOI:10.1097/ACO.0b013e3283326986 · 1.98 Impact Factor
  • Janet D Pavlin · Christopher D Kent ·
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    ABSTRACT: The purview of ambulatory anesthesia continues to broaden in response to national interest in controlling healthcare costs and eliminating unnecessarily expensive hospital stays. Recent advances in anesthesia allow us to minimize side effects and complications of anesthesia and surgery that might otherwise delay recovery and discharge. The purpose of this review is to highlight some of these latest advances in clinical care that may soon change how we practice. In many instances, hospitalization has been necessary to permit adequate control of pain and opioid-related side effects after surgery. A variety of multimodal analgesic techniques are described in this review (including alpha-2 agonists, beta-blockers,corticosteroids, cyclo-oxygenase 2 inhibitors, and regional anesthetic blocks) that reduce requirements for opioids, thereby eliminating some of the undesirable opioid related side effects. New antiemetic recommendations are included for management and prevention of postoperative nausea and vomiting. In addition, novel ways of reversing the effects of some anesthetic drugs (inhalational anesthetics and muscle relaxants) are described. The research and advances in clinical care described will likely influence how we manage our patients in the future, eliminating the need for prolonged hospital stay after surgery.
    Current opinion in anaesthesiology 01/2009; 21(6):729-35. DOI:10.1097/ACO.0b013e328316bb02 · 1.98 Impact Factor
  • Christopher D Kent · Frederick W Cheney ·
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    ABSTRACT: We report the case of a 32 year-old man who underwent a laparoscopic-assisted sigmoid colectomy and who developed bilateral upper trunk brachial plexopathy. The complication occurred with intraoperative signs of neurovascular compression. Failure to recognize the significance of a decrease in pulses in the upper extremities, with resulting lack of remedial action, may have been a major factor leading to patient injury.
    Journal of Clinical Anesthesia 10/2007; 19(6):482-4. DOI:10.1016/j.jclinane.2007.01.010 · 1.19 Impact Factor
  • Christopher D Kent · Karen B Domino ·
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    ABSTRACT: Increased attention in recent years in both the academic literature and general media on awareness during general anaesthesia has raised the spectre of an increase in the liability burden of anaesthesia awareness. Liability will be different around the world, largely influenced by factors such as the presence of no-fault compensation systems for medical complications in some countries and the characteristics of the common law tort systems in others, such as the United States. A review of the largest single source for liability data, the American Society of Anesthesiologists' Closed Claims database, found the proportion of anaesthesia malpractice claims and claim payment amounts for awareness did not increase during the 1990s. However, due to the time lag to settlement of claims, this data predates recent attention to awareness and electroencephalographic monitoring, factors that may increase liability for awareness in the future.
    Baillière&#x27 s Best Practice and Research in Clinical Anaesthesiology 10/2007; 21(3):369-83. DOI:10.1016/j.bpa.2007.04.007
  • Christopher D. Kent · Karen B. Domino ·
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    ABSTRACT: Explicit recall under anesthesia occurs with a frequency in general anesthesia between 0.1% and 0.2%. A multimodal strategy that includes the use of brain function monitoring in high-risk cases is optimal for prevention of awareness. Awareness may be unavoidable under certain challenging anesthetic conditions. When awareness does occur, it can cause significant long-term disturbance to the patient's health, including PTSD. The follow-up and treatment of patients who have experienced awareness should be proactive and probably will be a focus of JCAHO inspections of anesthesia departments.
    Advances in Anesthesia 01/2006; 24:109-125. DOI:10.1016/j.aan.2006.06.004