All patients should be informed of the risks of general anaesthesia, including the possibility of AAGA, before their surgery.
When consenting patients, practitioners should use a form of words that proportionately conveys the risks of AAGA.
Consent for sedation should emphasise that the patient will be awake and therefore may have recall for at least parts of the procedure.
Practitioners should identify certain situations or certain patient factors as constituting a higher risk for AAGA (including organisational factors such as overbooked or reorganised surgical lists) and highlight these at the WHO premeet/team brief.
During induction of anaesthesia, practitioners should adhere to suitable dosing of intravenous agent, check anaesthetic effect before paralysis or instrumentation of the airway and maintain anaesthetic administration, including during transfer of patients (which is facilitated by a simple ABCDE checklist).
If AAGA is suspected during maintenance (e.g., by patient movement), prompt attention should be paid to giving verbal reassurance to the patient, increasing analgesia, and deepening the level of anaesthesia.
For cases requiring paralysis, the minimum dose of neuromuscular blocking drugs (NMBDs) that achieves sufficient neuromuscular blockade for surgery should be used, and the nerve stimulator is an essential monitor to titrate the dosing of NMBDs to this minimum.
Where total intravenous anaesthesia (TIVA) is used, practitioners should adhere to the relevant recently published guidelines.
At emergence, practitioners should first confirm that surgery is complete, then ensure NMBDs are adequately reversed before allowing the patient to regain consciousness. Practitioners should then manage the patient experience, particularly during awake extubation, by speaking to the patient.
Cases of AAGA should be managed using the NAP5 pathway as a guide.