Background:
Sexual assault occurs every 73 seconds in the USA as per 2019 data collected by the US Department of Justice. Rates of sexual assault are between 17–18% for women and 3% for men. These numbers are likely to grow with LGBTQ sexual assaults inclusion, for which the rates are even higher. Studies reveal patients with sexual assault history undergoes significantly higher number of surgeries compared to patients with no such history. Likewise prevalence of abuse history tend to be the highest among patients in gastroenterology clinics who present with either functional disorder or gastrointestinal conditions like irritable bowel syndrome, abdominal pain and or endoscopic evaluation. Sexual assault victims are at increased risk for psychiatric issues and altered pain perception which should be taken into account by anesthesiologist. Similarly, unfamiliar environment and feeling of loss of control under anesthesia may lead to perioperative complications and poor patient satisfaction.
Anesthesia providers should ask about these experiences during routine perioperative care to avoid untoward patient experience.
Project:
We conducted a patient safety and quality improvement project that involved anesthesiologist’s awareness of patients with sexual assault history and special anesthetic considerations.
Methods:
A survey was distributed among our anesthesiology team about sexual assault, its incidence and consequences. Same survey was repeated after a lecture presentation by a guest speaker about anesthetic consideration of patients with the history of sexual assault. The post lecture survey showed improvement of our anesthesia team’s awareness of the perioperative anesthetic management of these at risk patients.
Results:
90% of our staff reported limited knowledge of sexual assault prevalence. 90% admitted of not asking a sexual abuse history during their assessment. Post presentation, 80% were willing to ask about sexual abuse history during preoperative interview under special circumstances and 20% would always ask about sexual assault. Furthermore, 90% would change their anesthetic practice.
Discussion:
Sexual assault is any unwanted sexual act or behavior which is threatening, violent, forced, or coercive and to which a person has not given consent. Many victims experience shock, denial, fear, confusion, anxiety, withdrawal, shame, guilt, nervousness and distrust following sexual assault that may lead to chronic psychological conditions such as major depression, generalized anxiety disorder, post-traumatic stress disorder and low self-esteem. It is also common for the victim to remain silent due to perceived shame, guilt and fear of implication.
These patients may present with exaggerated anxiety on the day of surgery. Patients on inquiry may disclose history of sexual assault during anesthesia evaluation. However, unprompted revelation just before surgery is also reported. Patients should be reassured about their safety and a loved one should accompany the patient to the operating room. Appropriate anxiolytic medication and counseling regarding the perioperative care should be employed. Anesthetic medications for some patients may elicits feeling of loss of control, for others vulnerability of being physically exposed on the operating room can be triggering, therefore they should be appropriately covered both on induction and extubation. Since these patients are more likely to suffer chronic pain and psychological conditions that alter pain perception, appropriate intraoperative and post operative analgesic plan should be in place.
Patient should be made aware of the social and psychiatric support to ensure current surgical experience did not add to their burden.
Since there is no consensus ASA guidelines regarding anesthetic management of sexual assault patients, we advocate increasing awareness among physicians through lectures and quality improvement projects to improve outcome.
Key words: Sexual assault, Anesthesia, Perioperative evaluation
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