Prevalence of Anesthesia Awareness during Surgery (original) (raw)
Related papers
Psychological aspects of anesthesia
1996
Background: Experiences of awareness and recall during general anesthesia can be most distressing for patients. To obtain relevant information, the authors systematically interviewed patients in whom awareness during surgery had occurred and questioned them about their experiences. Methods: Twenty-six patients, referred by colleagues, described the facts and feelings they had experienced during the period of awareness, and whether this had had any consequences. Available anesthetic records were independently judged by three experienced anesthesiologists for relevant parameters. Results: Auditory perception and the sensation of paralysis were most frequently mentioned, followed by the sensation of pain. Patients’ feelings were mostly related to anxiety, panic, powerlessness, and helplessness. Eighteen patients (70%) experienced unpleasant aftereffects, including sleep disturbances, dreams and nightmares, and flashbacks and anxiety during the day. Only nine patients (35%) had informed...
Incidence of awareness in patients undergoing elective surgeries during general anesthesia
2022
Introduction: General Anesthesia (GA) is reversible loss of consciousness. Awareness occurs when there is an explicit recall of intraoperative events with or without pain. It can cause distress, anxiety, chronic fear, depression, post-traumatic stress disorder, etc. There is an increasing concern over claims regarding awareness during anesthesia. Materials and Methods: The study was done on 188 patients. GA was administered as needed using Total Intra Venous Anaesthesia (TIVA), Mask, Supra glottic device, or Endo Tracheal Tube (ETT). Patients were encouraged to report any awareness in any form during the entire procedure voluntarily and were also directly questioned through a structured questionnaire in the recovery room, one hour and 24 hours after surgery. Results: Eighty-four females and 104 males with a mean age of 39.9 years constituted the study. In all, 89.3% of subjects underwent general anesthesia with ETT, 7.4% with a supraglottic device, and 2.1% and 1% with mask and TIVA, respectively. Patients recalled events just before induction (holding an oxygen mask-49%, receiving a painful injection-21%) and soon after emergence (shifting to a trolley-26.3%, holding an oxygen mask-17.2%) but did not complain of intraoperative awareness. No incidence of awareness was reported by any patient or at direct questioning. Conclusion: There was no incidence of awareness in any patient in our study.
M E D I C I N E Awareness Under General Anesthesia
Background: Awareness while under general anesthesia, and the later recall of what happened during surgery, can be experienced by patients as horrific events that leave lasting mental trauma behind. Patients may have both auditory and tactile perception, potentially accompanied by feelings of helplessness, inability to move, pain, and panic ranging to an acute fear of death. For some patients, the experience of awareness under anesthesia has no sequelae; for others, however, it can lead to the development of post-traumatic stress disorder, consisting of complex psychopathological phenomena such as anxiety, insomnia, nightmares, irritability, and depression possibly leading to suicidality.
Canadian Medical Association Journal, 2008
M ore than 40 million patients receive anesthesia each year in North America. The risks associated with anesthesia have progressively decreased, but the mechanisms of action of anesthetic drugs remain poorly understood. This lack of knowledge has limited the optimum use of drugs that are currently available and has slowed efforts to develop even safer anesthetics. Many complex and lengthy surgical procedures, often performed on medically compromised patients, have been made possible by modern anesthetic techniques. However, anesthetic drugs, like other medications, have limitations, contraindications and adverse effects.
Psychological Consequences of Awareness During Anaesthesia
Failure of general anesthesia to render a patient insensate, termed "awareness," is estimated to affect between 40,000 and 140,000 patients in the US each year. This study investigated the occurrence of post-traumatic stress disorder (PTSD) in subjects who reported a past episode of intraoperative awareness. We inquired about intraoperative and postoperative experiences and studied the relationship between various surgical experiences and currently meeting the diagnosis of PTSD. Sixteen postawareness subjects and 10 postgeneral anesthesia controls completed the Clinician Administered PTSD Scale (CAPS), a standardized clinical rating scale for PTSD, and a questionnaire about peri-operative experiences. Nine of 16 subjects (56.3%), a mean of 17.9 postoperative years, and no controls met diagnostic criteria for current PTSD (X 2 ϭ 8.6, df ϭ 1, PϽ.01). Common intraoperative experiences included an inability to communicate, helplessness, terror, and pain. Postawareness patients had significant postoperative distress related to feeling unable to communicate, unsafe, terrified, abandoned and betrayed. Perioperative dissociative experiences predicted having current PTSD. Being conscious during surgery is a traumatic event that may result in developing chronic PTSD. Further studies should include prospective designs of prevalence and long-term psychological, social, and overall health effects, and ways of preventing and treating awareness-induced PTSD.
Anaesthetic interventions for prevention of awareness during surgery
Cochrane Database of Systematic Reviews , 2016
Background General anaesthesia is usually associated with unconsciousness. ’Awareness’ is when patients have postoperative recall of events or experiences during surgery. ’Wakefulness’ is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness. Objectives To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, ISSUE 4 2016); PubMed from 1950 to April 2016;MEDLINE from 1950 to April 2016; and Embase from 1980 to April 2016. We contacted experts to identify additional studies. We performed a hand search of the citations in the review. We did not search trial registries. Selection criteria We included randomized controlled trials (RCTs) of either anaesthetic regimens or anaesthetic depth monitors. We excluded volunteerstudies,studiesofpatientspriortoskinincision,intensivecareunitstudies,andstudiesthatonlyrandomizeddifferentwordpresentationsfor memory tests (not anaesthetic interventions). Anaesthetic drug regimens included studies of induction or maintenance, or both. Anaesthetic depth monitors included the Bispectral Index monitor, M-Entropy, Narcotrend monitor, cerebral function monitor, cerebral state monitor, patient state index, and lower oesophageal contractility monitor. The use of anaesthetic depth monitors allows the titration of anaesthetic drugs to maintain unconsciousness. 1Anaesthetic interventions for prevention of awareness during surgery (Review)Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Data collection and analysis At least two authors independently scanned abstracts, extracted data from the studies, and evaluated studies for risk of bias. We made attempts to contact all authors for additional clarification. We performed meta-analysis statistics in packages of the R language. Main results We included 160 studies with 54,109 enrolled participants; 53,713 participants started the studies and 50,034 completed the studies or data analysis (or both). We could not use 115 RCTs in meta-analytic comparisons because they had zero awareness events. We did not merge 27 of the remaining 45 studies because they had excessive clinical and methodological heterogeneity. We pooled the remaining 18 eligible RCTs in meta-analysis. There are 10 studies awaiting classification which we will process when we update the review. The meta-analyses included 18 trials with 36,034 participants. In the analysis of anaesthetic depth monitoring (either Bispectral Index or M-entropy) versus standard clinical and electronic monitoring, there were nine trials with 34,744 participants. The overall event rate was 0.5%. The effect favoured neither anaesthetic depth monitoring nor standard clinical and electronic monitoring, with little precision in the odds ratio (OR) estimate (OR 0.98, 95% confidence interval (CI) 0.59 to 1.62).In a five-study subset of Bispectral Index monitoring versus standard clinical and electronic monitoring, with 34,181 participants, 503participants gave awareness reports to a blinded, expert panel who adjudicated or judged the outcome for each patient after reviewing the questionnaires: no awareness, possible awareness, or definite awareness. Experts judged 351 patient awareness reports to have no awareness, 87tohavepossibleawareness, and65tohavedefiniteawareness. The effect size favoured neither Bispectral Index monitoring nor standard clinical and electronic monitoring, with little precision in the OR estimate for the combination of definite and possible awareness (OR 0.96, 95% CI 0.35 to 2.65). The effect size favoured Bispectral Index monitoring for definite awareness, but with little precision in the OR estimate (OR 0.60, 95% CI 0.13 to 2.75). We performed three smaller meta-analyses of anaesthetic drugs. There were nine studies with 1290 participants. Wakefulness was reduced by ketamine and etomidate compared to thiopental. Wakefulness was more frequent than awareness. Benzodiazepines reduces awareness compared to thiopental, ketamine, and placebo., Also, higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness. We graded the quality of the evidence as low or very low in the ’Summary of findings’ tables for the five comparisons. Most of the secondary outcomes in this review were not reported in the included RCTs. Authors’ conclusions Anaesthetic depth monitors may have similar effects to standard clinical and electrical monitoring on the risk of awareness during surgery. In older studies comparing anaesthetics in a smaller portion of the patient sample, wakefulness occurred more frequently than awareness. Use of etomidate and ketamine lowered the risk of wakefulness compared to thiopental. Benzodiazepines compared to thiopental and ketamine, or higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness
Abstracts presented at the 8th International Symposium on Memory and Awareness in Anesthesia (MAA8)
British Journal of Anaesthesia, 2012
Anaesthesia offers an important tool for the scientific study of consciousness. Recent works will be discussed with an aim towards answering basic questions regarding the nature of consciousness and how it is removed by anaesthesia. What brain areas and systems must be turned off to remove consciousness? What brain regions or key processes must be turned back on to restore consciousness? How will a better understanding of the neurobiology of consciousness allow the clinician to give a better and safer anaesthetic? What new monitoring technology might enhance the safety of anaesthesia delivery and reduce the risks of intraoperative awareness? This lecture will touch upon these key topics in order to provide the background needed for understanding future developments in anaesthesia research.
Awareness during emergence from anesthesia: Features and future research directions
World Journal of Clinical Cases, 2020
The anesthesia awareness with recall (AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.