Accidental awareness during anesthesia in children

Sury, Michael R. J.

doi:10.1111/pan.12894

Cited by 16 publications

(14 citation statements)

References 19 publications

(23 reference statements)

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“…In their 2014 meta-analysis, Shen et al [ 38 ] reported that the prophylactic administration of dexamethasone, ondansetron, or their combination in pediatric strabismus surgery can reduce PONV incidence. In a 2016 guideline, ondansetron combined with dexamethasone—but not dexmedetomidine alone—was recommended to increase the effectiveness of PONV prevention in children scheduled for strabismus surgery [ 39 ]. In a 2019 meta-analysis [ 36 ], compared with placebo use, premedication with clonidine (another α2 agonist) decreased PONV incidence by 17% in children undergoing strabismus surgery, which is in agreement with our findings.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

et al. 2020

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Background Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. Method Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. Results In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

et al. 2020

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“…Our preference is to utilize NMBA during EP ablation procedures, as any patient movement can result in error by the cardiology team and/or breath holding might be requested by cardiologists during ablation. The risk of awareness has been estimated as 0.74% in children undergoing general anesthesia . In adults, an important risk factor remains the use of NMBA .…”

Section: Discussionmentioning

confidence: 99%

“…The risk of awareness has been estimated as 0.74% in children undergoing general anesthesia. 11 In adults, an important risk factor remains the use of NMBA. 12 We generally reserve TIVA-based approaches for those cases with PONV which has failed a strategy of a subhypnotic propofol infusion.…”

Section: Ta B L Ementioning

confidence: 99%

Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

Lee

Banooni

Yuki

et al. 2020

Pediatric Anesthesia

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Background Postoperative nausea and vomiting remains a significant concern for patients undergoing general anesthesia for percutaneous radiofrequency catheter ablation and cryoablation for tachyarrhythmias. Aim Our objective was to examine the incidence and risk factors for nausea and vomiting in the recovery room. Methods Children aged > 2 and ≤ 18 years who underwent general anesthesia for a percutaneous radiofrequency catheter ablation or cryoablation for a tachyarrhythmia between January 1, 2013, and January 1, 2016, were retrospectively reviewed. Outcomes included postoperative nausea, vomiting, and a composite of postoperative nausea and vomiting in the recovery room. Results We identified 611 patients with a mean age of 13.3 ± 3.9 years, 54.5% male, and a mean length of anesthesia was 3.9 ± 1.0 hours. Vomiting or retching in the postanesthesia care unit occurred in 7.4% of patients and nausea in an additional 12.4%. A composite of nausea and vomiting occurred in 95 patients (15.5%). On multivariable analysis, a subhypnotic propofol infusion (OR 0.45, 95% CI 0.23‐0.88, P = .019) and shorter anesthetic duration (OR 0.81 per 30 minutes, 95% CI 0.70‐0.94, P = .006) were independently associated with less vomiting in the recovery room. A history of PONV (OR 2.24, 95% CI 1.24‐4.05, P = .007) was independently associated with a composite of nausea and vomiting in the recovery room. Conclusions A shorter anesthetic time and a subhypnotic propofol infusion were predictive of a lower rate of postoperative vomiting in patients undergoing general anesthesia for electrophysiologic ablation procedures.

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“…AAGA is defined as the recall of events or experiences that occurred during anesthesia and is a potentially devastating complication affecting between 0.1% and 2% of all patients undergoing GA ( 8 – 10 ). Over three-quarters of the cases of AAGA are caused by a period of awareness under GA of less than 5 min duration.…”

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confidence: 99%

“…However, long-term adverse effects affect 41% of people with this condition ( 11 ). Patient recollection of AAGA range widely from nondistressing audiological recall to extremely distressing recollection of agony and paralysis, often associated with the development of posttraumatic stress disorder-like symptoms ( 10 , 12 ). Multiple potential risk factors for AAGA have been identified by the recent NAP5 study, including the type of surgery (obstetric, cardiac, and pediatric), higher patient American Society of Anesthesiologists score, and obesity ( 13 ).…”

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confidence: 99%

Assessing anesthetic activity through modulation of the membrane dipole potential

Davis

Brenton

Davis

et al. 2017

Journal of Lipid Research

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There is great individual variation in response to general anesthetics (GAs) leading to difficulties in optimal dosing and sometimes even accidental awareness during general anesthesia (AAGA). AAGA is a rare, but potentially devastating, complication affecting between 0.1% and 2% of patients undergoing surgery. The development of novel personalized screening techniques to accurately predict a patient’s response to GAs and the risk of AAGA remains an unmet clinical need. In the present study, we demonstrate the principle of using a fluorescent reporter of the membrane dipole potential, di-8-ANEPPs, as a novel method to monitor anesthetic activity using a well-described inducer/noninducer pair. The membrane dipole potential has previously been suggested to contribute a novel mechanism of anesthetic action. We show that the fluorescence ratio of di-8-ANEPPs changed in response to physiological concentrations of the anesthetic, 1-chloro-1,2,2-trifluorocyclobutane (F3), but not the structurally similar noninducer, 1,2-dichlorohexafluorocyclobutane (F6), to artificial membranes and in vitro retinal cell systems. Modulation of the membrane dipole provides an explanation to overcome the limitations associated with the alternative membrane-mediated mechanisms of GA action. Furthermore, by combining this technique with noninvasive retinal imaging technologies, we propose that this technique could provide a novel and noninvasive technique to monitor GA susceptibility and identify patients at risk of AAGA.

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Accidental awareness during anesthesia in children

Cited by 16 publications

References 19 publications

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

Assessing anesthetic activity through modulation of the membrane dipole potential

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