Awareness and Dreaming during Anaesthesia in a Paediatric Hospital

Bd, McKie; Ea, Thorp

doi:10.1177/0310057x7300100507

Cited by 39 publications

(29 citation statements)

References 5 publications

(3 reference statements)

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“…Few previous studies have examined awareness in children. In 1973, an audit of 202 children aged 7-14 years found an incidence of 5% (7). Many of the children in that study who reported awareness had an anesthetic without a volatile drug.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Awareness During Anesthesia in Children: A Prospective Cohort Study

Davidson¹,

Huang²,

Czarnecki³

et al. 2005

Anesthesia &Amp; Analgesia

140

110

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During routine adult anesthesia, the risk of awareness is 0.1%-0.2%. No recent studies have reported the incidence in children. Altered pharmacology and differing anesthesia techniques suggest that the incidence may differ in children. In this prospective cohort study, we determined the incidence of awareness during anesthesia in children. Eight-hundred-sixty-four children aged 5-12 yr who had undergone general anesthesia at The Royal Children's Hospital were interviewed on 3 occasions to determine the incidence of awareness. The awareness assessment was nested within a larger study of behavior change after anesthesia. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, a case was classified as true awareness. Twenty-eight reports were generated. There were 7 cases of true awareness, for an incidence of 0.8% (95% confidence interval, 0.3%-1.7%). Only one aware child received neuromuscular blockers, compared with 12% in the nonaware group. No aware child reported distress, and no substantial difference was detected in behavior disturbance between aware (20%) and nonaware (16%) children. The data provide some evidence that, like adults, children are also at risk of intraoperative awareness. Although the cause remains unclear, anesthesiologists should be alerted to the possibility of awareness in children.

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Section: Discussionmentioning

confidence: 98%

“…One study, performed in 1973, found an incidence of awareness in children of 5% (7). In this study, some children received nitrous oxide, a neuromuscular blocker, and no volatile or continuous IV anesthetic-the Liverpool technique.…”

mentioning

confidence: 89%

Awareness During Anesthesia in Children: A Prospective Cohort Study

Davidson¹,

Huang²,

Czarnecki³

et al. 2005

Anesthesia &Amp; Analgesia

140

110

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“…In einer älteren Arbeit wurde eine Inzidenz intraoperativer Wachheit bei 7-bis 14-jährigen Kindern von bis zu 5 gefunden. Hier kamen allerdings Anästhe-sieverfahren zur Anwendung, die heute nicht mehr zum Standard zählen [11].…”

Section: Diskussionunclassified

“…Zwar liegt die Inzidenz von Episoden intraoperativer Wachheit bei Erwachsenen im Promillebereich, dennoch fürchten Patienten gerade diesen Zwischenfall mit am häufigsten [20]. Es gibt deutliche Hinweise darauf, dass diese Inzidenz bei Kindern mindestens ebenso hoch, wenn nicht sogar um ein Vielfaches höher ist als bei Erwachsenen [3,4,8,11,16]. Daher erscheint ein objektivierbares Monitoringverfahren gerade in der pädiatrischen Anästhesie wünschens-wert.…”

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Detektion intraoperativer Wachheit bei einem Kleinkind mit akustisch evozierten Potenzialen

et al. 2006

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Intraoperative wakefulness is not only limited to adults and can also be found at a similar percentage (0.8%) in paediatric anaesthesia. For prevention of awareness neurophysiologic methods like auditory evoked potentials might be helpful. We report a case of a 2-year-old boy receiving balanced anaesthesia with sevoflurane and alfentanil. Midlatency auditory evoked potentials (MLAEPs) were recorded continuously before, during and after the surgical procedure. During the surgical procedure sevoflurane was withdrawn unintentionally. After a short period of time the boy started coughing and moved his legs, which was interpreted as insufficient analgesia. Several boli of alfentanil did not lead to the expected clinical effect on the depth of anaesthesia. After a recheck of the anaesthetic ventilator the error was determined and delivery of the volatile anaesthetic restored. The postoperative evaluation of the MLAEPs revealed the inadequate suppression of auditory processing during this incident with latencies comparable to the awake state. After reapplication of sevoflurane the MLAEPs were almost completely suppressed demonstrating adequate anesthetic depth. Exemplarily this case suggests that MLAEPs could be used to detect intraoperative awareness also in paediatric anaesthesia. Investigations to prove the validity and reproducibility of MLAEPs in children will be necessary.

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“…Wachheit in Narkose wird bei Erwachsenen mit einer Inzidenz von 0,1-0,2% angegeben [66,103].Bei Kindern liegen älte-re Berichte vor, nach denen Wachheit mit einer Frequenz von 5% bei 7-bis 14-Jäh-rigen beobachtet wurde [76].Spätere Untersuchungen haben das allerdings nicht bestätigen können [44,85]. Der Verzicht auf volatile Anästhetika erhöht bei Erwachsenen das Risiko intraoperativer Wachheit [29].Es ist vollkommen unklar, ob das auch bei Kindern zutrifft.…”

Section: Wachheit In Narkoseunclassified

Total intraven�se An�sthesie

Strauß

Giest

2003

Der Anaesthesist

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Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatri...

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Awareness and Dreaming during Anaesthesia in a Paediatric Hospital

Cited by 39 publications

References 5 publications

Awareness During Anesthesia in Children: A Prospective Cohort Study

Awareness During Anesthesia in Children: A Prospective Cohort Study

Detektion intraoperativer Wachheit bei einem Kleinkind mit akustisch evozierten Potenzialen

Total intraven�se An�sthesie

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