Awareness in children: a secondary analysis of five cohort studies

Davidson, Andrew; Smith, Katherine R.; Oud-Alblas, Heleen J. Blussé van; Lopez, Ursula; Malviya, Shobha; Bannister, Carolyn F.; Galinkin, Jeffrey L.; Habre, Walid; Ironfield, Craig M.; Voepel‐Lewis, Terri; Weber, Frank

doi:10.1111/j.1365-2044.2011.06703.x

Cited by 39 publications

(21 citation statements)

References 22 publications

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“…We identified AAGA to be much less common in children than in other series [14], at around 1:60 000. Some reports of AAGA were received by parents but not transmitted further, though the reasons for this are unclear.…”

Section: Paediatric Anaesthesiamentioning

confidence: 61%

“…Over several decades, the incidence appears to have consistently reported to be approximately 1-2:1000 general anaesthetics [7][8][9][10][11][12]. It has been reported to be higher in obstetric (1:384 [13]), cardiac (1:43 [14]), and paediatric (1:135 [15]) anaesthesia. However, some studies do report a much lower incidence (1:14 560 [16]), but these have been criticised for using a modified Brice interview within 48 h of anaesthesia and not repeating it [17].…”

Section: Introductionmentioning

confidence: 99%

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The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out‐of‐hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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Section: Paediatric Anaesthesiamentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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“…Clinical research projects need large datasets to answer important questions. The NAP5 project found the incidence of AAGA reports, within a month of the incident, was surprisingly low (n = 8) (17) compared to other studies relying on direct postoperative questioning (18). That the NAP5 reports were infrequent, may either be due to avoidance of reporting of an extremely distressing experience or that the experience was not distressing.…”

Section: Discussionmentioning

confidence: 95%

The state of UK pediatric anesthesia: a survey of National Health Service activity

Sury

Arumainathan

Belhaj

et al. 2015

Pediatric Anesthesia

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This secondary analysis of the 2013 United Kingdom National Health Service (NHS) Anaesthesia Activity Survey of the Fifth National Audit Project (of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland) shows pediatric anesthesia activity in detail. A local coordinator (LC) in every NHS hospital collected data on patients undergoing any procedure managed by an anesthetist. Questionnaires had 30 question categories. Each LC was randomized to a 2-day period. The pediatric age groups were infants, (<1 year), preschool age (1-5 year), and school age children (6-15 year). The median questionnaire return rate was 98%. The annual caseload was estimated to be 486 900 children: 36 500 infants, 184 700 preschool age, and 265 800 school age children. Almost 90% of children (1-15 year) were ASA 1 or 2 and the substantial majority underwent routine nonurgent ear nose and throat, dental, orthopaedics, or general surgery procedures; 65% were 'day cases'. One in six children were managed outside operating theater sites compared with one in 12 adults. Forty one per cent was in district general hospitals. Almost all ASA 4 and 5 children (89%) and infants (92%) were managed in specialist hospitals. 'Awake' cases and sedation accounted for only 2% of cases. There were notable differences in demography and anesthetic care compared with adults and between different age groups of children. These data enable analysis of the current state of UK pediatric anesthetic practice and highlight differences between pediatric and adult services.

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“…Although the studies were selected for this review with our criteria, meta-analysis and systematic review was not stated clearly in the title in several studies. There was one meta-regression [13] and study of review articles that was not accounted for statistically because of poor standardization and heterogeneity [1415]. Systematic review is a review of a formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and collect and analyze data from the study.…”

Section: Discussionmentioning

confidence: 99%

Reporting and methodologic evaluation of meta-analyses published in the anesthesia literature according to AMSTAR and PRISMA checklists: a preliminary study

Shin

Park

et al. 2017

Korean J Anesthesiol

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BackgroundThere have been few recent reports on the methodological quality of meta-analysis, despite the enormous number of studies using meta-analytic techniques in the field of anesthesia. The purpose of this study was to evaluate the quality of meta-analyses and systematic reviews according to the Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the anesthesia literature.MethodsA search was conducted to identify all meta-analyses ever been published in the British Journal of Anaesthesia (BJA), Anaesthesia, and Korean Journal of Anesthesiology (KJA) between Jan. 01, 2004 and Nov. 31, 2016. We aimed to apply the AMSTAR and PRISMA checklists to all published meta-analyses.ResultsWe identified 121 meta-analyses in the anesthesia literature from January 2004 through the end of November 2016 (BJA; 75, Anaesthesia; 43, KJA; 3). The number of studies published and percentage of ‘Yes’ responses for meta-analysis articles published after the year 2010 was significantly increased compared to that of studies published before the year 2009 (P = 0.014 for Anaesthesia). In the anesthesia literature as a whole, participation of statisticians as authors statistically improved average scores of PRISMA items (P = 0.004) especially in the BJA (P = 0.003).ConclusionsEven though there is little variability in the reporting and methodology of meta-analysis in the anesthesia literature, significant quality improvement in the reporting was observed in the Anaesthesia by applying the PRISMA checklist. Participation of a statistician as an author improved the reporting quality of the meta-analysis.

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Awareness in children: a secondary analysis of five cohort studies

Cited by 39 publications

References 22 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The state of UK pediatric anesthesia: a survey of National Health Service activity

Reporting and methodologic evaluation of meta-analyses published in the anesthesia literature according to AMSTAR and PRISMA checklists: a preliminary study

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