Awareness under anesthesia and the development of posttraumatic stress disorder☆

Osterman, Janet E.; Hopper, James W.; Heran, William J; Keane, Terence M.; Kolk, Bessel A. van der

doi:10.1016/s0163-8343(01)00142-6

Cited by 207 publications

(116 citation statements)

References 32 publications

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“…Implicit and explicit recalls after procedure, resulting from too low level of anesthesia, may cause posttraumatic stress disorder (PTSD) and both acute and chronic mental disorders. These problems can affect from 4% to 70% of patients up to two years after the traumatic event 5,[7][8][9][10][11] . On the other hand, too deep a level of anesthesia can increase the incidence of postoperative cognitive decline, postoperative delirium, time of hospitalization and accelerate the onset of senile dementia [12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Clinical monitoring is the most common method of adjusting the appropriate level of general anesthesia. However, episodes of intraoperative awareness (AWR) are still reported, suggesting that clinical observations may not be sufficient in some cases. The objective of this study was to compare the efficacy of clinical and instrumental neuromonitoring with auditory evoked potentials (AEP) in an intraoperative analysis of the proper level of general anesthesia. Methods. Patients scheduled for elective surgery were randomly divided into two groups. Subjects in the first group underwent intravenous, in the second group volatile anesthesia. The adequacy of anesthesia was analyzed using clinical parameters. All the participants were instrumentally monitored with the autoregressive AEP index (AAI). After the anesthesia, patients filled out a questionnaire on possible AWR. Results. Data of 208 patients (87 in the first, and 121 in the second group) were analyzed. Before surgery there were no changes in AAI values between groups (80 vs. 78, P=0.5192). The mean values of clinical parameters changed, but five minutes after the nociceptive stimuli. The mean values of AAI at analyzed time points were specific for general anesthesia. In patients under intravenous anesthesia, we found more episodes of too low (46/608 vs.15/847, P<0.000) anesthesia. One case of AWR was found in the TIVA group. Conclusions. AAI index is good indicator of patients' level of consciousness during general anesthesia. Standard clinical monitoring provides appropriate level of the procedure. However, it is insufficient during TIVA and does not prevent episodes of AWR.

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Section: Introductionmentioning

confidence: 99%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Since then, symptoms of posttraumatic stress disorder (PTSD) – such as awareness under anaesthesia (Osterman, Hopper, Heran, Keane, & van der Kolk, 2001), intensive care unit survivors (Davydow, Gifford, Desai, Needham, & Bienvenu, 2008), elective lumbar spinal arthrodesis (Deisseroth & Hart, 2012) and breast cancer (Mehnert & Koch, 2007) – have been investigated in various medical settings.…”

Section: Introductionmentioning

confidence: 99%

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

Shiban

Lehmberg

Hoffmann

et al. 2018

European Journal of Psychotraumatology

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Background: Growing evidence shows the significance of illness and surgical procedures as traumatizing stressors. Risk factors are widely investigated in various settings and samples, using numerous measures of posttraumatic stress and posttraumatic stress disorder (PTSD). While pretrauma psychological distress is acknowledged as an influential factor, peritraumatic experiences are controversially still being discussed as relevant to the development of PTSD. Objective: In a group of patients consecutively undergoing elective spine surgery (N = 89) in a German hospital, this longitudinal study addressed the question of how pretrauma PTSD symptoms and peritrauma distress interact with one another in regard to the amount of posttrauma symptoms of PTSD. Methods: Pre- and posttrauma symptoms of PTSD as well as peritrauma distress were assessed through questionnaires one week before, one week after or three months after surgery. Results: Even though all three variables showed significant correlations with one another, mediation analysis revealed that peritrauma distress fully mediated the relationship between pre- and posttrauma PTSD symptoms. Conclusions: These results add new insights to the controversial discussion on the role peritraumatic experiences play in the development of PTSD, especially in medical settings.

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“…9,10,13,15,16 In a retrospective study from Leslie and Davidson, 10 5 (71%) of the 7 patients experiencing unexpected intraoperative awareness during general anesthesia fulfilled the criteria for PTSD at the time of their interview. Although it has been described that awake craniotomy is well tolerated by the majority of patients, 17,19,21 psychological sequelae in terms of PTSD symptoms related to such an unusual situation are still mainly unknown.…”

Section: Discussionmentioning

confidence: 99%

“Imagine your neighbor mows the lawn”: a pilot study of psychological sequelae due to awake craniotomy

Milian¹,

Luerding

Ploppa

et al. 2013

JNS

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Object. Although it has been reported that awake neurosurgical procedures are well tolerated, the long-term occurrence of general psychological sequelae has not yet been investigated. This study assessed the frequency and effects of psychological symptoms after an awake craniotomy on health-related quality of life (HRQOL).Methods. Sixteen patients undergoing an awake surgery were surveyed with a self-developed questionnaire, the Posttraumatic Stress Disorder Inventory For Awake Surgery Patients, which adopts the core components of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) posttraumatic stress disorder (PTSD) criteria. The mean time between surgery and data collection was 97.3 ± 93.2 weeks. Health-related quality of life was assessed with the 36-Item Short Form Health Survey.Results. Forty-four percent of the patients stated that they had experienced either repetitive distressing recollections or dreams related to the awake surgery, 18.8% stated persistent avoidance of stimuli associated with the awake surgery, and symptoms of increased arousal occurred in 62.5%. Two patients presented with postoperative psychological sequelae resembling PTSD symptoms. Younger age at surgery and female sex were risk factors for symptoms of increased arousal. The experience of intense anxiety during awake surgery appears to favor the development of postsurgical PTSD symptoms, while recurrent distressing recollections particularly affect HRQOL negatively.Conclusions. In many cases awake craniotomy is necessary to preserve language and motor function. However, in some cases awake craniotomy can lead to postoperative psychological sequelae resembling PTSD symptoms. Therefore, possible long-term effects of an awake surgery should be considered and discussed with the patient when planning this type of surgery.

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Awareness under anesthesia and the development of posttraumatic stress disorder☆

Cited by 207 publications

References 32 publications

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

“Imagine your neighbor mows the lawn”: a pilot study of psychological sequelae due to awake craniotomy

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