Conscious awareness during general anaesthesia: relevance of autonomic signs and isolated arm movements as guides to depth of anaesthesia

Russell, I.F.

doi:10.1016/s0950-3501(89)80016-9

Cited by 25 publications

(22 citation statements)

References 47 publications

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“…Russell has demonstrated that 61% of a group of patients anaesthetised with thiopentone, tubocurarine and nitrous oxide/oxygen (70:30), with modest hyperventilation, were able to move their arm to command, were free of pain but had no explicit recall of intra-operative events. However, when questioned more closely, three patients showed definite evidence and three showed probable evidence of recall for one of the intraoperative commands [28]. Changes in blood pressure, pulse rate, sweating and tear information were shown to be poor indicators of awareness.…”

Section: Conscious Perception Without Explicit Memorymentioning

confidence: 88%

“…In his work using the isolated forearm technique, Russell showed that changes in blood pressure, heart rate, sweating and tear formation (PRST) correlated poorly with the presence of conscious awareness [28,29]. Similarly, Moerman demonstrated that the anaesthetic records of patients who had experienced an episode of awareness under general anaesthesia could not be reliably distinguished from controls by experienced anaesthetists [3].…”

Section: A R Bailey and J G Jones • Patients' Memories Of Eventsmentioning

confidence: 99%

“…They actually range from 30 to 100 Hz and may overlap with the beta band (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). It is believed that an important function of the '40-Hz' rhythm is to bind together the many discontinuous cortical networks needed in the conscious process.…”

Section: The 40-hz Steady-state Responsementioning

confidence: 99%

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Patients' memories of events during general anaesthesia

Bailey

Jones

1997

Anaesthesia

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SummaryAwareness remains a serious complication of general anaesthesia with potential adverse psychological sequelae. Even during seemingly adequate general anaesthesia, implicit memory may be retained along with the ability to subconsciously process auditory stimuli. As a result behaviour may be modified and postoperative progress influenced. We shall discuss the structure of memory and the effects of increasing doses of general anaesthesia on cognitive processes. In addition methods of assessing the depth of anaesthesia will be reviewed.

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Section: Conscious Perception Without Explicit Memorymentioning

confidence: 88%

Section: A R Bailey and J G Jones • Patients' Memories Of Eventsmentioning

confidence: 99%

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Patients' memories of events during general anaesthesia

Bailey

Jones

1997

Anaesthesia

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“…Obwohl in dieser Untersuchung bei nahezu allen Patienten postoperativ eine Amnesie für die intraoperativen Ereignisse bestand, ist es wohl unbestritten, dass das Befolgen verbaler Aufforderungen an das Bewusstsein gebundene komplexe Gehirnleistungen darstellen, es sich also um Situationen intraoperativer Wachheit handelte [42,43].…”

Section: Isolierte Unterarmtechnikunclassified

Messung der Narkosetiefe, Awareness und EEG

Daunderer¹,

Schwender²

2001

Der Anaesthesist

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Inapparent adverse intraoperative wakefulness is still a relevant problem in modern anaesthetic routine. It can be associated with serious negative effects on the postoperative recovery of the patients. Several different procedures have been developed to monitor and therefore avoid intraoperative situations of wakefulness during general anaesthesia. The most promising methods are the PRST-score, calculated from changes in the blood pressure, heart rate, sweating and tear production, the so-called isolated forearm technique, spontaneous EEG and its derived parameters such as spectral edge frequencies or BIS and finally mid-latency auditory evoked potentials. The observation of clinical autonomic signs, even including the calculation of the PRST-score does not seem to be valid enough to indicate or predict intraoperative wakefulness. The isolated forearm technique can be regarded as the most reliable tool to detect intraoperative wakefulness, but it can only be applied for a very limited period of time. The processed EEG with the median frequency, spectral edge frequency or bispectral index are important scientific tools to quantify central anaesthetic effects especially to develop pharmacodynamic-pharmacokinetic models of anaesthetic action. But they seem to be less suitable to indicate situations of intraoperative wakefulness or awareness. The mid-latency auditory evoked potentials are depressed dose-dependently by a series of anaesthetic agents, which correlate with the occurrence of situations of intraoperative wakefulness and awareness. There is a hierarchical correlation between certain values of the MLAEP and intraoperative wakefulness defined by purposeful movements, amnesic awareness with only implicit recall and conscious awareness with explicit recall. For some of the most commonly used anaesthetics reasonable threshold values of the MLAEP for the different states of consciousness have already been determined. Future studies in broad patient populations with all of the different routinely used anesthetics and procedures will have to finally identify the importance of the recording of mid-latency auditory evoked potentials as a routine method to assess the depth of anaesthesia.

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“…Pethidine is known to possess local anaesthetic properties similar in potency to conventional local anaesthetic agents [I, 21 and there is evidence to suggest that intrathecally, it does produce sympathetic block with the risk of hypotension [3]. Famewo and Naguib [4] observed that following intrathecal pethidine 1 mg.kg-', 15% of patients showed a decrease in arterial blood pressure of more than 20%. Sangarlangkarn et al [5], in a direct comparison of intrathecal pethidine 5% with lignocaine 5%, found a similar incidence of hypotension, greater than 30% below baseline.…”

Section: Intrathecal Pethidine: a Word Of Cautionmentioning

confidence: 99%