Late Psychological Symptoms after Awareness among Consecutively Included Surgical Patients

Samuelsson, Peter; Brudin, Lars; Sandin, R.

doi:10.1097/00000542-200701000-00009

Cited by 132 publications

(69 citation statements)

References 15 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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“…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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“…For example, at about 22% of patients have dreams during anesthesia (Leslie et al, 2007) and very serious problem represents intraoperative awareness with incidence at about 0.13% (Sebel et al, 2004), which may lead to serious psychological consequences and cause post-traumatic stress disorder (Osterman & van der Kolk, 1998;Samuelsson et al, 2007). These changes in awareness most likely might be detected using various methods that enable to detect neural binding which has very important consequences for anasthesiological practice.…”

Section: Discussionmentioning

confidence: 99%

Consciousness and Anesthesia: Towards a New Integrated Paradigm

Rzyman

2014

Act Nerv Super

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According to reported studies there is increasing evidence that an actual level of anesthesia may exist on a continuum between usual awareness and states of unconsciousness. Recent findings also indicate that levels of anesthesia may be related to specific disturbances in neural correlate of consciousness that is mainly based on large scale synchronization in the brain. Further research studies have also shown that these specific changes during loss of consciousness may be reflected in decreased large scale synchronization in the brain that is caused by decreased cooperation among simultaneously active neural assemblies. In this context, concept of cognitive unbinding has been proposed that is mainly caused by decreased synchronizaton and cooperation among neural assemblies, which leads to decreased level of consciousness and in the extreme case to global anesthesia. Several recent studies suggest that these findings could be very useful for detecting intraoperative awareness which may lead to serious adverse effects and symptoms of posttraumatic stress disorder (PTDS). According to these data episodes of intraoperative awareness could be detected by various techniques focused on detecting binding processes reflecting a level of dependence in neural activation.

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Late Psychological Symptoms after Awareness among Consecutively Included Surgical Patients

Abstract: The method for recruiting awareness cases in studies on late psychological symptoms may affect the result. The authors found fewer and milder problems, despite a similar degree of initial problems as in previous studies.

Cited by 132 publications

References 15 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

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

Consciousness and Anesthesia: Towards a New Integrated Paradigm

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