Unintended Return of Consciousness in a Patient during Surgery and General Anesthesia

Mędrzycka‐Dąbrowska, Wioletta; Dąbrowski, Sebastian; Gutysz-Wojnicka, Aleksandra; Ozga, Dorota; Wojtaszek, Marek

doi:10.1159/000471510

Cited by 303 publications

(7 citation statements)

References 33 publications

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“…Other situations where light GA is frequently observed are cardiac surgery and surgeries with a high risk for hemodynamic decompensation. However, it is interesting to note that no cases of awareness were found in obstetric patients in this study, agreeing with previous studies that observed no higher rates of awareness in obstetric patients [11].…”

Section: Discussionsupporting

confidence: 92%

“…However, when analyzing data from both inpatients and outpatients together, there was no observed variance in the occurrence of awareness and recall between patients who received benzodiazepine premedication and those who did not [12]. However, some researchers recommended using benzodiazepine when low doses of anesthetics are administered [3][4][5][6][7][8][9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…In 16 of these patients, failure to deliver volatile anesthetic resulted in awareness, while in 32 cases, a medication error resulted in unintentional paralysis of a conscious patient. Regularly checking the anesthesia machine, including the circuit and vaporizer, monitoring the inhalational drugs and concentrations of inspired and expired gases, and administering an anesthetic infusion via a dedicated intravenous line are all basic precautions that can help prevent awareness [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. BIS monitoring demonstrating the brain's electrical activity can be used to monitor the anesthesia depth, and this purpose is advocated mainly for TIVA.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study

Al Jabri,

Burad,

Al Moosa

2024

Cureus

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Background The intraoperative awareness with recall phenomenon involves the memory of intraoperative events. The reported incidence is 0.001%. Awareness is rare intraoperatively but has profound implications. This research aimed to study intraoperative awareness and dream experiences in the Omani population undergoing general anesthesia. Methods This prospective cohort study involving 300 adult patients was conducted at a tertiary-level hospital between July and December 2021. Awareness was assessed in the post-anesthesia care unit and then at home on the seventh day and one month telephonically using a modified Brice questionnaire. The study's primary outcome was the incidence of IOA and dreams in adult Omani patients undergoing GA. The secondary outcome was identifying the factors associated with intraoperative awareness and dreams under GA. Results In this study, the incidence of awareness was 0.3% while 7.6% of patients reported intraoperative dreams. The patient who experienced IOA underwent an endoscopic retrograde cholangiopancreatography under GA with neuromuscular blockade and had a prolonged recovery. A total of 49.33% developed psychological effects postoperatively; anxiety, irritability, fear of surgery, change in memory, and repetitive nightmares were the most common ones. Because of the limited sample size, no factor associated significantly with these outcomes was found. Conclusion This study observed a higher incidence of intraoperative awareness and dreams. Awareness might be due to prolonged recovery and the use of neuromuscular blocking agents, but a focused study is required to confirm this finding. The incidence of intraoperative dreams and postoperative psychological effects of GA was also high. It may be worth exploring these findings with larger population-based research.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study

Al Jabri,

Burad,

Al Moosa

2024

Cureus

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“…However, the incidence of this was low with about 1.2% of all patients reporting worse satisfaction due to recall. Awareness while under anesthesia has been shown to have potential psychological consequences such as PTSD causing anxiety, depression, and sleep disorders (Mędrzycka-Dąbrowska et al 2017). Strategies to potentially reduce the rate of and potential harmful consequences of anesthesia awareness include putting headphones on the patients during surgery and administering proper doses of medication specific to each patient (Mędrzycka-Dąbrowska et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Incidence and Impact of Sensory Recall in Patients Undergoing Total Joint Arthroplasty

Weiner

Barringer

Silvério

et al. 2023

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction Recall of auditory and physical sensations during hip and knee arthroplasty surgery is inadequately studied. We investigated rates of sensory recall, impact on satisfaction, and risk factors. Methods We surveyed 164 consecutive patients after primary or revision arthroplasty about sensory recall and its impact on satisfaction (improved, worsened, or no effect), without exclusions. Three surgeons and 25 anesthesiologists in an academic university hospital setting provided care. Demographic data (age, gender, BMI, comorbidities, ASA class), type of anesthesia, intravenous fentanyl and midazolam doses, pre-operative diagnosis, type of surgery, anesthesia duration, and surgery time (morning vs afternoon case) were analyzed. Pearson’s correlation coefficient was calculated for each variable. A binary logistic regression model was used to identify risk factors for sensory recall. Results 147 patients (89.6%) received spinal anesthesia. No patients receiving general anesthesia had recall. Twenty-three patients (14.0% of the total, 15.6% of neuraxial anesthesia patients) had sensory recall after surgery: 19 (11.6%) auditory, 2 (1.2%) physical, and 2 (1.2%) both. There was a correlation between spinal anesthesia and sensory recall, r = 0.163, p = 0.037. On logistic regression, decreasing age (p=0.032, 95% CI, 0.894–0.995) and less midazolam (p = 0.009, 95% CI, 0.283–0.832) were significant risk factors for sensory recall. Seventeen (73.9%) reported no impact on satisfaction (14 auditory, 2 physical, 1 both), while two (8.7%) reported worse satisfaction (1 auditory, 1 both) and four (17.4%) reported improved satisfaction (all auditory). Conclusion We found a 14.0% rate of sensory recall. Spinal anesthesia, decreasing age, and lower benzodiazepine administration were associated with sensory recall. Sensory recall has a minimal effect on patient satisfaction, although some were still affected. Although we focused on instrument sounds, our high rate of sensory recall serves as a reminder to also be mindful of conversations in the operating room. Level of Evidence Level II

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“…Відомості щодо частоти інтраопераційного пробудження під час загальної анестезії досить суперечливі. За даними закордонних авторів, частота їх у цілому коливається від 0,1 до 0,8 % навіть при добре проведеній анестезії [4]. Одним з основних показників, на яких заснована сучасна теорія контролю перебігу загальної анестезії, є оцінка функціонування ЦНС.…”

Section: вступunclassified

Актуальность Определения Глубины Анестезии С Помощью Индекса Состояния Пациента При Лапароскопической Холецистэктомии У Пациентов Пожилого И Старческого Возраста

Bielykh¹,

Georgiyants²

2021

ЕМ

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Харківська медична академія післядипломної освіти, м. Харків, Україна актуальність визначення глибини анестезії за допомогою індексу стану пацієнта при лапароскопічній холецистектомії у пацієнтів похилого та старечого віку Резюме. Актуальність. Сучасна концепція анестезіологічного забезпечення має на меті не тільки адекватне знеболювання, але й управління життєво важливими функціями організму пацієнта впродовж операції. Тому одним із найбільш значущих завдань сучасної анестезіології є об'єктивізація контролю адекватності загального знеболювання, що передбачає конт роль функцій та процесів, виявлення їх небезпечних відхилень для запобігання ускладненням під час анестезії. Мета: оцінити ефективність і значущість використання індексу стану пацієнта (Patient State Index -PSI) при введенні різних комбінацій анестетиків упродовж загальної анестезії у пацієнтів похилого та старечого віку під час лапароскопічної холецистектомії. Матері али та методи.

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Unintended Return of Consciousness in a Patient during Surgery and General Anesthesia

Cited by 303 publications

References 33 publications

Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study

Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study

Incidence and Impact of Sensory Recall in Patients Undergoing Total Joint Arthroplasty

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