Victims of awareness

Lennmarken, C.; Bildfors, K; Enlund, Gunnar; Samuelsson, Peter; Sandin, R.

doi:10.1034/j.1399-6576.2002.t01-1-460301.x

Cited by 156 publications

(84 citation statements)

References 8 publications

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“…However, the absence of early complaints does not guarantee the absence of further psychological sequelae. Lennmarken et al showed that despite the adequate early management of adults who had experienced intra-operative awareness, 44% presented important psychological sequelae two years after the event [24].…”

Section: Intra-operative Perceptionsmentioning

confidence: 99%

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

et al. 2007

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SummaryIntra-operative awareness in paediatric patients has been little studied for many years because of the difficulties in relying on children's testimony. Earlier questionnaires used to detect this complication were not adapted to children's language and memory capacities. By using a qualitative method, a semi-structured in-depth interview adapted to their cognitive abilities, we have now conducted a prospective evaluation of the incidence and risk factors for intra-operative awareness in children undergoing general anaesthesia. Data were obtained from interviews with 410 children (aged 6-16 years) which were conducted within 36 h of general anaesthesia for elective or emergency surgery. One month after surgery, 293 of these patients were interviewed again. Three independent adjudicators classified each potential case of awareness. We considered awareness to include both the 'confirmed awareness' and the 'possible awareness' cases. The accuracy of the children's recall was calculated. The relationship between their awareness and the anaesthesia management was examined. There were five cases of confirmed awareness, and six cases of possible awareness. The incidence of confirmed awareness was 1.2%, but when the possible cases were also considered, the overall incidence of this complication was as high as 2.7% (95% confidence interval, 1.4-5.0%). The only predictive factor identified was the multiple manoeuvres with which the airways were secured (odds ratio, 8.4; 95% confidence interval, 2.4-29.07%). The present study confirms the existence of intra-operative awareness in the paediatric population. The application of a semi-structured in-depth interview adapted to the cognitive capacities of the children appears to enhance the detection of awareness in this population.

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Section: Intra-operative Perceptionsmentioning

confidence: 99%

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

et al. 2007

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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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“…awareness, is evident in approximately 0.2% of cases when no neurophysiological monitoring is used to guide the conduction of anaesthesia using muscle relaxants (1). Awareness is a serious complication with a substantial likelihood of severe, long-lasting psychiatric sequelae (2). This study was designed to determine whether the introduction of routine clinical neurophysiological monitoring using the BIS A-2000 monitor (Aspect Medical Systems, Newton, MA) had any effect on the incidence of awareness.…”

mentioning

confidence: 99%

Reduction in the incidence of awareness using BIS monitoring

Ekman

Lindholm

Lennmarken

et al. 2003

Acta Anaesthesiol Scand

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326

175

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Background: Explicit recall (ER) is evident in approximately 0.2% of patients given general anaesthesia including muscle relaxants. This prospective study was performed to evaluate if cerebral monitoring using BIS to guide the conduction of anaesthesia could reduce this incidence significantly. Patients and methods: A prospective cohort of 4945 consecutive surgical patients requiring muscle relaxants and/or intubation were monitored with BIS and subsequently interviewed for ER on three occasions. BIS values between 40 and 60 were recommended. The results from the BIS-monitored group of patients was compared with a historical group of 7826 similar cases in a previous study when no cerebral monitoring was used. Results: Two patients in the BIS-monitored group, 0.04%, had ER as compared with 0.18% in the control group (P < 0.038). Both BIS-monitored patients with ER were aware during intubation when they had high BIS values (>60) for 4 min and more than 10 min, respectively. However, periods with high

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Victims of awareness

Cited by 156 publications

References 8 publications

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

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

Reduction in the incidence of awareness using BIS monitoring

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