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Al Jabri R, Burad J, Al Moosa AM. Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study. Cureus 2024; 16:e62843. [PMID: 39036241 PMCID: PMC11260424 DOI: 10.7759/cureus.62843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
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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Affiliation(s)
- Roudha Al Jabri
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
| | - Jyoti Burad
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
| | - Al Muayad Al Moosa
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
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Zhang Y, Song B, Zhu J. The relationship between different bispectral index and the occurrence of dreams in elective surgery under general anesthesia: protocol for a randomized controlled clinical trial. Trials 2023; 24:205. [PMID: 36941648 PMCID: PMC10026450 DOI: 10.1186/s13063-023-07222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Dreaming reported after anesthesia remains a poorly understood phenomenon. At present, there is a hypothesis that dreaming occurs intraoperatively and is related to light or inadequate anesthesia; thus, in order to further verify the hypothesis, we choose elective surgery under general anesthesia to observe whether the generation of dreams is related to the dose of general anesthetics maintenance. METHODS AND ANALYSIS This randomized, double-blind controlled trial to observe whether the generation of dreams is related to the dose of general anesthetics maintenance in the elective surgery under general anesthesia. A total of 124 participants will be randomly allocated to a low bispectral index or high bispectral index group at a ratio of 1:1. The Hospital Anxiety and Depression Scale (HADS) is used to assess the anxiety and depression status of participants during the perioperative period. Ramsay score is used to assess patients' sedation level after surgery in the PACU. Modified Brice questionnaire and awareness classification are used to assess whether patients experienced dreaming during the surgery. ETHICS AND DISSEMINATION This randomized, double-blind controlled trial received prospective ethics committee approval at the Human Research Ethical Committee of Shengjing Hospital, Shenyang, Liaoning Province, China (Institutional Review Board registration number 2021PS664K), and was compliant with the Declaration of Helsinki. Written informed consent was obtained from all subjects participating in the trial.
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Affiliation(s)
- Yufei Zhang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Chow HS, Hack LM, Kawai M, Heifets BD. Anesthetic-Induced Intraoperative Dream Associated With Remission of a Psychiatric Disorder: A Case Report. A A Pract 2022; 16:e01613. [DOI: 10.1213/xaa.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Radek L, Koskinen L, Sandman N, Laaksonen L, Kallionpää RE, Scheinin A, Rajala V, Maksimow A, Laitio T, Revonsuo A, Scheinin H, Valli K. On no man's land: Subjective experiences during unresponsive and responsive sedative states induced by four different anesthetic agents. Conscious Cogn 2021; 96:103239. [PMID: 34801782 DOI: 10.1016/j.concog.2021.103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
To understand how anesthetics with different molecular mechanisms affect consciousness, we explored subjective experiences recalled after responsive and unresponsive sedation induced with equisedative doses of dexmedetomidine, propofol, sevoflurane, and S-ketamine in healthy male participants (N = 140). The anesthetics were administered in experimental setting using target-controlled infusion or vapouriser for one hour. Interviews conducted after anesthetic administration revealed that 46.9% (n = 46) of arousable participants (n = 98) reported experiences, most frequently dreaming or memory incorporation of the setting. Participants receiving dexmedetomidine reported experiences most often while S-ketamine induced the most multimodal experiences. Responsiveness at the end of anesthetic administration did not affect the prevalence or content of reported experiences. These results demonstrate that subjective experiences during responsive and unresponsive sedation are common and anesthetic agents with different molecular mechanisms of action may have different effects on the prevalence and complexity of the experiences, albeit in the present sample the differences between drugs were minute.
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Affiliation(s)
- Linda Radek
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland.
| | - Lauri Koskinen
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Nils Sandman
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Lauri Laaksonen
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Roosa E Kallionpää
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Annalotta Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Ville Rajala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Anu Maksimow
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Timo Laitio
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Antti Revonsuo
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
| | - Harry Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Institute of Biomedicine and Unit of Clinical Pharmacology, University of Turku and Turku University Hospital, FI-20014 Turun yliopisto, Finland
| | - Katja Valli
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
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Yoshida A, Fujii K, Yoshikawa T, Kawamata T. Factors associated with quality of dreams during general anesthesia: a prospective observational study. J Anesth 2021; 35:576-580. [PMID: 33950294 DOI: 10.1007/s00540-021-02942-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Patients frequently report having dreams during general anesthesia, and the dreams are often reported to be pleasant dreams. However, factors associated with the quality of dreams during general anesthesia have not been clarified. The aim of this study was to determine the relationships between the quality of dreams during general anesthesia and perioperative factors. This prospective observational study included patients scheduled for elective surgery under general anesthesia. Preoperative mental status was assessed by the Hospital Anxiety and Depression Scale (HADS). A postoperative interview was carried out in the operating room after recovery from general anesthesia. Dreams and awareness during general anesthesia were assessed by a modified Brice interview. The quality of dreams was classified in accordance with the patient's own opinion as pleasant, indifferent, or unpleasant. A total of 1100 patients were included in the study, and 293 (25.4%) of the patients reported having dreams during anesthesia. Half of the patients who experienced dreams during anesthesia (50.2%, 147/293 patients) reported having a pleasant dream. Multivariate logistic regression analysis revealed that only HADS-depression score of less than 11 was related to pleasant dreams (OR: 3.3 [95% CI 1.3-10.0]).
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Affiliation(s)
- Akari Yoshida
- Department of Anesthesiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Keisuke Fujii
- Department of Anesthesiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Takanori Yoshikawa
- Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Villegas S, Suarez S, Owuor J, Wuyke GM, Nelson BD, Imbamba J, Rogo D, Rogo K, Burke TF. Intraoperative awareness and experience with a ketamine-based anaesthesia package to support emergency and essential surgery when no anaesthetist is available. Afr J Emerg Med 2018; 9:S56-S60. [PMID: 30976503 PMCID: PMC6440926 DOI: 10.1016/j.afjem.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/20/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Five of the 7.2 billion people on earth have limited access to emergency and essential surgical procedures. The lack of safe, affordable and timely anaesthesia services are primary barriers to universal surgical coverage. The objective of this study was to assess intraoperative awareness when the 'Every Second Matters for Emergency and Essential Surgery - Ketamine' (ESM-Ketamine) package was used to support emergency and essential surgeries and painful procedures in rural Kenya when no anaesthetist was available. METHODS Forty-seven consecutive adult patients that underwent an operative procedure under ESM-Ketamine at Sagam Community Hospital in Luanda, Kenya were enrolled. Participants underwent two semi-structured interviews that explored the patient's experience with ESM-Ketamine both after the operative procedure and four to six weeks after surgery. RESULTS Forty-seven participants completed the first interview and 37 (78.7%) the second interview. Thirty-seven (78.7%) cases were procedural sedations and ten were (21.3%) emergency surgeries. Intraoperative awareness occurred in nine (24.3%) participants who underwent procedural sedation and two (20%) who underwent emergency surgery. Twenty-six (55.3%) participants reported dreams during the procedure. Thirty-two (86.5%) participants considered their experience positive, and 35 (95%) would recommend a procedure supported by ketamine to a friend. DISCUSSION Most patients whose painful procedures and emergency operations were supported by the ESM-Ketamine package when no anaesthetist was available reported favourable experiences.
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Affiliation(s)
- Sarah Villegas
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Sebastian Suarez
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Owuor
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Gabriella M. Wuyke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Brett D. Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Javan Imbamba
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Debora Rogo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Khama Rogo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Thomas F. Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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7
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Radek L, Kallionpää R, Karvonen M, Scheinin A, Maksimow A, Långsjö J, Kaisti K, Vahlberg T, Revonsuo A, Scheinin H, Valli K. Dreaming and awareness during dexmedetomidine- and propofol-induced unresponsiveness. Br J Anaesth 2018; 121:260-269. [DOI: 10.1016/j.bja.2018.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/01/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022] Open
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Kuo PJ, Lee CL, Wang JH, Hsieh SY, Huang SC, Lam CF. Inhalation of volatile anesthetics via a laryngeal mask is associated with lower incidence of intraoperative awareness in non-critically ill patients. PLoS One 2017; 12:e0186337. [PMID: 29073151 PMCID: PMC5658000 DOI: 10.1371/journal.pone.0186337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/01/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Increased incidence of intraoperative awareness was reported in critically ill patients during major operations, particularly under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). However, the incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention. METHODS AND RESULTS This retrospective matched case-control study was conducted between January 2009 to December 2014. Surgical patients (ASA physical status I-III) whom reported intraoperative awareness during this study period were interviewed and their medical records were reviewed. The potential risk factors for awareness were compared with the non-case matched controls, who were randomly selected from the database. A total of 61436 patients were included and 16 definite cases of intraoperative awareness were identified. Patients who received ETGA and TIVA had significantly higher incidence of developing awareness compared to those who were anesthetized using laryngeal masks (LMA) (P = 0.03). Compared with the matched controls (n = 80), longer anesthesia time was associated with increased incidence of awareness (odds ratio 2.04; 95% CI 1.30-3.20, per hour increase). Perioperative use of muscle relaxant was also associated with increased incidence of awareness, while significantly lower incidence of awareness was found in patients who were anesthetized with volatile anesthetics. CONCLUSIONS The overall incidence of awareness was 0.023% in the ASA≤ III surgical patients who received general anesthesia. Anesthesia with a laryngeal mask under spontaneous ventilation and supplemented with volatile anesthetics may be the preferred anesthesia technique in generally healthy patients in order to provide a lower risk of intraoperative awareness.
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Affiliation(s)
- Pei-Jen Kuo
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chia-Ling Lee
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Jen-Huang Wang
- Department of Medical Research, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Shiu-Ying Hsieh
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Shian-Che Huang
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
- Department of Anesthesiology, E-Da Hospital/E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
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Matsuyama T, Iranami H, Fujii K, Hirayama M, Kawashima K. Is recall of dreaming during anesthesia a sign of occurrence of postoperative nausea and vomiting? J Anesth 2013; 27:945-8. [DOI: 10.1007/s00540-013-1653-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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Aceto P, Lai C, Perilli V, Dello Russo C, Federico B, Navarra P, Proietti R, Sollazzi L. Stress-related biomarkers of dream recall and implicit memory under anaesthesia. Anaesthesia 2013; 68:1141-7. [PMID: 23952901 DOI: 10.1111/anae.12386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate whether auditory presentation of a story during general anaesthesia might influence stress hormone changes and thus affecting dream recall and/or implicit memory. One hundred and ten patients were randomly assigned either to hear a recording of a story through headphones or to have routine care with no auditory recording while undergoing laparoscopic cholecystectomy. Anaesthesia was standardised. Blood samples for cortisol and prolactin assays were collected 20 min before anaesthesia and 5 min after pneumoperitoneum. Dream recall and explicit/implicit memory were investigated upon awakening from anaesthesia and approximately 24 h after the end of the operation. Auditory presentation was associated with lower intra-operative serum prolactin concentration compared with control (p = 0.0006). Twenty-seven patients with recall of dreaming showed higher intra-operative prolactin (p = 0.004) and lower cortisol (p = 0.03) concentrations compared with those without dream recall. The knowledge of this interaction might be useful in the quest to ensure postoperative amnesia.
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Affiliation(s)
- P Aceto
- Department of Anaesthesiology and Intensive Care, A. Gemelli Hospital, Rome, Italy
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12
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Schneemilch C, Schiltz K, Meinshausen E, Hachenberg T. [Sexual hallucinations and dreams under anesthesia and sedation : medicolegal aspects]. Anaesthesist 2012; 61:234-41. [PMID: 22430554 DOI: 10.1007/s00101-012-1999-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dreams and hallucinations under sedation or anesthesia have been well known phenomena since the introduction of anesthesia. Sexual hallucinations may lead to allegations of sexual molestation or assault by medical doctors or professional nursing staff. Hallucinations under the influence of sedative or hypnotic drugs may be very vivid and as misinterpreted as being real and it is therefore often difficult to disprove the resulting false allegations. In this report the terms drug-induced dreams and hallucinations are defined and the probable mechanism described. By a historical review and case reports the medicolegal consequences are demonstrated and procedures recommended to avoid allegations of sexual assault.
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Affiliation(s)
- C Schneemilch
- Universitätsklinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Deutschland.
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Brown EN, Purdon PL, Van Dort CJ. General anesthesia and altered states of arousal: a systems neuroscience analysis. Annu Rev Neurosci 2011; 34:601-28. [PMID: 21513454 PMCID: PMC3390788 DOI: 10.1146/annurev-neuro-060909-153200] [Citation(s) in RCA: 348] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intravenous anesthetics by relating their behavioral and physiological features to the molecular targets and neural circuits at which these drugs are purported to act. The altered states of arousal are sedation-unconsciousness, sedation-analgesia, dissociative anesthesia, pharmacologic non-REM sleep, and neuroleptic anesthesia. Each altered arousal state results from the anesthetic drugs acting at multiple targets in the central nervous system. Our analysis shows that general anesthesia is less mysterious than currently believed.
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Affiliation(s)
- Emery N. Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Patrick L. Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Christa J. Van Dort
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
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Büttner N, Schultz B, Grouven U, Schultz A. EEG-adaptierte „target-controlled infusion“. Anaesthesist 2010; 59:126-34. [DOI: 10.1007/s00101-009-1666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stait ML, Leslie K, Bailey R. Dreaming and recall during sedation for colonoscopy. Anaesth Intensive Care 2009; 36:685-90. [PMID: 18853587 DOI: 10.1177/0310057x0803600509] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dreaming is reported by one in five patients who are interviewed on emergence from general anaesthesia, but the incidence, predictors and consequences of dreaming during procedural sedation are not known. In this prospective observational study, 200 patients presenting for elective colonoscopy under intravenous sedation were interviewed on emergence to determine the incidences of dreaming and recall. Sedation technique was left to the discretion of the anaesthetist. The incidence of dreaming was 25.5%. Patients reporting dreaming were younger than those who did not report dreaming. Doses of midazolam and fentanyl were similar between dreamers and non-dreamers, however propofol doses were higher in patients who reported dreams than those who did not. Patients reported short, simple dreams about everyday life--no dream suggested near-miss recall of the procedure. Frank recall of the procedure was reported by 4% of the patients, which was consistent with propofol doses commensurate with light general anaesthesia. The only significant predictor of recall was lower propofol dose. Satisfaction with care was generally high, however dreamers were more satisfied with their care than non-dreamers.
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Affiliation(s)
- M L Stait
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
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Abstract
Anesthesia awareness can cause adverse psychological symptoms in patients after surgery. Although rare, posttraumatic stress disorder (PTSD) has been documented in surgical patients who have a history of previous trauma or maladaptive coping patterns. Plastic surgical nurses should assess all patients for anesthesia awareness postoperatively, recognize the diagnostic criteria of PTSD, and offer support of psychiatric referrals if indicated.
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Affiliation(s)
- Kate Leslie
- Department of Pahrmacology, University of Melbourne, Melbourne, Australia.
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