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Wasilczuk AZ, Rinehart C, Aggarwal A, Stone ME, Mashour GA, Avidan MS, Kelz MB, Proekt A. Hormonal basis of sex differences in anesthetic sensitivity. Proc Natl Acad Sci U S A 2024; 121:e2312913120. [PMID: 38190526 PMCID: PMC10801881 DOI: 10.1073/pnas.2312913120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
General anesthesia-a pharmacologically induced reversible state of unconsciousness-enables millions of life-saving procedures. Anesthetics induce unconsciousness in part by impinging upon sexually dimorphic and hormonally sensitive hypothalamic circuits regulating sleep and wakefulness. Thus, we hypothesized that anesthetic sensitivity should be sex-dependent and modulated by sex hormones. Using distinct behavioral measures, we show that at identical brain anesthetic concentrations, female mice are more resistant to volatile anesthetics than males. Anesthetic sensitivity is bidirectionally modulated by testosterone. Castration increases anesthetic resistance. Conversely, testosterone administration acutely increases anesthetic sensitivity. Conversion of testosterone to estradiol by aromatase is partially responsible for this effect. In contrast, oophorectomy has no effect. To identify the neuronal circuits underlying sex differences, we performed whole brain c-Fos activity mapping under anesthesia in male and female mice. Consistent with a key role of the hypothalamus, we found fewer active neurons in the ventral hypothalamic sleep-promoting regions in females than in males. In humans, we demonstrate that females regain consciousness and recover cognition faster than males after identical anesthetic exposures. Remarkably, while behavioral and neurocognitive measures in mice and humans point to increased anesthetic resistance in females, cortical activity fails to show sex differences under anesthesia in either species. Cumulatively, we demonstrate that sex differences in anesthetic sensitivity are evolutionarily conserved and not reflected in conventional electroencephalographic-based measures of anesthetic depth. This covert resistance to anesthesia may explain the higher incidence of unintended awareness under general anesthesia in females.
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Affiliation(s)
- Andrzej Z. Wasilczuk
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
| | - Cole Rinehart
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
| | - Adeeti Aggarwal
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA19104
| | - Martha E. Stone
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA19104
| | - George A. Mashour
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI48105
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO63110
| | - Max B. Kelz
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA19104
- Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - Alex Proekt
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Neuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA19104
- Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104
| | - ReCCognition Study Group
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA19104
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI48105
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO63110
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Braithwaite HE, Payne T, Duce N, Lim J, McCulloch T, Loadsman J, Leslie K, Webster AC, Gaskell A, Sanders RD. Impact of female sex on anaesthetic awareness, depth, and emergence: a systematic review and meta-analysis. Br J Anaesth 2023; 131:510-522. [PMID: 37453840 DOI: 10.1016/j.bja.2023.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Suggested anaesthetic dose ranges do not differ by sex, likely because of limited studies comparing sexes. Our objective was to systematically synthesise studies with outcomes of unintended anaesthesia awareness under anaesthesia, intraoperative connected consciousness, time to emergence from anaesthesia, and dosing to achieve adequate depth of anaesthesia, and to compare between females and males. METHODS Studies were identified from MEDLINE, Embase, and the Cochrane library databases until August 2, 2022. Controlled clinical trials (randomised/non-randomised) and prospective cohort studies that reported outcomes by sex were included. Results were synthesised by random effects meta-analysis where possible, or narrative form. RESULTS Of the 19 749 studies identified, 64 (98 243 participants; 53 143 females and 45 100 males) were eligible for inclusion, and 44 citations contributed to meta-analysis. Females had a higher incidence of awareness with postoperative recall (33 studies, odds ratio 1.38, 95% confidence interval [CI] 1.09-1.75) and connected consciousness during anaesthesia (three studies, OR 2.09, 95% CI 1.04-4.23) than males. Time to emergence was faster in females, including time to eye-opening (10 studies, mean difference -2.28 min, 95% CI -3.58 to -0.98), and time to response to command (six studies, mean difference -2.84 min, 95% CI -4.07 to -1.62). Data on depth of anaesthesia were heterogenous, limiting synthesis to a qualitative review which did not identify sex differences. CONCLUSIONS Female sex was associated with a greater incidence of awareness under general anaesthesia, and faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022336087.
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Affiliation(s)
- Hannah E Braithwaite
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia.
| | - Thomas Payne
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas Duce
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Jessica Lim
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Tim McCulloch
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - John Loadsman
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Kate Leslie
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amy Gaskell
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Robert D Sanders
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Pennington BRT, Politi MC, Abdallah AB, Janda AM, Eshun-Wilsonova I, deBourbon NG, Siderowf L, Klosterman H, Kheterpal S, Avidan MS. A survey of surgical patients' perspectives and preferences towards general anesthesia techniques and shared-decision making. BMC Anesthesiol 2023; 23:277. [PMID: 37592215 PMCID: PMC10433576 DOI: 10.1186/s12871-023-02219-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The decision about which type of general anesthetic to administer is typically made by the clinical team without patient engagement. This study examined patients' preferences, experiences, attitudes, beliefs, perceptions, and perceived social norms about anesthesia and about engaging in the decision regarding general anesthetic choice with their clinician. METHODS We conducted a survey in the United States, sent to a panel of surgical patients through Qualtrics (Qualtrics, Provo, UT) from March 2022 through May 2022. Questions were developed based on the Theory of Planned Behavior and validated measures were used when available. A patient partner who had experienced both intravenous and inhaled anesthesia contributed to the development and refinement of the questions. RESULTS A total of 806 patients who received general anesthesia for an elective procedure in the last five years completed the survey. 43% of respondents preferred a patient-led decision making role and 28% preferred to share decision making with their clinical team, yet only 7.8% reported being engaged in full shared decision making about the anesthesia they received. Intraoperative awareness, pain, nausea, vomiting and quickly returning to work and usual household activities were important to respondents. Waking up in the middle of surgery was the most commonly reported concern, despite this experience being reported only 8% of the time. Most patients (65%) who searched for information about general anesthesia noted that it took a lot of effort to find the information, and 53% agreed to feeling frustrated during the search. CONCLUSIONS Most patients prefer a patient-led or shared decision making process when it comes to their anesthetic care and want to be engaged in the decision. However, only a small percentage of patients reported being fully engaged in the decision. Further studies should inform future shared decision-making tools, informed consent materials, educational materials and framing of anesthetic choices for patients so that they are able to make a choice regarding the anesthetic they receive.
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Affiliation(s)
| | - Mary C Politi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Lilly Siderowf
- College of Arts and Sciences, Washington University, St. Louis, MO, USA
| | | | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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Hachenberg T, Scheller B. [Accidental Awareness during General Anaesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:380-390. [PMID: 37385244 DOI: 10.1055/a-1768-5161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Accidental awareness during general anaesthesia (AAGA) is a rare but severe complication. The reported incidence of AAGA may depend on the assessment of intraoperative awareness with explicit recall and there are substantial variations between subspecialties and groups of patients. The majority of prospective studies using structured interviews reported an incidence of AAGA at 0.1-0.2% during general anaesthesia, however, higher values were observed in paediatric (0.2-1.2%) and obstetric patients (0.47%). Risk factors that predispose to AAGA are patient conditions, ASA status, female gender, patient age, history of AAGA, surgical procedure, anaesthetic drug type, muscle relaxation, dosages of hypnotic or analgesic drugs, monitoring and malfunction of anaesthesia systems. Preventive strategies include careful assessment of risk factors, avoidance of underdosages of hypnotics and analgetics during general anaesthesia and monitoring of depth of anaesthesia in risk patients. The health-related consequences can be serious and psychopharmacological and psychotherapeutic interventions are indicated in patients who have experienced AAGA.
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Rimbert S, Lelarge J, Guerci P, Bidgoli SJ, Meistelman C, Cheron G, Cebolla Alvarez AM, Schmartz D. Detection of Motor Cerebral Activity After Median Nerve Stimulation During General Anesthesia (STIM-MOTANA): Protocol for a Prospective Interventional Study. JMIR Res Protoc 2023; 12:e43870. [PMID: 36729587 PMCID: PMC10013682 DOI: 10.2196/43870] [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: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Accidental awareness during general anesthesia (AAGA) is defined as an unexpected awareness of the patient during general anesthesia. This phenomenon occurs in 1%-2% of high-risk practice patients and can cause physical suffering and psychological after-effects, called posttraumatic stress disorder. In fact, no monitoring techniques are satisfactory enough to effectively prevent AAGA; therefore, new alternatives are needed. Because the first reflex for a patient during an AAGA is to move, but cannot do so because of the neuromuscular blockers, we believe that it is possible to design a brain-computer interface (BCI) based on the detection of movement intention to warn the anesthetist. To do this, we propose to describe and detect the changes in terms of motor cortex oscillations during general anesthesia with propofol, while a median nerve stimulation is performed. We believe that our results could enable the design of a BCI based on median nerve stimulation, which could prevent AAGA. OBJECTIVE To our knowledge, no published studies have investigated the detection of electroencephalographic (EEG) patterns in relation to peripheral nerve stimulation over the sensorimotor cortex during general anesthesia. The main objective of this study is to describe the changes in terms of event-related desynchronization and event-related synchronization modulations, in the EEG signal over the motor cortex during general anesthesia with propofol while a median nerve stimulation is performed. METHODS STIM-MOTANA is an interventional and prospective study conducted with patients scheduled for surgery under general anesthesia, involving EEG measurements and median nerve stimulation at two different times: (1) when the patient is awake before surgery (2) and under general anesthesia. A total of 30 patients will receive surgery under complete intravenous anesthesia with a target-controlled infusion pump of propofol. RESULTS The changes in event-related desynchronization and event-related synchronization during median nerve stimulation according to the various propofol concentrations for 30 patients will be analyzed. In addition, we will apply 4 different offline machine learning algorithms to detect the median nerve stimulation at the cerebral level. Recruitment began in December 2022. Data collection is expected to conclude in June 2024. CONCLUSIONS STIM-MOTANA will be the first protocol to investigate median nerve stimulation cerebral motor effect during general anesthesia for the detection of intraoperative awareness. Based on strong practical and theoretical scientific reasoning from our previous studies, our innovative median nerve stimulation-based BCI would provide a way to detect intraoperative awareness during general anesthesia. TRIAL REGISTRATION Clinicaltrials.gov NCT05272202; https://clinicaltrials.gov/ct2/show/NCT05272202. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/43870.
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Affiliation(s)
- Sébastien Rimbert
- CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium.,Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium.,Inria Bordeaux Sud-Ouest, University of Bordeaux, Talence, France
| | - Julien Lelarge
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | | | - Claude Meistelman
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Guy Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium
| | - Ana Maria Cebolla Alvarez
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles Neurosciences Institute, Bruxelles, Belgium
| | - Denis Schmartz
- CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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Kamel YA, Sasa NAG, Helal SM, Attallah HA, Yassen KA. Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:74-83. [PMID: 37250255 PMCID: PMC10220192 DOI: 10.4103/joacp.joacp_168_21] [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: 04/08/2021] [Revised: 08/10/2021] [Accepted: 09/25/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups. Material and Methods This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO2 40% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded. Results IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ2 (Y) (df = 1) = 0.88, P (Y) = 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12-0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85-0.97] mL/min propofol with TCI. The cost was higher with TCI, P < 0.00. Conclusions Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier.
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Affiliation(s)
- Yasmeen Abdelsalam Kamel
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Egypt
| | - Noura Adel Ghareeb Sasa
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Egypt
| | - Safaa Mohamed Helal
- Department Anesthesia and Intensive Care, Faculty of Medicine, Menoufia University, Egypt
| | - Hatem Amin Attallah
- Department Anesthesia and Intensive Care, Faculty of Medicine, Menoufia University, Egypt
| | - Khaled A. Yassen
- Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Egypt
- Department of Anesthesia Division-Surgery, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia
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Nawafleh S, Alrawashdeh A, Ababneh O, Bani-Hani M, Al Modanat Z, Hani DB, Bataineh A, Al-Salameh F, Abuzaid S, Yasser O, Khairallah K. Perception and practices of depth of anesthesia monitoring and intraoperative awareness event rate among Jordanian anesthesiologists: a cross-sectional study. BMC Anesthesiol 2022; 22:402. [PMID: 36575378 PMCID: PMC9793501 DOI: 10.1186/s12871-022-01941-w] [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: 10/12/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there is a wide variation in the incidence of intraoperative awareness and in the practices and attitudes toward depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists' practice and attitudes toward DoA monitoring and estimate the event rate of intraoperative awareness among the participating anesthesiologists. METHODS A descriptive cross-sectional survey of Jordanian anesthesiologists working in public, private, and university hospitals was utilized using a questionnaire developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests. RESULTS A total of 107 anesthesiologists responded and completed the survey. About one-third of the respondents (34.6%; 95% CI 26.1-44.2) had never used a DoA monitor and only 6.5% (95% CI 3.1-13.2) reported using it as a "daily practice". The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5-83.5) believed that currently available DoA monitors are effective for DoA monitoring and only 4.7% (95%CI 1.9-10.8) reported it as being "invalid". Most respondents reported that the main purpose of using a DoA monitor was to prevent awareness (86.0%; 95%CI 77.9-91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9-72.2), and reduce recovery time (57%; 95%CI 47.4-66.1). The event rate of intraoperative awareness was estimated at 0.4% among participating anesthesiologists. Most Jordanian hospitals lacked policy intending to prevent intraoperative awareness. CONCLUSIONS Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.
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Affiliation(s)
- Sager Nawafleh
- grid.33801.390000 0004 0528 1681Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, 13115 Jordan
| | - Ahmad Alrawashdeh
- grid.37553.370000 0001 0097 5797Department of Allied Medical Science, Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid, 22110 Jordan
| | - Omar Ababneh
- grid.9670.80000 0001 2174 4509Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942 Jordan
| | - Morad Bani-Hani
- grid.33801.390000 0004 0528 1681Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, 13115 Jordan
| | - Zaid Al Modanat
- grid.14440.350000 0004 0622 5497Faculty of Medicine, Yarmouk University, Irbid, 21110 Jordan
| | - Diab Bani Hani
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | - Adel Bataineh
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | | | - Sajeda Abuzaid
- Department of Research and Data Analytics, Kernel Center, Irbid, 21110 Jordan
| | - Omer Yasser
- grid.37553.370000 0001 0097 5797Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110 Jordan
| | - Khaled Khairallah
- grid.37553.370000 0001 0097 5797Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110 Jordan
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Remimazolam Anesthesia for MitraClip Implantation in a Patient with Advanced Heart Failure. Case Rep Anesthesiol 2021; 2021:5536442. [PMID: 34035965 PMCID: PMC8116154 DOI: 10.1155/2021/5536442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 12/30/2022] Open
Abstract
Remimazolam, a novel and ultrashort-acting benzodiazepine, has been available for general anesthesia in Japan. The administration of remimazolam does not induce injection pain, has been reported to have less cardiovascular depressant effects during general anesthesia, and flumazenil can antagonize the effects of remimazolam. However, in clinical trials, no patient who is complicated with severe heart failure or undergoes cardiac surgery was included. We present anesthetic management with remimazolam for MitraClip® implantation in a patient with severe mitral regurgitation and advanced heart failure. Remimazolam was administered both in anesthetic induction and maintenance with less cardiovascular depressant effects. After surgical procedures were completed, the patient smoothly recovered from anesthesia and the tracheal was extubated just after administration of flumazenil. Remimazolam may be able to achieve appropriate anesthetic management in patients complicated with severe cardiovascular diseases.
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Akavipat P, Eiamcharoenwit J, Punjasawadwong Y, Pitimana-Aree S, Sriraj W, Laosuwan P, Viengteerawat S, Wasinwong W. Unintended intraoperative awareness: An analysis of Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai). INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 32:123-132. [PMID: 32538875 DOI: 10.3233/jrs-200023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the improvement of anesthetic-related modalities, the incidence of unintended intraoperative awareness remains at around 0.005-0.038%. OBJECTIVE We aimed to describe the intraoperative awareness incidents that occurred across Thailand between January to December, 2015. METHODS Observational data was collected from 22 hospitals throughout Thailand. The awareness category was selected from incident reports according to the Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study database and descriptive statistics were analyzed. The awareness characteristics and the related factors were recorded. RESULTS A total of nine intraoperative awareness episodes from 2000 incidents were observed. The intraoperative awareness results were as follows: experience of pain (38.1%), perception of sound (33.3%), perception of intubation (9.5%) and feeling of paralysis (14.3%). The observed factors that affect intraoperative awareness were anesthesia-related (100%), patient-related (55.5%), surgery-related (22.2%) and systematic process-related (22.2%). The contributing factors were situational inexperience (77.8%) and inappropriate patient evaluation (44.4%). An awareness of anesthetic performer (100%) and experience (88.9%) were defined as incident-mitigating factors. The suggested corrective strategies were quality assurance activity (88.9%), improved supervision (44.4%) and equipment utilization (33.3%), respectively. CONCLUSION Nine intraoperative awareness incidents were observed, however the causes were preventable. The anesthetic component seems to be the most influential to prevent these events.
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Affiliation(s)
- Phuping Akavipat
- Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand
| | - Jatuporn Eiamcharoenwit
- Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | | | - Wimonrat Sriraj
- Faculty of Medicine, Khon Kaen University, Srinagarind Hospital, Khon Kaen, Thailand
| | - Prok Laosuwan
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Wirat Wasinwong
- Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Deis AS, Schnetz MP, Ibinson JW, Vogt KM. Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period. BMC Anesthesiol 2020; 20:62. [PMID: 32151241 PMCID: PMC7061486 DOI: 10.1186/s12871-020-00974-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Awareness with recall under general anesthesia remains a rare but important issue that warrants further study. Methods We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics. Results The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case. Conclusions Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.
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Affiliation(s)
- Amanda S Deis
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Michael P Schnetz
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - James W Ibinson
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, USA.,Department of Anesthesiology, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA
| | - Keith M Vogt
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA. .,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA. .,Center for the Neural Basis of Cognition, Pittsburgh, USA.
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11
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Lai HC, Wu KL, Wu ZF, Lai MF, Huang YH, Tseng WC, Chen JY. A 10-year retrospective analysis on the incidence of anesthesia awareness with recall in adult patients under total intravenous anesthesia. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/1011-4564.282530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Lai HC, Wu KL, Wu ZF, Lai MF, Huang YH, Tseng WC, Chen JY. A 10-year retrospective analysis on the incidence of anesthesia awareness with recall in adult patients under total intravenous anesthesia. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_224_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Rimbert S, Schmartz D, Bougrain L, Meistelman C, Baumann C, Guerci P. MOTANA: study protocol to investigate motor cerebral activity during a propofol sedation. Trials 2019; 20:534. [PMID: 31455386 PMCID: PMC6712668 DOI: 10.1186/s13063-019-3596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Accidental Accidental awareness during general anesthesia (AAGA) occurs in 1–2% of high-risk practice patients and is a cause of severe psychological trauma, termed post-traumatic stress disorder (PTSD). However, no monitoring techniques can accurately predict or detect AAGA. Since the first reflex for a patient during AAGA is to move, a passive brain-computer interface (BCI) based on the detection of an intention of movement would be conceivable to alert the anesthetist. However, the way in which propofol (i.e., an anesthetic commonly used for the general anesthesia induction) affects motor brain activity within the electroencephalographic (EEG) signal has been poorly investigated and is not clearly understood. For this reason, a detailed study of the motor activity behavior with a step-wise increasing dose of propofol is required and would provide a proof of concept for such an innovative BCI. The main goal of this study is to highlight the occurrence of movement attempt patterns, mainly changes in oscillations called event-related desynchronization (ERD) and event-related synchronization (ERS), in the EEG signal over the motor cortex, in healthy subjects, without and under propofol sedation, during four different motor tasks. Methods MOTANA is an interventional, prospective, exploratory, physiological, monocentric, and randomized study conducted in healthy volunteers under light anesthesia, involving EEG measurements before and after target-controlled infusion of propofol at three different effect-site concentrations (0 μg.ml −1, 0.5 μg.ml −1, and 1.0 μg.ml −1). In this exploratory study, 30 healthy volunteers will perform 50 trials for the four motor tasks (real movement, motor imagery, motor imagery with median nerve stimulation, and median nerve stimulation alone) in a randomized sequence. In each conditions and for each trial, we will observe changes in terms of ERD and ERS according to the three propofol concentrations. Pre- and post-injection comparisons of propofol will be performed by paired series tests. Discussion MOTANA is an exploratory study aimed at designing an innovative BCI based on EEG-motor brain activity that would detect an attempt to move by a patient under anesthesia. This would be of interest in the prevention of AAGA. Trial registration Agence Nationale de Sécurité du Médicament (EUDRACT 2017-004198-1), NCT03362775. Registered on 29 August 2018. https://clinicaltrials.gov/ct2/show/NCT03362775?term=03362775&rank=1 Electronic supplementary material The online version of this article (10.1186/s13063-019-3596-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sébastien Rimbert
- Université de Lorraine, Inria, LORIA, Neurosys team, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France.
| | - Denis Schmartz
- CHU Brugmann, Université Libre de Bruxelles, Place A.Van Gehuchten 4, Bruxelles, 1020, Belgium
| | - Laurent Bougrain
- Université de Lorraine, Inria, LORIA, Neurosys team, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France
| | - Claude Meistelman
- Department of Anesthesiology and Critical Care Medicine, Universisty Hospital of Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre-lès-Nancy, 54500, France
| | - Cédric Baumann
- CHRU Nancy, plateforme d'aide à la recherche clinique, UMDS, Vandoeuvre-lès-Nancy, 54500, France
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, Universisty Hospital of Nancy, 9 Avenue de la Forêt de Haye, Vandoeuvre-lès-Nancy, 54500, France.,INSERM, U1116, Université de Lorraine, 615 rue du Jardin Botanique, Vandoeuvre-lès-Nancy, France
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Rimbert S, Riff P, Gayraud N, Schmartz D, Bougrain L. Median Nerve Stimulation Based BCI: A New Approach to Detect Intraoperative Awareness During General Anesthesia. Front Neurosci 2019; 13:622. [PMID: 31275105 PMCID: PMC6593137 DOI: 10.3389/fnins.2019.00622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/29/2019] [Indexed: 11/24/2022] Open
Abstract
Hundreds of millions of general anesthesia are performed each year on patients all over the world. Among these patients, 0.1–0.2% are victims of Accidental Awareness during General Anesthesia (AAGA), i.e., an unexpected awakening during a surgical procedure under general anesthesia. Although anesthesiologists try to closely monitor patients using various techniques to prevent this terrifying phenomenon, there is currently no efficient solution to accurately detect its occurrence. We propose the conception of an innovative passive brain-computer interface (BCI) based on an intention of movement to prevent AAGA. Indeed, patients typically try to move to alert the medical staff during an AAGA, only to discover that they are unable to. First, we examine the challenges of such a BCI, i.e., the lack of a trigger to facilitate when to look for an intention to move, as well as the necessity for a high classification accuracy. Then, we present a solution that incorporates Median Nerve Stimulation (MNS). We investigate the specific modulations that MNS causes in the motor cortex and confirm that they can be altered by an intention of movement. Finally, we perform experiments on 16 healthy participants to assess whether an MI-based BCI using MNS is able to generate high classification accuracies. Our results show that MNS may provide a foundation for an innovative BCI that would allow the detection of AAGA.
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Affiliation(s)
| | - Pierre Riff
- Université de Lorraine, CNRS, Inria, LORIA, Nancy, France
| | - Nathalie Gayraud
- Université Côte d'Azur, Inria, Sophia-Antipolis Méditerrannée, Athena Team, Nice, France
| | - Denis Schmartz
- Le Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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15
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Tasbihgou SR, Vogels MF, Absalom AR. Accidental awareness during general anaesthesia - a narrative review. Anaesthesia 2018; 73:112-122. [PMID: 29210043 DOI: 10.1111/anae.14124] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
Unintended accidental awareness during general anaesthesia represents failure of successful anaesthesia, and so has been the subject of numerous studies during the past decades. As return to consciousness is both difficult to describe and identify, the reported incidence rates vary widely. Similarly, a wide range of techniques have been employed to identify cases of accidental awareness. Studies which have used the isolated forearm technique to identify responsiveness to command during intended anaesthesia have shown remarkably high incidences of awareness. For example, the ConsCIOUS-1 study showed an incidence of responsiveness around the time of laryngoscopy of 1:25. On the other hand, the 5th Royal College of Anaesthetists National Audit Project, which reported the largest ever cohort of patients who had experienced accidental awareness, used a system to identify patients who spontaneously self-reported accidental awareness. In this latter study, the incidence of accidental awareness was 1:19,600. In the recently published SNAP-1 observational study, in which structured postoperative interviews were performed, the incidence was 1:800. In almost all reported cases of intra-operative responsiveness, there was no subsequent explicit recall of intra-operative events. To date, there is no evidence that this occurrence has any psychological consequences. Among patients who experience accidental awareness and can later remember details of their experience, the consequences are better known. In particular, when awareness occurs in a patient who has been given neuromuscular blocking agents, it may result in serious sequelae such as symptoms of post-traumatic stress disorder and a permanent aversion to surgery and anaesthesia, and is feared by patients and anaesthetists. In this article, the published literature on the incidence, consequences and management of accidental awareness under general anaesthesia with subsequent recall will be reviewed.
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Affiliation(s)
- S R Tasbihgou
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - M F Vogels
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - A R Absalom
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, the Netherlands
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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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17
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Wong GTC, Choi SW, Tran DH, Kulkarni H, Irwin M. An International Survey Evaluating Factors Influencing the Use of Total Intravenous Anaesthesia. Anaesth Intensive Care 2018; 46:332-338. [DOI: 10.1177/0310057x1804600312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The purpose of this study was to evaluate factors influencing the use of propofol-based total intravenous anaesthesia (TIVA) since despite TIVA being a well-established technique, it is used far less frequently than volatile anaesthesia. Questions were formulated after reviewing the literature for perceived disadvantages of TIVA and meeting with a focus group consisting of both senior and junior anaesthestists from our department. Once the survey had been formulated, specialist anaesthetists from professional colleges and societies from several countries were invited to complete the survey on an electronic web-based platform to allow evaluation of the respondent's rating of the importance of a range of factors in their decision not to use TIVA for a particular case. Basic descriptive statistics were determined using SPSS statistical software, while graphical depictions of data were handled using R for statistical analysis. A total of 763 survey responses were included in the final analysis and stratified according to the frequency of TIVA use. Among the infrequent users, issues such as additional effort, institutional preference, lack of real-time monitoring of propofol concentration, risk of missing drug delivery failure and increased turnaround time were among the top reasons mentioned. Interestingly, these issues were considered far less important among the frequent users when not choosing TIVA. We concluded that frequent and infrequent users respond quite differently to similar technical TIVA-related factors. Non-technical factors may play an important role in the infrequent user's decision not to use TIVA for a particular case.
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Affiliation(s)
- G. T. C. Wong
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
| | - S. W. Choi
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
| | - D. H. Tran
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong
| | - H. Kulkarni
- Senior Vice President of Global Medical; Global Medical, Clinical & Regulatory Affairs; Fresenius Kabi, Germany
| | - M. Irwin
- Professor and Head, Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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18
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Gao WW, He YH, Liu L, Yuan Q, Wang YF, Zhao B. BIS Monitoring on Intraoperative Awareness: A Meta-analysis. Curr Med Sci 2018; 38:349-353. [PMID: 30074196 DOI: 10.1007/s11596-018-1886-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/30/2017] [Indexed: 11/24/2022]
Abstract
Intraoperative awareness is a very serious complication of general anesthesia. Several studies have evaluated the potential association between bispectral index (BIS) and intraoperative awareness, however, the results obtained were controversial. Therefore, we performed a meta-analysis to further assess the association between the BIS monitoring and the incidence of intraoperative awareness. A comprehensive search was conducted to identify all eligible studies from the online literature databases published prior to Feb. 2017. A total of five studies with 17 432 cases and 16 749 controls were included. An odds ratio (OR) and a 95% confidence interval (CI) were calculated to examine the strength of the association. The results showed that in the overall analysis, the association between the BIS monitoring and the incidence of intraoperative awareness was not significant (OR=0.58, 95% CI= 0.22-1.58, P=0.29). A stratified analysis by comparing different anesthesia methods revealed that BIS monitoring group showed a lower incidence of intraoperative awareness in patients with intravenous anesthesia when compared with non-BIS monitoring group (OR=0.20, 95% CI=0.08-0.49, P=0.0004), whereas there was no statistically significant difference in the incidence of intraoperative awareness between BIS and non-BIS monitoring groups in patients with inhalation anesthesia (OR=1.13, 95% CI=0.56-2.26, P=0.73). In conclusion, our meta-analysis showed that BIS monitoring had no appreciable advantage in the reduction of the intraoperative awareness incidence in inhalation anesthesia, while showed a remarkable superiority in intravenous anesthesia.
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Affiliation(s)
- Wen-Wei Gao
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yu-Hong He
- Office of Infection Control, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lian Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Yuan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ya-Feng Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Bo Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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19
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Kart K, Hanci A. Effects of remifentanil and dexmedetomidine on the mother's awareness and neonatal Apgar scores in caesarean section under general anaesthesia. J Int Med Res 2018. [PMID: 29536783 PMCID: PMC5991248 DOI: 10.1177/0300060518759891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective This study aimed to compare the effects of remifentanil and dexmedetomidine on awareness during the induction of general anaesthesia. Material and Methods Ninety patients scheduled for elective caesarean section under general anaesthesia were included and randomly divided into three anaesthesia groups: 2 mg/kg propofol (control group); 2 mg/kg propofol and 1 µg/kg dexmedetomidine (dexmedetomidine group); and 2 mg/kg propofol and 1 µg/kg remifentanil (remifentanil group). All patients received routine monitoring, and Apgar scores at 1 and 5 minutes were recorded. The bispectral index and the isolated forearm technique were used to determine the depth of anaesthesia. Results Bispectral index values at skin and uterine incisions and at delivery were similar among the groups. The number of patients who responded positively to the isolated arm technique during the induction period was also similar. One-minute Apgar scores in the control group were significantly lower and 5-minute Apgar scores significantly higher than those in the other groups. Conclusion The effects of remifentanil and dexmedetomidine added to propofol on maternal awareness, neonatal Apgar scores, and bispectral index values were similar compared with propofol alone. However, it was observed that remifentanil controlled the haemodynamic responses to sympathetic stimuli in a better manner than dexmedetomidine.
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Affiliation(s)
- Kenan Kart
- 1 Anesthesiology and Reanimation Clinics, Istinye University Liv Hospital, Istanbul, Turkey
| | - Ayse Hanci
- 2 Anesthesiology and Reanimation Clinics, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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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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Abstract
The purpose of the study was to investigate the effects of total intravenous anesthesia (TIVA) and combined of intravenous and inhaled anesthesia (CIIA) on intraoperative awareness in surgical patients.A total of 678 patients were recruited in the CIIA group, while TIVA group included 566 patients. The clinical characteristics and the occurrence of intraoperative awareness were compared between the groups. Mini-Mental State Examination, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 tests were performed to estimate cognitive and psychological functions of the patients. In addition, logistic regression analysis was applied to identify the risk factors for intraoperative awareness in surgical patients.In CIIA group, 3 patients (0.44%) were confirmed with intraoperative awareness, while 11 patients (1.94%) in TIVA group underwent intraoperative awareness. The occurrence rate of intraoperative awareness was significantly higher in VITA group than that in the CIIA group (P = .029). Awareness classification demonstrated that intraoperative awareness mainly included auditory, tactile, and pain perceptions. Moreover, 4 patients showed distress after operation. Patients with intraoperative awareness exhibited poor performance in cognitive and psychological tests (P < .001 for all). Logistic regression analysis demonstrated that CIIA (odds ratio [OR] = 0.198, 95% confidence interval [CI] = 0.047-0.827), age (OR = 0.951, 95% CI = 0.908-0.997), midazolam application (OR = 0.158, 95% CI = 0.034-0.736), awareness history (OR = 10.131, 95% CI = 2.206-45.517), and duration of surgery (OR = 1.016, 95% CI = 1.001-1.032) were significantly associated with intraoperative awareness.Intraoperative awareness can significantly influence the cognitive and psychological functions of surgical patients. CIIA and midazolam application may lower the risk of intraoperative awareness.
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MESH Headings
- Adult
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Anesthesia, General/psychology
- Anesthesia, Inhalation/adverse effects
- Anesthesia, Inhalation/psychology
- Anesthesia, Intravenous/adverse effects
- Anesthesia, Intravenous/psychology
- Anesthetics, Inhalation/administration & dosage
- Anesthetics, Inhalation/adverse effects
- Female
- Humans
- Intraoperative Awareness/psychology
- Logistic Models
- Male
- Methyl Ethers/administration & dosage
- Methyl Ethers/adverse effects
- Middle Aged
- Operative Time
- Postoperative Complications/chemically induced
- Postoperative Complications/psychology
- Postoperative Period
- Propofol/administration & dosage
- Propofol/adverse effects
- Sevoflurane
- Stress, Psychological/chemically induced
- Stress, Psychological/psychology
- Treatment Outcome
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Mędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A, Ozga D, Wojtaszek M. Unintended Return of Consciousness in a Patient during Surgery and General Anesthesia. Eur Neurol 2017; 77:262-266. [PMID: 28365683 DOI: 10.1159/000471510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/15/2017] [Indexed: 12/20/2022]
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Singla D, Mangla M. Incidence of Awareness with Recall under General Anesthesia in Rural India: An Observational Study. Anesth Essays Res 2017; 11:489-494. [PMID: 28663647 PMCID: PMC5490134 DOI: 10.4103/aer.aer_44_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Awareness under anesthesia is a rare but extremely unpleasant phenomenon. There are very few studies in the developing world and none from rural areas where incidence of intraoperative awareness may be higher due to increased patient load, limited patient knowledge and lack of trained hospital staff, reliance on older, cheaper but less effective drugs, and lack of proper equipment both for providing anesthesia, as well as monitoring the patient. Aims: To assess the incidence of intraoperative awareness during general anesthesia among patients in rural India and any factors associated with the same. Settings and Design: Prospective, nonrandomized, observational study. Subjects and Methods: Patients undergoing elective surgical procedures in various specialties under general anesthesia from over a period of 1 year were considered for this study. Approximately, after 1 h of arrival in postanaesthesia care unit, anesthesiologist (not involved in administering anesthesia) assessed intraoperative awareness using a modified form of Brice questionnaire. Statistical Analysis Used: Data were collected on a Microsoft Excel® sheet and analyzed using Statistical Package for the Social Sciences® version 23 (SPSS Inc., Chicago, IL, USA) for windows. Results: A total of 896 patients completed the questionnaire. Postoperatively, in response to the questionnaire, seven patients reported to have remembered something under anesthesia. Out of these, three patients described events that were confirmed by operation theater staff to have occurred whereas they were under anesthesia. Conclusions: Incidence of definite awareness under anesthesia with postoperative recall was found to be 0.33% (three patients out of total 896) in our study.
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Affiliation(s)
- Deepak Singla
- Department of Anaesthesia, AIIMS, Rishikesh, Uttarakhand, India
| | - Mishu Mangla
- Department of Obstetrics and Gynaecology, Himalayan Hospital, Dehradun, Uttarakhand, India
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Messina AG, Wang M, Ward MJ, Wilker CC, Smith BB, Vezina DP, Pace NL. Anaesthetic interventions for prevention of awareness during surgery. Cochrane Database Syst Rev 2016; 10:CD007272. [PMID: 27755648 PMCID: PMC6461159 DOI: 10.1002/14651858.cd007272.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND General anaesthesia is usually associated with unconsciousness. 'Awareness' is when patients have postoperative recall of events or experiences during surgery. 'Wakefulness' is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness. OBJECTIVES To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, ISSUE 4 2016); PubMed from 1950 to April 2016; MEDLINE from 1950 to April 2016; and Embase from 1980 to April 2016. We contacted experts to identify additional studies. We performed a handsearch of the citations in the review. We did not search trial registries. SELECTION CRITERIA We included randomized controlled trials (RCTs) of either anaesthetic regimens or anaesthetic depth monitors. We excluded volunteer studies, studies of patients prior to skin incision, intensive care unit studies, and studies that only randomized different word presentations for memory tests (not anaesthetic interventions).Anaesthetic drug regimens included studies of induction or maintenance, or both. Anaesthetic depth monitors included the Bispectral Index monitor, M-Entropy, Narcotrend monitor, cerebral function monitor, cerebral state monitor, patient state index, and lower oesophageal contractility monitor. The use of anaesthetic depth monitors allows the titration of anaesthetic drugs to maintain unconsciousness. DATA COLLECTION AND ANALYSIS At least two authors independently scanned abstracts, extracted data from the studies, and evaluated studies for risk of bias. We made attempts to contact all authors for additional clarification. We performed meta-analysis statistics in packages of the R language. MAIN RESULTS We included 160 studies with 54,109 enrolled participants; 53,713 participants started the studies and 50,034 completed the studies or data analysis (or both). We could not use 115 RCTs in meta-analytic comparisons because they had zero awareness events. We did not merge 27 of the remaining 45 studies because they had excessive clinical and methodological heterogeneity. We pooled the remaining 18 eligible RCTs in meta-analysis. There are 10 studies awaiting classification which we will process when we update the review.The meta-analyses included 18 trials with 36,034 participants. In the analysis of anaesthetic depth monitoring (either Bispectral Index or M-entropy) versus standard clinical and electronic monitoring, there were nine trials with 34,744 participants. The overall event rate was 0.5%. The effect favoured neither anaesthetic depth monitoring nor standard clinical and electronic monitoring, with little precision in the odds ratio (OR) estimate (OR 0.98, 95% confidence interval (CI) 0.59 to 1.62).In a five-study subset of Bispectral Index monitoring versus standard clinical and electronic monitoring, with 34,181 participants, 503 participants gave awareness reports to a blinded, expert panel who adjudicated or judged the outcome for each patient after reviewing the questionnaires: no awareness, possible awareness, or definite awareness. Experts judged 351 patient awareness reports to have no awareness, 87 to have possible awareness, and 65 to have definite awareness. The effect size favoured neither Bispectral Index monitoring nor standard clinical and electronic monitoring, with little precision in the OR estimate for the combination of definite and possible awareness (OR 0.96, 95% CI 0.35 to 2.65). The effect size favoured Bispectral Index monitoring for definite awareness, but with little precision in the OR estimate (OR 0.60, 95% CI 0.13 to 2.75).We performed three smaller meta-analyses of anaesthetic drugs. There were nine studies with 1290 participants. Wakefulness was reduced by ketamine and etomidate compared to thiopental. Wakefulness was more frequent than awareness. Benzodiazepines reduces awareness compared to thiopental, ketamine, and placebo., Also, higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness.We graded the quality of the evidence as low or very low in the 'Summary of findings' tables for the five comparisons.Most of the secondary outcomes in this review were not reported in the included RCTs. AUTHORS' CONCLUSIONS Anaesthetic depth monitors may have similar effects to standard clinical and electrical monitoring on the risk of awareness during surgery. In older studies comparing anaesthetics in a smaller portion of the patient sample, wakefulness occurred more frequently than awareness. Use of etomidate and ketamine lowered the risk of wakefulness compared to thiopental. Benzodiazepines compared to thiopental and ketamine, or higher doses of inhaled anaesthetics versus lower doses, reduced the risk of awareness.
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Affiliation(s)
- Anthony G Messina
- School of Management, University of Texas at DallasThe Alliance for Medical Management EducationBox 2331920 N. Coit RoadRichardsonTXUSA75080
| | - Michael Wang
- University of LeicesterClinical Psychology UnitLancaster RoadLeicesterUKLE1 7HA
| | - Marshall J Ward
- Dartmouth‐Hitchcock Medical Center1 Medical Center DrLebanonNHUSA03766
| | - Chase C Wilker
- ARUP LaboratoriesClinical Toxicology IIISalt Lake CityUTUSA
| | - Brett B Smith
- University of UtahUniversity of Utah School of MedicineSalt Lake CityUTUSA84112
| | - Daniel P Vezina
- University of UtahDepartment of Anesthesiology, Department of Internal Medicine, Division of CardiologySalt Lake CityUTUSA
- Veteran's AdministrationEchocardiography LaboratorySalt Lake CityUTUSA
| | - Nathan Leon Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUTUSA84132‐2304
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Total intravenous anaesthesia versus single-drug pharmacological antiemetic prophylaxis in adults. Eur J Anaesthesiol 2016; 33:750-60. [DOI: 10.1097/eja.0000000000000520] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Bischoff P, Rundshagen I, Schneider G. [Undesired awareness phenomena during general anesthesia: Evidence-based state of knowledge, current discussions and strategies for prevention and management]. Anaesthesist 2016; 64:732-9. [PMID: 26411583 DOI: 10.1007/s00101-015-0095-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient awareness during general anesthesia and the later recall of what happened during surgery can be experienced by patients as horrifying events that leave lasting mental trauma in the form of posttraumatic stress syndrome (PTSS). Awareness is related to a temporary insufficient depth of anesthesia. This phenomenon has been discussed for more than 20 years. According to randomized controlled studies, in the absence of risk factors awareness phenomena occur in 1-2 per 1000 operations involving general anesthesia (0.1-0.2%) and are classified as occasionally occurring critical events. An astonishing twist occurred elicited by the recent data from the 5th National Audit Project from Great Britain (NAP5) published in the British Journal of Anaesthesia and in Anaesthesia. The NAP5 evaluated patient reports of accidental awareness during general anesthesia (AAGA) in a multicenter manner in more than 2.7 million cases and indicated incidences of awareness of only 1:19,600, a frequency 20 times less than previously reported. These results gave rise to some controversy. It seems likely that, due to the absence of structured interviews, the NAP5 data only demonstrated the tip of the iceberg and may have vastly underestimated the real incidence of intraoperative awareness. The present overview summarizes the current knowledge about awareness. Furthermore, it addresses the question whether the awareness problem has been overestimated by evidence-based criteria or underestimated by the results of the NAP5. The responsibility for sufficient anesthesia in the clinical routine requires knowledge of awareness risks and potential sequelae. A formal recommendation from the German Society of Anesthesia and Intensive Care Medicine (DGAI) concerning awareness is not yet available; however, the recognition of evidence-based strategies in the management of anesthesia may minimize the occurrence of awareness and its sequelae.
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Affiliation(s)
- P Bischoff
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - I Rundshagen
- Praxisgemeinschaft Dupierry, Callesen, Rundshagen, Hamburg, Deutschland
| | - G Schneider
- Klinik für Anästhesiologie, HELIOS Klinikum Wuppertal, Klinikum der Universität Witten/Herdecke, Wuppertal, Deutschland
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27
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Zheng Q, Wang Q, Wu C, Wang Z, Ao H. Is hyperlipidemia a potential protective factor against intraoperative awareness in cardiac surgery? J Cardiothorac Surg 2016; 11:60. [PMID: 27068284 PMCID: PMC4828887 DOI: 10.1186/s13019-016-0454-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative awareness is a dreaded complication that leads to psychological sequelae such as posttraumatic stress disorder, especially in patients undergoing cardiac surgery. This study investigated the incidence of awareness among patients receiving cardiac surgery and sought to identify the risk factors contributing to intraoperative awareness. Methods Patients with informed consent undergoing cardiac surgery from June to September in 2012 were enrolled. At least one structured interview was performed postoperatively with the modified Brice Interview Questionnaire to identify intraoperative awareness as confirmed awareness, possible awareness, and no awareness. Confirmed awareness events reported by patients were classified into different categories with the Michigan Awareness Classification Instrument. The questionnaire results were combined with the patient medical records. A logistic regression model was used to analyze the risk factors that may have led to intraoperative awareness. Results An estimated 2136 patients were included, and 1874 patients completed at least one interview. 83 patients (4.4 %) were identified as possible or confirmed awareness, among which 46 (2.5 %) reported confirmed awareness. Patients who experienced confirmed awareness were mostly of Class 1 and 2, 15 and 24 patients respectively, which represented isolated auditory and tactile perceptions. And 11 patients reported feelings of distress intraoperatively. Hyperlipidemia was associated with intraoperative awareness (OR = 0.499, 95 % CI = 0.252–0.989, p = 0.043) and using chi-square test, however, no significance was found with logistic regression. Conclusion Patients undergoing cardiac surgery are at high risk for intraoperative awareness. Distress is a common feeling in patients with intraoperative awareness. Hyperlipidemia is a potential protective factor for intraoperative awareness in cardiac surgery.
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Affiliation(s)
- Qingshui Zheng
- Department of Anesthesiology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Anesthesiology, Ordos Central Hospital, Inner Mongolia Medical University, Inner Mongolia, China
| | - Chaoqun Wu
- Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhifa Wang
- Department of Anesthesiology, Ordos Central Hospital, Inner Mongolia Medical University, Inner Mongolia, China.
| | - Hushan Ao
- Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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Cascella M, Viscardi D, Schiavone V, Mehrabmi-Kermani F, Muzio MR, Forte CA, De Falco F, Barberio D, Cuomo A. A 7-Year Retrospective Multisource Analysis on the Incidence of Anesthesia Awareness With Recall in Cancer Patients: A Chance of Collaboration Between Anesthesiologists and Psycho-Oncologists for Awareness Detection. Medicine (Baltimore) 2016; 95:e2757. [PMID: 26844523 PMCID: PMC4748940 DOI: 10.1097/md.0000000000002757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although randomized controlled studies reported an incidence of anesthesia awareness with recall ∼1 to 2 per 1000 (0.1-0.2%), recent data from the NAP5 study showed an incidence of only 1:19,600. Although in a prospective study many tools for anesthesia awareness detection can be used, a retrospective analysis requires a careful collection of information.The aim of the study was to evaluate the incidence of anesthesia awareness with recall in a cohort of cancer patients through a multisource retrospective analysis, and the clinical description, including the psychological outcome, of the cases detected. We also tested whether our retrospective analysis would be improved by a routinely psycho-oncological assessment. As secondary endpoints we evaluated the use of depth of anesthesia monitoring over a large cohort of patients, and the correlation between the brain monitoring and the incidence of awareness.We have carried out a 7-year retrospective analysis in a large cohort of cancer patients on the incidence of awareness with recall during general anesthesia. Of 35,595 patients assessed for eligibility, 21,099 were studied. We analyzed all data from the operative rooms' database, the anesthesia records, and from the database of the surgical divisions. In addition we examined reports from psychologists and spontaneous reports to the quality team of the hospital.Two certain cases of awareness were detected, with an incidence of 1:10,550 (0.0095%). They occurred during elective surgery, in female patients without other risk factors. One case came from the report of a psychologist. In both episodes, brain monitoring was not applied and no long-term psychological sequelae were reported.Despite the limitations, our investigation suggests that the incidence of anesthesia awareness is very low, also in a specific cohort of patients, such as the cancer patients, and even when the depth of anesthesia monitoring is rarely used. The limitations caused by both the retrospective analysis and the absence of specific tools for direct awareness detection, such as structured interviews, can be filled with an effective postoperative psychological assessment which is often of routine in a cancer center. This observation could suggest the usefulness of inserting specific questions within the psychological tools commonly used by psycho-oncologists.
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Affiliation(s)
- Marco Cascella
- From the Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology Istituto Nazionale Tumori "Fondazione G. Pascale"- IRCCS, Naples, Italy (MC, DV, AC); Division of Anesthesia and Intensive Care, Hospital "Pineta Grande," Castel Volturno, Caserta, Italy (VS); Division of Neurosurgery, Hospital "Pineta Grande," Castel Volturno, Caserta, Italy (FM-K); Division of Infantile Neuropsychiatry, UOMI-Maternal and Infant Health, Asl NA 3 SUD, Torre del Greco, Naples, Italy (MRM); Psychology, Division of Pain Medicine, Department of Anesthesia, Endoscopy and Cardiology Istituto Nazionale Tumori "Fondazione G. Pascale"- IRCCS, Naples, Italy; Psychooncology, Department of Quality of Life, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy (FDF, DB)
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29
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Castellon-Larios K, Rosero BR, Niño-de Mejía MC, Bergese SD. The use of cerebral monitoring for intraoperative awareness. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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30
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The use of cerebral monitoring for intraoperative awareness☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644010-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Castellon-Larios K, Rosero BR, Niño-de Mejía MC, Bergese SD. Uso de monitorizacion cerebral para el despertar intraoperatorio. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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32
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Hernandez-Meza G, Izzetoglu M, Osbakken M, Green M, Izzetoglu K. Near-infrared spectroscopy for the evaluation of anesthetic depth. BIOMED RESEARCH INTERNATIONAL 2015; 2015:939418. [PMID: 26495317 PMCID: PMC4606411 DOI: 10.1155/2015/939418] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/23/2015] [Indexed: 01/30/2023]
Abstract
The standard-of-care guidelines published by the American Society of Anesthesiologists (ASA) recommend monitoring of pulse oximetry, blood pressure, heart rate, and end tidal CO2 during the use of anesthesia and sedation. This information can help to identify adverse events that may occur during procedures. However, these parameters are not specific to the effects of anesthetics or sedatives, and therefore they offer little, to no, real time information regarding the effects of those agents and do not give the clinician the lead-time necessary to prevent patient "awareness." Since no "gold-standard" method is available to continuously, reliably, and effectively monitor the effects of sedatives and anesthetics, such a method is greatly needed. Investigation of the use of functional near-infrared spectroscopy (fNIRS) as a method for anesthesia or sedation monitoring and for the assessment of the effects of various anesthetic drugs on cerebral oxygenation has started to be conducted. The objective of this paper is to provide a thorough review of the currently available published scientific studies regarding the use of fNIRS in the fields of anesthesia and sedation monitoring, comment on their findings, and discuss the future work required for the translation of this technology to the clinical setting.
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Affiliation(s)
- Gabriela Hernandez-Meza
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Meltem Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Mary Osbakken
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Michael Green
- Department of Anesthesiology, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, MS 310, Philadelphia, PA 19102, USA
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
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33
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The 9th International Symposium on Memory and Awareness in Anesthesia (MAA9). Br J Anaesth 2015. [DOI: 10.1093/bja/aev204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Mashour GA, Avidan MS. Intraoperative awareness: controversies and non-controversies. Br J Anaesth 2015; 115 Suppl 1:i20-i26. [PMID: 25735710 DOI: 10.1093/bja/aev034] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 01/17/2023] Open
Abstract
Intraoperative awareness, with or without recall, continues to be a topic of clinical significance and neurobiological interest. In this article, we review evidence pertaining to the incidence, sequelae, and prevention of intraoperative awareness. We also assess which aspects of the complication are well understood (i.e. non-controversial) and which require further research for clarification (i.e. controversial).
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Affiliation(s)
- G A Mashour
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - M S Avidan
- Washington University School of Medicine, St Louis, MO, USA
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35
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Errando CL. [Comments to the article "Spanish anesthesiologists approach on intraoperative awareness with explicit recall. Results of a national survey performed in 2011"]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:530-531. [PMID: 25053146 DOI: 10.1016/j.redar.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 03/29/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
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36
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Avidan MS, Sleigh JW. Beware the Boojum: the NAP5 audit of accidental awareness during intended general anaesthesia. Anaesthesia 2014; 69:1065-8. [PMID: 25204232 DOI: 10.1111/anae.12828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M S Avidan
- Department of Anesthesiology and Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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37
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Abstract
Awareness under anaesthesia is a rare but important phenomenon which has become a source of fear - and of fascination - to the public and anaesthetists alike. This article discusses the incidence, aetiology, sequelae and prevention of awareness.
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Affiliation(s)
- Edward Rule
- Medical Student, University College London, London
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38
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Escallier KE, Nadelson MR, Zhou D, Avidan MS. Monitoring the brain: processed electroencephalogram and peri‐operative outcomes. Anaesthesia 2014; 69:899-910. [DOI: 10.1111/anae.12711] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. E. Escallier
- Washington University School of Medicine Saint Louis Missouri USA
| | - M. R. Nadelson
- Washington University School of Medicine Saint Louis Missouri USA
| | - D. Zhou
- Washington University School of Medicine Saint Louis Missouri USA
| | - M. S. Avidan
- Washington University School of Medicine Saint Louis Missouri USA
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39
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Musialowicz T, Lahtinen P. Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0061-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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40
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Errando C, Aldecoa C. I. Awareness with explicit recall during general anaesthesia: current status and issues. Br J Anaesth 2014; 112:1-4. [DOI: 10.1093/bja/aet333] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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MacGregor K. A waking nightmare: how can we avoid accidental awareness during general anaesthesia? J Perioper Pract 2013; 23:185-90. [PMID: 24245360 DOI: 10.1177/175045891302300902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anaesthesia awareness is a terrifying prospect for any patient undergoing a surgical procedure and can cause considerable physical and psychological distress. Recommendations to reduce the risk of anaesthesia awareness include: undertaking a thorough preoperative assessment, ensuring that equipment has been checked, reducing drug error, consistent monitoring, and investment in safer technology. By implementing these recommendations it is hoped that patient safety and care can be improved during clinical anaesthesia.
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Affiliation(s)
- Kerry MacGregor
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, BH15 2JB.
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42
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Affiliation(s)
- M G Irwin
- University of Hong Kong, Hong Kong, China.
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43
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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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Prevention of intraoperative awareness with explicit recall: making sense of the evidence. Anesthesiology 2013; 118:449-56. [PMID: 23263014 DOI: 10.1097/aln.0b013e31827ddd2c] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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45
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Pandit JJ, Cook TM, Jonker WR, O'Sullivan E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Anaesthesia 2013; 68:343-53. [PMID: 23488832 DOI: 10.1111/anae.12190] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 12/21/2022]
Abstract
As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant and staff and associate specialist anaesthetist in the UK. The survey was designed to ascertain the number of new cases of accidental awareness that became known to them, for patients under their direct or supervised care, for a calendar year, and also to estimate how many cases they had experienced during their careers. The survey also asked about use of monitoring designed to measure the depth of anaesthesia. All local co-ordinators responsible for each of 329 hospitals (organised into 265 'centres') in the UK responded, as did 7125 anaesthetists (82%). There were 153 new cases of accidental awareness notified to respondents in 2011, an estimated incidence of 1:15 414, lower than the 1-2:1000 previously reported in prospective clinical trials. Almost half the cases (72, 47%) occurred at or after induction of anaesthesia but before surgery, with 46 (30%) occurring during surgery and 35 (23%) after surgery before full recovery. Awareness during surgery appeared to lead more frequently to pain or distress than at induction and emergence (62% vs 28% and 23%, respectively). Depth of anaesthesia monitors were available in 164 centres (62%), but routinely used by only 132 (1.8%) of anaesthetists. The disparity between the incidence of awareness as notified to anaesthetists and that reported in trials warrants further examination and explanation.
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Affiliation(s)
- J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.
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46
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Avidan MS, Mashour GA. II. The incidence of intraoperative awareness in the UK: under the rate or under the radar? Br J Anaesth 2013; 110:494-7. [DOI: 10.1093/bja/aet012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Pandit J, Cook T, Jonker W, O'Sullivan E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK †. Br J Anaesth 2013; 110:501-9. [DOI: 10.1093/bja/aet016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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48
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Russell IF. The ability of bispectral index to detect intra-operative wakefulness during total intravenous anaesthesia compared with the isolated forearm technique. Anaesthesia 2013; 68:502-11. [DOI: 10.1111/anae.12177] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- I. F. Russell
- Department of Anaesthesia; Hull Royal Infirmary; Hull; UK
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49
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Avidan MS, Mashour GA. The incidence of intra-operative awareness in the UK: under the rate or under the radar? Anaesthesia 2013; 68:334-8. [DOI: 10.1111/anae.12215] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. S. Avidan
- Department of Anesthesiology; Washington University School of Medicine; Saint Louis Missouri USA
| | - G. A. Mashour
- Department of Anesthesiology; University of Michigan; Ann Arbor Michigan USA
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50
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Wang J, Ren Y, Zhu Y, Chen JW, Zhu MM, Xu YJ, Tan ZM. Effect of penehyclidine hydrochloride on the incidence of intra-operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia. Anaesthesia 2012; 68:136-41. [DOI: 10.1111/anae.12092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 11/30/2022]
Affiliation(s)
- J. Wang
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - Y. Ren
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - Y. Zhu
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - J. W. Chen
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - M. M. Zhu
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - Y. J. Xu
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
| | - Z. M. Tan
- Department of Anaesthesiology; Fudan University; Shanghai Cancer Centre; Shanghai; China
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