Awareness under general anaesthesia

The Evaluation of YouTube™ Videos Pertaining to Intraoperative Anaesthesia Awareness: A Reliability and Quality Analysis

Aim The objective of this study was to evaluate the reliability and quality of YouTube™ (Google, Inc., Mountain View, CA) videos pertaining to anaesthesia awareness. Methods We evaluated the most commonly viewed 100 videos pertaining to anaesthesia awareness. The YouTube™ videos' image type, qualification of the uploaders, video content, video length in minutes, upload time, time since upload, total view count, daily view count and comment and like counts were recorded. The quality of the YouTube™ videos was evaluated using the Global Quality Scale (GQS), and the reliability was determined using the modified DISCERN scale. Results Of all videos, 34 (34%) were uploaded directly by physicians, 16 (16%) by patients, 14 (14%) by health channels, 13 (13%) by TV shows and 23 (23%) by others. The mean video length was 11.48±11.96 minutes. The average DISCERN score was 4.47±0.58 in the professional and 3.28±0.65 in the non-professional video group (p<0.001). The mean GQS score was 4.47±0.52 in the professional and 3.35±0.67 in the non-professional video group (p<0.001). Conclusion The results of this study indicate that a significant portion of the YouTube™ videos pertaining to anaesthesia awareness were uploaded directly by physicians or by health channels. Physicians and professional health institutions should be promoted to provide accurate and more reliable videos to direct patients to the right solutions for their problems. YouTube™ videos should be subjected to supervision before they can be publicly viewed.

Unintended intraoperative awareness: An analysis of Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai)

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.

Influence of Isoflurane on Immediate-Early Gene Expression

Background: Anterograde amnesia is a hallmark effect of volatile anesthetics. Isoflurane is known to affect both the translation and transcription of plasticity-associated genes required for normal memory formation in many brain regions. What is not known is whether isoflurane anesthesia prevents the initiation of transcription or whether it halts transcription already in progress. We tested the hypothesis that general anesthesia with isoflurane prevents learning-induced initiation of transcription of several memory-associated immediate-early genes (IEGs) correlated with amnesia; we also assessed whether it stops transcription initiated prior to anesthetic administration.

Methods: Using a Tone Fear Conditioning paradigm, rats were trained to associate a tone with foot-shock. Animals received either no anesthesia, anesthesia immediately after training, or anesthesia before, during, and after training. Animals were either sacrificed after training or tested 24 h later for long-term memory. Using Cellular Compartment Analysis of Temporal Activity by Fluorescence in situ Hybridization (catFISH), we examined the percentage of neurons expressing the IEGs Arc/Arg3.1 and Zif268/Egr1/Ngfi-A/Krox-24 in the dorsal hippocampus, primary somatosensory cortex, and primary auditory cortex.

Results: On a cellular level, isoflurane administered at high doses (general anesthesia) prevented initiation of transcription, but did not stop transcription of Arc and Zif268 mRNA initiated prior to anesthesia. On a behavioral level, the same level of isoflurane anesthesia produced anterograde amnesia for fear conditioning when administered before and during training, but did not produce retrograde amnesia when administered immediately after training.

Conclusion: General anesthesia with isoflurane prevents initiation of learning-related transcription but does not stop ongoing transcription of two plasticity-related IEGs, Arc and Zif268, a pattern of disruption that parallels the effects of isoflurane on memory formation. Combined with published research on the effects of volatile anesthetics on memory in behaving animals, our data suggests that different levels of anesthesia affect memory via different mechanisms: general anesthesia prevents elevation of mRNA levels of Arc and Zif268 which are necessary for normal memory formation, while anesthesia at lower doses affects the strength of memory by affecting levels of plasticity-related proteins.