BackgroundIncreased 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 resultsThis 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.ConclusionsThe 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.

BackgroundIn-hospital falls may result in serious clinical adverse consequences, but the effects of anesthesia in the occurrence of postoperative falls are still undetermined. Anesthesia may theoretically cause postoperative falls due to the residual pharmacologic and neuromuscular blocking effects of anesthetics. We retrospectively reviewed events of in-hospital falls occurred after anesthesia management to identify the incidence and risk factors of postanesthesia falls.MethodsWe reviewed the postanesthesia visit of patients received anesthesia in the Hualien Buddhist Tzu Chi General Hospital from January 2009 to December 2013. Falls happened within 24 h after anesthesia were recorded. The Poisson regression model was used for simultaneous analysis of the association between incidence proportion of postanesthesia falls and the potential risk factors.ResultsA total of 60,796 inpatients received anesthesia management over the past 5 years, and ten patients fell within 24 h after anesthesia. All cases happened in the general wards. Falls occurred more often at the bedside, presence of caregivers, and during the daytime. Patients underwent regional anesthesia, and old age significantly increased the risk of postanesthesia falls, while differences in gender and ASA physical status did not affect the occurrence of postanesthesia falls.ConclusionsThe overall incidence proportion of postanesthesia falls is 1.6 cases per 10,000 patients (95 % CI 0.006 to 0.026 %) over a 24-h observation period. Falls are more commonly happened during the less expected periods after operation and are increased in the elderly and patients received regional anesthesia. This study highlights that more comprehensive clinical practice guidelines for postoperative care should be exercised to prevent the in-hospital falls.

BackgroundLingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA) or endotracheal (ETGA) general anesthesia in a single center experience.Methods and resultsAll surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio) from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314), patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002) and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001). Patient gender, anesthesia technique used, and airway device type (LMA or ETGA) did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002) developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03–28.70).ConclusionThe overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.