Anaesthetic interventions for prevention of awareness during surgery

Messina, Anthony G.; Wang, Michael; Ward, Marshall J; Wilker, Chase; Smith, Brett B; Vézina, Daniel P.; Pace, Nathan L.

doi:10.1002/14651858.cd007272.pub2

Cited by 49 publications

(40 citation statements)

References 454 publications

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“…Averaging across the data from these trials gives an incidence of 0.25% for definite AWR and an additional 0.32% of patients having possible AWR. This is corroborated by an incidence of 0.44% in a recent meta-analysis that included randomized trials focused on either anesthetic regimens or anesthetic depth monitors (but not necessarily specifically focused on AWR detection) [7].…”

Section: Introductionmentioning

confidence: 74%

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

et al. 2020

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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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Section: Introductionmentioning

confidence: 74%

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

et al. 2020

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“…The term awareness is used when patients have postoperative recall of events or experiences during surgery, while the term wakefulness is reserved for patients who become conscious during surgery without postoperative memory of the period of consciousness [15]. BIS index monitoring allows measurement of the anesthesia depth and in a randomized controlled trial it reduced the risk of awareness by 82%, with a routine cost of USD 16 per use [16].…”

Section: Discussionmentioning

confidence: 99%

Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping?

et al. 2018

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Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm. Surgical treatment was performed with the head resting on a gel cushion horseshoe; aneurysm clipping was achieved without wakefulness or awareness and the patient had a good recovery.

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“…A systematic review examining the effectiveness of various anesthetic interventions to prevent intraoperative awareness found very low-quality evidence that benzodiazepines reduce awareness compared with thiopental, ketamine, and placebo. 24 When examining the four included studies, the evidence of effect becomes questionable. The earliest study compared the effect of 2 mgÁkg -1 of ketamine with 30 mg diazepam and supplemental nitrous oxide on the incidence of awareness in 26 parturients undergoing forceps delivery: 4/13 patients experienced awareness with ketamine while none did with diazepam.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepine administration during adult cardiac surgery: a survey of current practice among Canadian anesthesiologists working in academic centres

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Belley‐Côté

Devereaux

et al. 2017

Can J Anesth/J Can Anesth

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Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L'administration de benzodiazépines pendant la chirurgie cardiaque chez l'adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire.

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Anaesthetic interventions for prevention of awareness during surgery

Cited by 49 publications

References 454 publications

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping?

Benzodiazepine administration during adult cardiac surgery: a survey of current practice among Canadian anesthesiologists working in academic centres

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