Peri‐operative dreaming and awareness in children

Hobbs, Adrian J.; Bush, Gordon H.; Downham, D. Y.

doi:10.1111/j.1365-2044.1988.tb06687.x

Cited by 37 publications

(35 citation statements)

References 8 publications

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“…McKie and Thorp regarded awareness as 'definite' when the postoperative recall of facts had 'an obvious correlation with events occurring or spoken during the procedure' [8]. In the second and third studies, no clear definition was given [9,10], whereas in the most recent publication, Davidson Details of the intra-operative sensations, emotions and cognition. ................................................................................................................................................................................................................... Ó 2007 The Authors et al [11] categorised the awareness as 'awareness' and 'possible awareness'.…”

Section: Methodological Considerationsmentioning

confidence: 99%

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

et al. 2007

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SummaryIntra-operative awareness in paediatric patients has been little studied for many years because of the difficulties in relying on children's testimony. Earlier questionnaires used to detect this complication were not adapted to children's language and memory capacities. By using a qualitative method, a semi-structured in-depth interview adapted to their cognitive abilities, we have now conducted a prospective evaluation of the incidence and risk factors for intra-operative awareness in children undergoing general anaesthesia. Data were obtained from interviews with 410 children (aged 6-16 years) which were conducted within 36 h of general anaesthesia for elective or emergency surgery. One month after surgery, 293 of these patients were interviewed again. Three independent adjudicators classified each potential case of awareness. We considered awareness to include both the 'confirmed awareness' and the 'possible awareness' cases. The accuracy of the children's recall was calculated. The relationship between their awareness and the anaesthesia management was examined. There were five cases of confirmed awareness, and six cases of possible awareness. The incidence of confirmed awareness was 1.2%, but when the possible cases were also considered, the overall incidence of this complication was as high as 2.7% (95% confidence interval, 1.4-5.0%). The only predictive factor identified was the multiple manoeuvres with which the airways were secured (odds ratio, 8.4; 95% confidence interval, 2.4-29.07%). The present study confirms the existence of intra-operative awareness in the paediatric population. The application of a semi-structured in-depth interview adapted to the cognitive capacities of the children appears to enhance the detection of awareness in this population.

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Section: Methodological Considerationsmentioning

confidence: 99%

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

et al. 2007

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“…Liverpool-Technik) oder unter alleiniger hochdosierter Opioidgabe [25,44] ein häufiges Phänomen. So berichteten 23 von 120 Kindern, die lediglich mit Lachgas und Opioid anästhe-siert wurden, über "Träume" während der Operation [26]. Mit der Verwendung volatiler Anästhetika oder Propofol ist dies seltener geworden.…”

Section: Bewusste Wahrnehmung Ohne Schmerzenunclassified

“…B. BIS) sehr schwierig. Es kann durchaus sein, dass Awareness hier sehr viel häufiger ist, wir sie aber nicht erkennen können und darum fortfahren, ungenügende Anästhesietechniken zu verwenden.Nach einer Anästhesie, in der lediglich Lachgas und Opioid verabreicht wurden, berichteten 19 der Kinder über "Träu-me"[26]. Lachgas und Opioid allein entsprechen heute nicht mehr der gängigen Praxis.…”

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Awareness

Jöhr

2006

Anaesthesist

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Intraoperative awareness has been reported to occur in 0.8-5.0% of paediatric patients undergoing anaesthesia and, therefore, seems to be more common than in adults (incidence 0.1-0.2%). In adult patients, the consequences of intraoperative awareness are well known and can be severe, in children, however, they have not yet been adequately studied. The causes for intraoperative awareness can be divided into three broad categories: First, no or only a light anaesthetic is given on purpose, second, an insufficient dose of an anaesthetic is given inadvertently, third, there is equipment malfunction or the anaesthesiologist makes an error. Unfortunately, especially in young children, painful interventions are still performed without adequate analgesia, e.g. awake intubation or fracture manipulation under midazolam sedation alone. The key issue is, however, that pharmacokinetics and pharmacodynamics change enormously from the 500 g preterm baby to the adolescent patient. Adequate dosing is much more difficult in paediatric patients compared to standard adult surgical patients. Solid knowledge of the pharmacokinetic and pharmacodynamic characteristics of commonly used drugs in different paediatric age groups, as well as aiming for perfection in daily care will help to reduce the incidence of awareness. Methods for monitoring the depth of hypnosis, e.g. the bispectral index, will be used increasingly, at least in children above 1 year of age. In addition to clinical parameters, they will hopefully help to further reduce the incidence of intraoperative awareness.

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“…Wachheit in Narkose wird bei Erwachsenen mit einer Inzidenz von 0,1-0,2% angegeben [66,103].Bei Kindern liegen älte-re Berichte vor, nach denen Wachheit mit einer Frequenz von 5% bei 7-bis 14-Jäh-rigen beobachtet wurde [76].Spätere Untersuchungen haben das allerdings nicht bestätigen können [44,85]. Der Verzicht auf volatile Anästhetika erhöht bei Erwachsenen das Risiko intraoperativer Wachheit [29].Es ist vollkommen unklar, ob das auch bei Kindern zutrifft.…”

Section: Wachheit In Narkoseunclassified

Total intraven�se An�sthesie

Strauß

Giest

2003

Der Anaesthesist

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Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatri...

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Peri‐operative dreaming and awareness in children

Cited by 37 publications

References 8 publications

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

Awareness

Total intraven�se An�sthesie

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