Peri‐operative dreaming in paediatric patients who receive suxamethonium

Abstract

1 3 prospective .mdJ is described of peri-operative dreaming in 144 paediatric patients uged 5-14 years who received suxaniethunium .f.r c h j~ case surgery. No care of awarene.w WNS elicited. One group received pretreatment with 80 niglkg ruhocxrurinc. The incidence of dreaming in the 72 patients who were not pretreated was 16.7% compared with 2.8% in the putienfs pretreated with tubocurarine. This ddermce is statistic~ally sign$cant. The use of an intermittent suxaniethonium techniqiw g i w s m high incidence of dreaming which may be roused by muscle spindle discharge that produce.r cerehral orozrsul. Pretreatnient IcLith u non-depobrising ugent decreases this risk of dreaming. Key wordsC'ouiplicutions; dreaming. Nc~urornii.sciilar reln.xnnts; suxanicthoniuni.There have been marly studies of dreaming and awareness during anaesthesia in adults, but few in children. Hobbs P I ul.' performed a prospective study of 373 children aged 5-16 years who were anaesthetised using the 'Liverpool technique' of paediatric anaesthesia (nitrous oxide/ oxygcn/niusclc relaxant). A much higher incidence of dreaming was observed in day case patients who had received suxamethonium than in any other single group. A large synchronoub afferent stimulus from muscle spindle discharge after suxamethonium administration has been implicated in the production of an arousal-type electroencephalograph (EEG) pattern in adults and children; this pattern can be abolished by prctrcatment with a nondepolarising muscle relaxant.' The purpose of the present study was to detcrminc whcther pretreatment with a nondepolarising relaxant would rcsult in a reduction in the incidence ot' dreaming in children who received suxamc thoni uni . MethodA prospective study was carried out on 144 patients (84 male) agcd 5 14 years. who underwent day case surgery for which suxamcthonium was indicated clinically. The patients received either no preniedication, 'Ponstan Mix' (a mixture o f IrirnepraLine. mefenamic acid and atropine) or pethidine and atropine. They were allocatcd into one of two groups depending on their datc of birth. Patients with an even birth date received prctreatmcnt with 80 pglkg tubocurarinc one minute before induction of anaesthesia; those with an odd birth date received no pretrcatnicnt. A standard anaesthetic was used, which consisted of an induction dose of thiopentone 5 mglkg, atropine 20 pg:'kg, suxamethonium 1.5 ingikg and tracheal intubation. Thc patients' lungs were ventilated manually using an Ayrc's T-piece with the Jackson-Rees modification with a mixture of 70% nitrous oxide and 30% oxygen; increments of suramethonium were given as required during the proccdure. Details of the patient, anaesthetic, opcration, prcSence or absence of fasciculations at induction and degree o f intra-operative movement (none, slight. inoderate) werc rccorded by the anaesthetist.One obscrver (who was unaware of the pretreatment details) interviewed the child on return to the ward. before dischargc. A standard questionnaire ( Table 1 ) modified fi-om Brice...

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

“…memory strategies to retrieve information); • the avoidance of a first interview that could help a child elaborate a more coherent and structured representation of the events that took place during the pre-, intraand postoperative periods. Accordingly, authors who conducted only an early postoperative interview failed to detect intra-operative awareness in children [9,10,22]. Nevertheless, the present study failed to demonstrate a strong effect of the second interview, as only one of the 11 children was detected at the second interview.…”

“…Heard people talking. 10 Felt as if his arm was moving and jiggling. Felt no pain and was not worried.…”

“…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'.…”

“…Three studies performed 19 and 34 years ago furnished conflicting results [8][9][10]. McKie and Thorp [8] reported an alarming 5% incidence of awareness among 202 school-aged children who underwent elective and emergency surgery (without a standardised anaesthetic technique), whereas Hobbs et al [9] and Sullivan et al [10] did not describe any cases of awareness among 120 and 144 children, respectively, who participated in intravenous induction of anaesthesia without volatile agents for maintenance. In a very recent study on 864 children, in which modern techniques were applied for anaesthetic management [11], the incidence of awareness was reported to be 0.8%.…”

Awareness During Anesthesia in Children: A Prospective Cohort Study

“…This technique, known as the Liverpool technique, has a frequent incidence of awareness and has since been abandoned. In 1988, two studies also using the Liverpool technique investigated the incidence of dreaming and awareness in children (8,9). No cases of awareness were recorded.…”