Anaesthetic Awareness: A Past, Present and Future Challenge
Keywords:
MedicineAbstract
Anaesthetic awareness is a rare complication of general anaesthesia. Its occurrence is likely to be multifactorial, with young age, female sex, Chinese ethnicity, previous awareness, gestation, and pulmonary hypertension associated with a higher risk of awareness. Awareness is a distressing complication for patients, with 30% of patients who experience awareness developing psychiatric symptoms ranging from nightmares, flashbacks, and anxiety to post-traumatic stress. Therefore, attempts to monitor awareness are desirable. The aim of this short article is to look at past achievements and future challenges in detecting, monitoring, managing and avoiding awareness.
References
1 Warren, JC. Inhalation of ethereal vapour for the pre- vention of pain in surgical operations. Boston Med Surg J. 35, 363- 65 (1846).
2 Mainzer, J. Awareness, muscle relaxants and balanced anaesthesia. Can J Anesth.26.5, 386-393 (1979).
3 Lennmarken, C. Sandin, R. Neuromonitoring for aware- ness during surgery. Lancet. 363, 1747-1748 (2004).
4 Aceto, P. Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia. Br J Anaesth. 90,630-635 (2003).
5 Myles, P. et. al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised con- trolled trial. Lancet. 363, 1757-1763 (2004).
6 Ewart, L. Are you aware of awareness? J Periop Pract. 21,93-6 (2001).
7 Sandin, RH. Enlund, G. Samuelsson, P. Lennmarken, C. Awareness during anaesthesia: a prospective case study. Lancet. 355, 707–11 (2000).
8 Wennervirta, J. Ranta, SO. Hynynen, M. Awareness and recall in outpatient anesthesia. Anesth Analg 95, 72-77 (2002).
9 Sebel, P. et al. The incidence of awareness during anes- thesia: a multicenter United States study. Anesth Analg. 99, 833- 839 (2004).
10 Avidan, M. et al. Anesthesia awareness and the bispec- tral index. NEJM. 358, 1097–108(208).
11 Davidson, AJ et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg.100, 653–661 (2005).
12 Lopez ,H. et al. Intra-operative awareness in children: the value of an interview adapted to their cognitive abilities. Anaesth. 62, 778–89 (2007).
13 Andrade, J. Deeprose, C. Barker, I. Awareness and memory function during paediatric anaesthesia. Br J Anaesth. 100,389-396 (2008).
14 Pandit, J. Cook, T. Jonker, W. O’Sullivan, E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Anaesth. 68, 343-353 (2013).
15 MacGregor, K. A waking nightmare: How can we avoid accidental awareness during general anaesthesia? J Periop Pract. 23,185-90 (2013).
16 Davidson, AJ. et al. Awareness in children: a secondary analysis of five cohort studies. Anaesth. 66, 446-54 (2011).
17 Errando, C. et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 pa- tients. Br J Anaesth. 101,178-185 (2008).
18 Xu, L. Wu, A.S. Yue, Y. The incidence of intraoperative awareness during general anesthesia in China: a multi-center ob- servational study. Anaesthesiol Scand. 53, 873-882 (2009).
19 Sebel, P. et al. The incidence of awareness during anes- thesia: a multicenter United States study. Anesth Analg. 99, 833-839 (2004).
20 Osborne, G. Runciman, W. & Helps, S. Crisis manage- ment during anaesthesia: awareness and anaesthesia. Qual Saf Health Care .14, e16 (2005).
21 Radovanovic, D. & Radovanovic, Z. Awareness during general anaesthesia - implications of explicit intraoperative re- call.Eur Rev Med Pharmacol Sci. 15, 1085-9 (2011).
22 Niranjan, N. Wilson, I.Tutorial of the week: Awareness under anaesthesia 2008. Available from: www.aagbi.org/sites/ default/files/108-Awareness-under-anaesthesia.pdf [Accessed Novmeber 2014].
23 Ghoneim, M.M. Incidence of and risk factors for aware- ness during anaesthesia. Best Pract Res Clin Anaesthesiol. 21, 327- 343 (2007).
24 Moerman, N. Bonke, B.Oosting, J. Awareness and recall during general anaesthesia: Facts and feelings. Anesthesiol 79, 454-464 (1993).
25 Osterman, J. et al. Awareness under anesthesia and the development of post-traumatic stress disorder. Gen Hosp Psych 23, 198–204 (2001).
26 Lennmarken, C. & Sydsjo, G. Psychological consequenc- es of awareness and their treatment. Best Pract Res Clin Anaes- thesiol. 21, 357-367(2007).
27 Hardman, J. & Aitkenhead, A. Awareness during anaes- thesia. Continuing Education in Anaesth, Crit Care Pain. 5,183- 186 (2005).
28 Eger, E. Saidman, L. Brandstater, B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. An- esthesiol. 26.6,756-763 (1995).
29 Stevens, W. et al. Minimum alveolar concentrations (MAC) of isoflurane with and without nitrous oxide in patients of various ages. Anesthesiol. 42,197-200(1975).
30 de Wolff, M. Leather, H. Wouters, P. Effects of tramadol on minimum alveolar concentration (MAC) of isoflurane in rats. Brit J Anaesth. 83, 780-783(1999).
31 Sigl, J.C. & Chamoun, N.G. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 10, 392-404 (1994).
32 Song, D. Joshi, GP. White, PF. Titration of volatile anes- thetic using bispectral index facilitates recovery after ambulato- ry anesthesia. Anesthesiol. 87, 842-848 (1997).
33 Dressler, O. Schneider, G. Stockmanns, G. Kochs, E. Awareness and the EEG power spectrum: analysis of frequencies. Brit J Anaesth 93, 806–809 (2004).
34 Chiu, C.L. Ong, G. Majid, A. A. Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass. Anaestha Intensive Care. 35, 342–347
(2007).
35 Schneider, G. et al. Detection of awareness in surgical patients with EEG-based indices bispectral index and patient state index. Brit J Anaesth. 91: 329-335 (2003).
36 Bruhn, J. et al. Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia com- pared with a standard practice group: a multicentre study. Brit J Anaesth. 94, 63–69 (2005).
37 Zohar, E. et al. Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures. Can J Anesth. 53, 20–25 (2006).
38 Morioka, N. et al. Ketamine causes a paradoxical in- crease in the bispectral index. Anesthesiol. 87,A502 (1997).
39 Puri, G.D. Paradoxical changes in bispectral index dur- ing nitrous oxide administration. British J Anaesth. 86,141-142 (2001).
40 National Institute for Health and Care Excellence. Depth of anaesthesia monitors (E-Entropy, BIS and Nar- cotrend) 2012; DG6. http://www.nice.org.uk/nicemedia/ live/13965/61547/61547.pdf [Accessed November 2014].
41 Plourde, G. Auditory evoked potentials. Best Pract Res Clini Anaesthesiol. 20,129–139 (2006).
42 Aceto, P. et al. Relationship between awareness and middle latency auditory evoked responses during surgical anaes- thesia. Brit J Anaesth. 90, 630-635 (2003).
43 Osborne, G. Bacon, A. Runciman, W. Helps, S.Crisis management during anaesthesia: awareness and anaesthesia. Qual Saf Health Care. 14,16-21 (2005).
44 Lafleur, L. Discourse on Method and Meditations. New York :The Liberal Arts Press (1960).
45 Nidditch, P. Locke, John. (1690–4). An Essay Concerning Human Understanding. Oxford: Oxford University Press (1979). 46 Pandit J. National Audit Project 5, Accidental awareness during general anaesthesia partnership of RCOA/AAGBI. Pre- sented at The Royal College of Anaesthetists Annual Congress, London 2012. http://webcast.rcoa.ac.uk/Mediasite/Play/5d- 3f2ae3788544b292aac63e3d297a761d?cata [Accessed Noveme- ber 2014].
47 Avidan, M, Mashour, G.II. The incidence of intraopera- tive awareness in the UK: under the rate or under the radar? Brit J Anaesth. 110, 494-497 (2013).
48 Pryor, K. O., & Root, J. C. III. Intraoperative awareness: a pound of prevention, an ounce of cure? Brit J Anaesth. 111, 529- 531 (2013).
49 Panditt, J.J. et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth.113, 549-59 (2014).
2 Mainzer, J. Awareness, muscle relaxants and balanced anaesthesia. Can J Anesth.26.5, 386-393 (1979).
3 Lennmarken, C. Sandin, R. Neuromonitoring for aware- ness during surgery. Lancet. 363, 1747-1748 (2004).
4 Aceto, P. Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia. Br J Anaesth. 90,630-635 (2003).
5 Myles, P. et. al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised con- trolled trial. Lancet. 363, 1757-1763 (2004).
6 Ewart, L. Are you aware of awareness? J Periop Pract. 21,93-6 (2001).
7 Sandin, RH. Enlund, G. Samuelsson, P. Lennmarken, C. Awareness during anaesthesia: a prospective case study. Lancet. 355, 707–11 (2000).
8 Wennervirta, J. Ranta, SO. Hynynen, M. Awareness and recall in outpatient anesthesia. Anesth Analg 95, 72-77 (2002).
9 Sebel, P. et al. The incidence of awareness during anes- thesia: a multicenter United States study. Anesth Analg. 99, 833- 839 (2004).
10 Avidan, M. et al. Anesthesia awareness and the bispec- tral index. NEJM. 358, 1097–108(208).
11 Davidson, AJ et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg.100, 653–661 (2005).
12 Lopez ,H. et al. Intra-operative awareness in children: the value of an interview adapted to their cognitive abilities. Anaesth. 62, 778–89 (2007).
13 Andrade, J. Deeprose, C. Barker, I. Awareness and memory function during paediatric anaesthesia. Br J Anaesth. 100,389-396 (2008).
14 Pandit, J. Cook, T. Jonker, W. O’Sullivan, E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Anaesth. 68, 343-353 (2013).
15 MacGregor, K. A waking nightmare: How can we avoid accidental awareness during general anaesthesia? J Periop Pract. 23,185-90 (2013).
16 Davidson, AJ. et al. Awareness in children: a secondary analysis of five cohort studies. Anaesth. 66, 446-54 (2011).
17 Errando, C. et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 pa- tients. Br J Anaesth. 101,178-185 (2008).
18 Xu, L. Wu, A.S. Yue, Y. The incidence of intraoperative awareness during general anesthesia in China: a multi-center ob- servational study. Anaesthesiol Scand. 53, 873-882 (2009).
19 Sebel, P. et al. The incidence of awareness during anes- thesia: a multicenter United States study. Anesth Analg. 99, 833-839 (2004).
20 Osborne, G. Runciman, W. & Helps, S. Crisis manage- ment during anaesthesia: awareness and anaesthesia. Qual Saf Health Care .14, e16 (2005).
21 Radovanovic, D. & Radovanovic, Z. Awareness during general anaesthesia - implications of explicit intraoperative re- call.Eur Rev Med Pharmacol Sci. 15, 1085-9 (2011).
22 Niranjan, N. Wilson, I.Tutorial of the week: Awareness under anaesthesia 2008. Available from: www.aagbi.org/sites/ default/files/108-Awareness-under-anaesthesia.pdf [Accessed Novmeber 2014].
23 Ghoneim, M.M. Incidence of and risk factors for aware- ness during anaesthesia. Best Pract Res Clin Anaesthesiol. 21, 327- 343 (2007).
24 Moerman, N. Bonke, B.Oosting, J. Awareness and recall during general anaesthesia: Facts and feelings. Anesthesiol 79, 454-464 (1993).
25 Osterman, J. et al. Awareness under anesthesia and the development of post-traumatic stress disorder. Gen Hosp Psych 23, 198–204 (2001).
26 Lennmarken, C. & Sydsjo, G. Psychological consequenc- es of awareness and their treatment. Best Pract Res Clin Anaes- thesiol. 21, 357-367(2007).
27 Hardman, J. & Aitkenhead, A. Awareness during anaes- thesia. Continuing Education in Anaesth, Crit Care Pain. 5,183- 186 (2005).
28 Eger, E. Saidman, L. Brandstater, B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. An- esthesiol. 26.6,756-763 (1995).
29 Stevens, W. et al. Minimum alveolar concentrations (MAC) of isoflurane with and without nitrous oxide in patients of various ages. Anesthesiol. 42,197-200(1975).
30 de Wolff, M. Leather, H. Wouters, P. Effects of tramadol on minimum alveolar concentration (MAC) of isoflurane in rats. Brit J Anaesth. 83, 780-783(1999).
31 Sigl, J.C. & Chamoun, N.G. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 10, 392-404 (1994).
32 Song, D. Joshi, GP. White, PF. Titration of volatile anes- thetic using bispectral index facilitates recovery after ambulato- ry anesthesia. Anesthesiol. 87, 842-848 (1997).
33 Dressler, O. Schneider, G. Stockmanns, G. Kochs, E. Awareness and the EEG power spectrum: analysis of frequencies. Brit J Anaesth 93, 806–809 (2004).
34 Chiu, C.L. Ong, G. Majid, A. A. Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass. Anaestha Intensive Care. 35, 342–347
(2007).
35 Schneider, G. et al. Detection of awareness in surgical patients with EEG-based indices bispectral index and patient state index. Brit J Anaesth. 91: 329-335 (2003).
36 Bruhn, J. et al. Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia com- pared with a standard practice group: a multicentre study. Brit J Anaesth. 94, 63–69 (2005).
37 Zohar, E. et al. Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures. Can J Anesth. 53, 20–25 (2006).
38 Morioka, N. et al. Ketamine causes a paradoxical in- crease in the bispectral index. Anesthesiol. 87,A502 (1997).
39 Puri, G.D. Paradoxical changes in bispectral index dur- ing nitrous oxide administration. British J Anaesth. 86,141-142 (2001).
40 National Institute for Health and Care Excellence. Depth of anaesthesia monitors (E-Entropy, BIS and Nar- cotrend) 2012; DG6. http://www.nice.org.uk/nicemedia/ live/13965/61547/61547.pdf [Accessed November 2014].
41 Plourde, G. Auditory evoked potentials. Best Pract Res Clini Anaesthesiol. 20,129–139 (2006).
42 Aceto, P. et al. Relationship between awareness and middle latency auditory evoked responses during surgical anaes- thesia. Brit J Anaesth. 90, 630-635 (2003).
43 Osborne, G. Bacon, A. Runciman, W. Helps, S.Crisis management during anaesthesia: awareness and anaesthesia. Qual Saf Health Care. 14,16-21 (2005).
44 Lafleur, L. Discourse on Method and Meditations. New York :The Liberal Arts Press (1960).
45 Nidditch, P. Locke, John. (1690–4). An Essay Concerning Human Understanding. Oxford: Oxford University Press (1979). 46 Pandit J. National Audit Project 5, Accidental awareness during general anaesthesia partnership of RCOA/AAGBI. Pre- sented at The Royal College of Anaesthetists Annual Congress, London 2012. http://webcast.rcoa.ac.uk/Mediasite/Play/5d- 3f2ae3788544b292aac63e3d297a761d?cata [Accessed Noveme- ber 2014].
47 Avidan, M, Mashour, G.II. The incidence of intraopera- tive awareness in the UK: under the rate or under the radar? Brit J Anaesth. 110, 494-497 (2013).
48 Pryor, K. O., & Root, J. C. III. Intraoperative awareness: a pound of prevention, an ounce of cure? Brit J Anaesth. 111, 529- 531 (2013).
49 Panditt, J.J. et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth.113, 549-59 (2014).
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2015-01-01
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Shanahan, D. (2015). Anaesthetic Awareness: A Past, Present and Future Challenge. Trinity Student Medical Journal , 16(1), Page 36–42. Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1873
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