Intraoperative Awareness during General Anesthesia: Experience in 200 Patients in “185’s Hospital for Emergency Surgeries and Burn”. (An Observational Questionnaire-based Study)
DOI:
https://doi.org/10.3889/oamjms.2020.4453Keywords:
Intraoperative awareness, General anesthesia, Emergency operations, Brice questionnaireAbstract
BACKGROUND: General anesthesia (GA) is a complex state of hypnosis, amnesia, and suppression of stress response to stimuli and production of a quiet surgical field. Awareness under GA considered as unexpected and undesirable complication which can be source of pain and torture for many individuals after surgery.
AIM: The aim of the study was to evaluate the incidence of intraoperative awareness during general anesthesia in emergency operations using Brice questionnaire.
METHODS: Two hundred patients were included and undergone emergency operations under GA at Cairo University’s Hospitals. Intravenous induction then inhalational maintenance of anesthesia with muscle relaxant was commenced, basic vital signs were monitored and kept within normal range. Depth of anesthesia was manipulated and kept adequate intraoperatively according to patient’s clinical status. At the end of surgery, patients were fully reversed and extubated fully awake then transferred to the recovery room, then data were collected.
RESULTS: Data analysis showed 110 (55%) men and 90 (45%) women. Two hours postoperatively, one patient (0.5%) reported intraoperative awareness, while 199 patients (99.5%) remembered nothing intraoperatively.
CONCLUSION: The incidence of intraoperative awareness in our emergency hospital is relatively fair and clinical evaluation of anesthesia depth is an effective measure to detect and prevents intraoperative awareness.
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Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. 5th national audit project (NAP5) on accidental awareness during general anaesthesia: Protocol, methods, and analysis of data. Br J Anaesth 2014;113(4):540-8. https://doi.org/10.1093/bja/aeu312 PMid:25204695
Tempe DK. In seach of a reliable a warness monitors. Anesth Analg 2001;92(4):801-4. PMid:11273904
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999;89(3):652-8. https://doi.org/10.1093/bja/aeu312 PMid:10475299
Ghoneim MM. Awareness during anesthesia. Anesthesiology 2000;92(2):597-602. PMid:10691248
Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR, Ramachandran SK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: A randomized comparative effectiveness trial. Anesthesiology 2012;117(4):717-25. https://doi.org/10.1213/ane.0b013e318281e9ad PMid:22990178
Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, et al. Prevention of intra operative awareness in a high-risk surgical population. N Engl J Med 2011;365(7):591-600.PMid:21848460
Sanders RD, Tononi G, Laureys S, Sleigh JW. Unresponsiveness versus unconsciousness. Anesthesiology 2012;116(4):946-59. https://doi.org/10.1097/aln.0b013e318249d0a7 PMid:22314293
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84(1):6-10. PMid:10740539
Mashour GA, Esaki RK, Tremper KK, Glick DB, O’Connor M, Avidan MS. A novel classification instrument for intraoperative awareness events. Anesth Analg 2010;110(3):813-5. https://doi.org/10.1213/ane.0b013e3181b6267d PMid:19713251
Sebel BS, Bowdle A, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, et al. The incidence of awareness during anesthesia: A multicentrer United States Study. Anesth Analg 2004;99(3):833-9. https://doi.org/10.1213/01.ane.0000130261.90896.6c PMid:15333419
Ghoneim MM, Weiskopf, Richard B. Awaerness during anesthesia clinical concept and commentary. Anesthesiology 2000;92(2):597. PMid:10691248
Mashour GA, Tremper KK, Avidan MS. Protocol for the “Michigan Awareness Control Study”: A prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness. BMC Anesthesiol 2009;9:7. https://doi.org/10.1186/1471-2253-9-7 PMid:19891771
Morimoto Y, Nogami Y, Harada K, Tsubokawa T, Masui K. Awareness during anesthesia: The results of a questionnaire survey in Japan. J Anesth 2011;25(1):72-7. https://doi.org/10.1007/s00540-010-1050-y PMid:21153846
Xu L, Wu AS, Yue Y. The incidence of intra-operative awareness during general anesthesia in China: A multi-center observational study. Acta Anaesthesiol Scand 2009;53(7):873-82. https://doi.org/10.1111/j.1399-6576.2009.02016.x PMid:19496761
Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: A review of reported cases in the literature. Anesth Analg 2009;108(2):527-35. https://doi.org/10.1213/ane.0b013e318193c634 PMid:19151283
Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, et al. Anesthesia awareness and the bispectral index. N Engl Med 2008;358(11):1097-8. https://doi.org/10.1213/01.ane.0000130261.90896.6c PMid:18337600
Mahla ME, Black S, Cucchiara RF. Neurologic monitoring. In: Miller RD, editor. Anaesthesia. 6th ed., Vol. 38. New York: Churchill Livingstone; 2005. p. 1511-50.
Ye Z, Guo QL, Zheng H. Investigation and analysis of the incidence of awareness during general anesthesia. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2008;33(6):533-6. PMid:18600003
Pollard RJ, Coyle JP, Gilbert RL, Beck JE. Intraoperative awareness in a regional medical system: A review of 3 years’ data. Anesthesiology 2007;106(2):269-74. PMid:17264720
Mashour GA, Wang LY, Turner CR, Vandervest JC, Shanks A, Tremper KK. A retrospective study of intraoperative awareness with methodological implications. Anesth Analg 2009;108(2):521-6. https://doi.org/10.1097/00000542-200702000-00014 PMid:19151282
Mashour GA, Kent C, Picton P, Ramachandran SK, Tremper KK, Turner CR, et al. Assessment of intraoperative awareness with explicit recall: A comparison of 2 methods. Anesth Analg 2013;116(4):889-91. https://doi.org/10.3410/f.718775534.793505509 PMid:23460567
Errando CL, Sigl JC, Robles M, Calabuig E, Garcia J, Arocas F, et al. Awareness with recall during general anaesthesia: A prospective observational evaluation of 4001 patients. Br J Anaesth 2008;101(2):178-85. https://doi.org/10.1097/aln.0b013e31826904a6 PMid:18515816
Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: The B-aware randomised controlled trial. Lancet 2004;363(9423):1757-63. https://doi.org/10.1093/bja/aen144 PMid:15172773.
Zhang C, Xu L, Ma YQ, Sun YS, Li YH, Zhang L, et al. Bispectral index monitoring prevent awareness during total intravenous anesthesia: A prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J (Engl) 2011;124(22):3664-9. https://doi.org/10.1016/s0140-6736(04)16300-9 PMid:22340221
Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2014;6(1):CD003843. https://doi.org/10.1056/nejmoa1100403 PMid:24937564
Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. 5th National audit project (NAP5) on accidental awareness during general anaesthesia: Summary of main findings and risk factors. Br J Anaesth 2014;113(4):549-59. https://doi.org/10.1213/ane.0b013e3181732b0c PMid:25204697
Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: A prospective case study. Lancet 2000;355(9205):707-11. https://doi.org/10.1002/14651858.cd003843.pub2 PMid:10703802
Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: Patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth 2014;113(4):560-74. https://doi.org/10.1016/s0140-6736(99)11010-9 PMid:25204696
Leslie K, Skrzypek H, Paech MJ, Kurowski I, Whybrow T. Dreaming during anesthesia and anesthetic depth in elective surgery patients: A prospective cohort study. Anesthesiology 2007;106(1):33-42. https://doi.org/10.1093/bja/aeu314 PMid:17197843
Samuelsson P, Brudin L, Sandin RH. Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness. Acta Anaesthesiol Scand 2008;52(6):805-9. https://doi.org/10.1097/00000542-200701000-00010 PMid:18477084
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Copyright (c) 2020 eslam heggy, Sherif Abbas, Ahmed Fetouh, Atef Galal, Mina Adolf (Author)
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