Preventing and managing awareness during general anesthesia

  • Jelena Berger Klinični oddelek za anesteziologijo in intenzivno terapijo operativnih strok, UKC Ljubljana
  • Polona Mušič Klinični oddelek za anesteziologijo in intenzivno terapijo operativnih strok, UKC Ljubljana
  • Bernarda Logar Zakrajšek SPS Kirurška klinika, UKC Ljubljana
  • Dušan Mekiš Oddelek za anesteziologijo, intenzivno terapijo in terapijo bolečin, UKC Maribor Medicinska fakulteta, Univerza v Mariboru
Keywords: depth of general anesthesia, intraoperative awareness, anesthesia complications, prevention, post-traumatic stress disorder

Abstract

Background: General anesthesia is a reversible state of a temporary loss of consciousness, analgesia, muscle paralysis, blunted autonomic responses and amnesia. To achieve this, an adequate depth of anesthesia should be maintained throughout the surgery. Awareness is a serious complication of general anesthesia, which occurs when the depth of anesthesia is not appropriate due to various causes.

In this paper the underlying neurobiology of intraoperative awareness is presented, as well as risk factors for awareness and methods for assessing the depth of anesthesia. Possible psychological consequences of awareness and their management are also discussed. At the end, the recommendations for preventing intraoperative awareness are given.

Conclusions: Awareness during general anesthesia may have adverse psychological sequelae in individual patients, therefore guidelines for preventing and managing of intraoperative awareness need to be adopted. In case of a possible awareness, the recommendations for offering a psychological support should also be followed.

Downloads

Download data is not yet available.

References

Zietkiewicz M, Nestorowicz A. Intraoperative awareness-recommendations of the committee on quality and safety in anesthesia. Anesthesiology Intensive Therapy 2012; 44: 57–62.

Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awereness during anesthesia: A closed claims analysis. Anesthesiology 1999; 90: 1053–1061.

Davidson AJ, Huang GH, Czarnecki C. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 2005; 100: 653–661.

Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: A closed claims analysis. Anesthesiology 1999; 90: 1053–1061.

Orser BA, Mazer CD, Baker AJ. Awareness during anesthesia. CMAJ 2008; 178: 185–188.

Liem EB, Suleman MI, Doufas AG et al. Anesthetic requirements is increased in redheads. Anesthesiology 2004; 101: 279–283.

Hardman JG, Aitkenhead AR. Awareness during anesthesia. Continuing Education in Anaesthesia, Critical Care & Pain 2005; 5: 183–186.

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: 527–535.

Kent CD, Domino KB. Depth of anesthesia. Curr Opin Anaesth 2009; 22: 782–787.

Avidan MS, et al. Anesthesia Awareness and the Bispectral Index. N Engl J Med 2008; 358: 1097–108.

Klopman MA, Sebel PS. Cost-effectiveness of bispectral index monitoring. Curr Opin Anesthesiol 2011; 24: 177–181.

Mashour GA, Orser BA, Avidan MS. Intraoperative awareness. From neurobiology to clinical practice. Anestehsiology 2011; 114: 1218–33.

Myles PS, Leslie K, McNeil J, Forbes A, Chan MTV. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004; 363: 1757–63.

Lobo FA, Schraag S. Limitations of anaesthesia depth monitoring. Curr Opin Anaesthesiol 2011; 24: 657–664.

Serfontein L. Awareness in cardiac anesthesia. Curr Opin Anesthesiol 2010; 23: 103–108.

Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA: Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry 2001; 23: 198–204.

Leslie K, Chan MTV, Myles PS, Forbes A, McCulloch TJ: Postraumatic Stress Disorder ina Aware patients from B-Aware trial. Anesth Analg 2010; 110: 823–8.

Samuelsson P, Brudin L, Sandin RH: Late Psychological Symptoms after awareness among Consecutively Included Surgical Patients. Anesthesiology 2007; 106: 26–32.

Sebel P, Bowdle T, Ghoneim M, Rampil I, Padilla R, Gan t, Domino K. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99: 833–9.

Mednarodna klasifikacija bolezni ICD 10. WHO, nov 2012. Dosegljivo na: http://www.who.int/classifications/icd/en/

Bischoff P, Rundshagen I. Awareness Under General Anesthesia- Rewiev. Dtsch Arztebl Int 2011; 108: 1–7.

Kent CD: Awareness during general anesthesia: ASA Closed Claims Database and Anesthesia Awareness Registry. ASA Newsletter. 2010; 74: 14–16.

American Society of Anesthesiologists Task Force on Intraoperative Awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the American Society of Anesthesiologists task force on intraoperative awareness. Anesthesiology. 2006; 104: 847–64.

Nickalls RW, Mapleson WW. Age-related iso-MAC charts for isoflurane, sevoflurane and desflurane in man. Br J Anaesth. 2003; 91: 170–4.

Bonin RP, Orser BA. GABA(A) receptor subtypes underlying general anesthesia. Pharmacol Biochem Behav. 2008; 90: 105–12.

How to Cite
1.
Berger J, Mušič P, Logar Zakrajšek B, Mekiš D. Preventing and managing awareness during general anesthesia. ZdravVestn [Internet]. 1 [cited 18Apr.2019];83(2). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1099
Section
Review