Inhalation of volatile anesthetics via a laryngeal mask is associated with lower incidence of intraoperative awareness in non-critically ill patients.

Pei-Jen Kuo,Shiu-Ying Hsieh,Chia-Ling Lee,Chen-Fuh Lam,Shian-Che Huang,Jen-Huang Wang,Jianjun Yang

doi:10.1371/journal.pone.0186337

Pei-Jen Kuo, Shiu-Ying Hsieh + Show 5 more

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https://doi.org/10.1371/journal.pone.0186337

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Abstract

BackgroundIncreased incidence of intraoperative awareness was reported in critically ill patients during major operations, particularly under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). However, the incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention.Methods and resultsThis retrospective matched case-control study was conducted between January 2009 to December 2014. Surgical patients (ASA physical status I-III) whom reported intraoperative awareness during this study period were interviewed and their medical records were reviewed. The potential risk factors for awareness were compared with the non-case matched controls, who were randomly selected from the database. A total of 61436 patients were included and 16 definite cases of intraoperative awareness were identified. Patients who received ETGA and TIVA had significantly higher incidence of developing awareness compared to those who were anesthetized using laryngeal masks (LMA) (P = 0.03). Compared with the matched controls (n = 80), longer anesthesia time was associated with increased incidence of awareness (odds ratio 2.04; 95% CI 1.30–3.20, per hour increase). Perioperative use of muscle relaxant was also associated with increased incidence of awareness, while significantly lower incidence of awareness was found in patients who were anesthetized with volatile anesthetics.ConclusionsThe overall incidence of awareness was 0.023% in the ASA≤ III surgical patients who received general anesthesia. Anesthesia with a laryngeal mask under spontaneous ventilation and supplemented with volatile anesthetics may be the preferred anesthesia technique in generally healthy patients in order to provide a lower risk of intraoperative awareness.

Highlights

Intraoperative awareness is the unexpected recall of explicit memory during anesthesia
Accidental awareness in noncritical patients supplemented with volatile anesthetics may be the preferred anesthesia technique in generally healthy patients in order to provide a lower risk of intraoperative awareness
Patients presenting with higher American Society of Anesthesiologists (ASA) physical status (ASA PS) and critically ill patients who received cardiothoracic traumatic resuscitation or other major/emergency surgeries are at significantly higher risk of developing intraoperative awareness [10,11,12], probably due to suboptimal levels of anesthesia during the procedures [13]

Summary

Introduction

Intraoperative awareness is the unexpected recall of explicit memory during anesthesia. Patients presenting with higher ASA physical status (ASA PS) and critically ill patients who received cardiothoracic traumatic resuscitation or other major/emergency surgeries are at significantly higher risk of developing intraoperative awareness [10,11,12], probably due to suboptimal levels of anesthesia during the procedures [13]. The primary objective of our study was to identify the risk factors for accidental intraoperative awareness in generally healthy patients, and the second objective was to determine the effects of different anesthesia techniques on the development of awareness during operation. Increased incidence of intraoperative awareness was reported in critically ill patients during major operations, under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). The incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention

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