Incidence Of Intraoperative Awareness Research Articles

Influences of Propofol, Ciprofol and Remimazolam on Dreaming During Anesthesia for Gastrointestinal Endoscopy: A Randomized Double-Blind Parallel-Design Trial.

To compare the influences of propofol, ciprofol and remimazolam on dreaming during painless gastrointestinal endoscopy. This study was a single-center, prospective, parallel-design, double-blind, randomized clinical trial. Between May 2023 and October 2023, patients undergoing elective painless gastrointestinal endoscopy were recruited and randomly allocated into one of the three groups. Demographic data, intraoperative information, incidence of dreaming, insufficient anesthesia and intraoperative awareness, type of dream, patient satisfaction score, adverse events, and improvement of sleep quality were collected. The difference in incidence of dreaming among the three groups was not significant (33.33% vs 48.33% vs 41.67%, p=0.061). The number of patients with intraoperative hypotension in the propofol group was larger than that of the remimazolam group (32 vs 12, p=0.001). However, the cases of intraoperative hypotension between propofol group and ciprofol group or ciprofol group and remimazolam group were comparable (32 vs 22, p=0.122; 22 vs 12, p=0.064). The percentage of insufficient anesthesia between propofol group and remimazolam group was significant (13.33% vs 1.67%, p=0.001), while no statistical difference was detected between propofol group and remimazolam group or ciprofol group and remimazolam group (13.33% vs 5.00%, p=0.025; 5.00% vs 1.67%, p=0.150). The ability of propofol to improve sleep quality at 1st post-examination day was significantly better than that of remimazolam (86.21% vs 72.88%, p=0.015), while it was not significant between propofol group and ciprofol group or ciprofol group and remimazolam group (86.21% vs 80.36%, p=0.236; 72.88% vs. 72.88%, p=0.181). Incidence of intraoperative awareness, intraoperative hypoxia, type of dream, satisfaction score, adverse events during recovery, and sleep improvement on the 7th post-examination day was not significant among the groups. Anesthesia with propofol, ciprofol and remimazolam, respectively, for gastrointestinal endoscopy did not induce statistical difference in the incidence of dreaming, despite that all of them are more likely to induce pleasant dreams.

The feasibility of dexmedetomidine-led anesthesia maintenance strategy during major abdominal surgery

BackgroundDexmedetomidine is known for its selective action on α2-adrenoceptor sites and is recognized for its neuroprotective capabilities. It can improve postoperative cognitive function. Commonly used anesthetics, such as sevoflurane and propofol, have been reported to affect postoperative cognitive function. Therefore, it could be valuable to explore dexmedetomidine-led anesthesia strategy. This study was designed to assess the performance, safety, and effective infusion rate in anesthesia maintenance, to explore a feasible dexmedetomidine-led anesthesia maintenance protocol, and to provide a foundation for potential combined anesthesia. MethodsThirty patients aged 18–60 years, classified as ASA I or II, undergoing abdominal surgery were involved. The anesthesia maintenance was achieved with dexmedetomidine, remifentanil and rocuronium. Dixon up-and-down sequential methodology was utilized to ascertain the ED50 of dexmedetomidine for maintaining Patient State Index (PSI) 25–40 (depth of stage III anesthesia). Intraoperative HR, BP and depth of anesthesia were monitored and controlled. The wake-up time from anesthesia, the incidence of intraoperative awareness and postoperative delirium, and the patients’ satisfaction were assessed. ResultsThe results indicated that dexmedetomidine-led anesthesia could maintain the depth of stage III anesthesia during abdominal surgery. The ED50 and ED95 of dexmedetomidine infusion rates during anesthesia maintenance were 2.298 μg/kg·h (95%CI: 2.190–2.404 μg/kg·h) and 3.765 μg/kg·h (95%CI: 3.550–4.050 μg/kg·h). Continuous infusion of dexmedetomidine and 0.1–0.3 μg/kg·min remifentanil could maintain PSI 25–40, and provide appropriate anesthesia depth for abdominal surgery. Perioperative bradycardia and hypertension could be rapidly corrected with atropine and nitroglycerin. The median wake-up time after anesthesia was 4.8 min, the perioperative maximum HR had significant correlation with wake-up time and intraoperative dexmedetomidine dose. No intraoperative awareness and postoperative delirium occurred; the patients were satisfied with dexmedetomidine-led anesthesia. Conclusionsdexmedetomidine-led strategy could maintain stable depth of anesthesia throughout surgery, and the ED50 of dexmedetomidine infusion rates was 2.298 μg/kg·h. Intraoperative HR, BP and depth of anesthesia require monitoring, the bradycardia and hypertension could be rapidly corrected.

Efficacy and safety of ciprofol-remifentanil versus propofol-remifentanil during fiberoptic bronchoscopy: A prospective, randomized, double-blind, non-inferiority trial.

Objective: Ciprofol is a novel 2,6-disubstituted phenol derivative that has improved pharmacokinetic and pharmacodynamic properties compared with propofol. This study was conducted to compare the efficacy and safety of ciprofol-remifentanil versus propofol-remifentanil for patients undergoing fiberoptic bronchoscopy. Methods: Overall, 92 patients undergoing fiberoptic bronchoscopy were included in this prospective, randomized, double-blind, non-inferiority trial and were equally divided into two groups (n = 46 each). Fentanyl (50μg) was given 2min before the intravenous infusion of 0.3mg/kg of ciprofol or 1.2mg/kg of propofol over a time period of 30s. During anesthesia maintenance, 0.05-0.2μg/kg/min of remifentanil combined with one-third to one-fourth of the initial dose of ciprofol or propofol was repeated at 2-min intervals, as required, to maintain a Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale score <3. The primary outcome was the successful rate of fiberoptic bronchoscopy. Secondary outcomes included demographic characteristics, time metrics, hemodynamics, coughing severity, intubating conditions, lowest oxygen saturation, utilization of study drug doses, number of remedies (lidocaine and vasoactive drugs) used, satisfaction scores of both patients and the endoscopist, occurrence of intraoperative awareness, patients' willing to repeat fiberoptic bronchoscopy, and occurrence and severity of adverse events. Results: The successful completion rate of fiberoptic bronchoscopy was 91.30% (42 of 46; 95% confidence interval [CI]: 82.80%-99.80%) in the ciprofol-remifentanil group and 89.13% (41 of 46; 95% CI: 79.80%-98.50%) in the propofol-remifentanil group. Though the clinically acceptable intubating condition was improved in the ciprofol-remifentanil group, this difference has no clinical statistical difference (p > 0.05). No significant differences were noted between the two groups with respect to time metrics, consumption of fentanyl and remifentanil, or number of remedies (lidocaine and vasoactive drugs). Patients' willingness to repeat fiberoptic bronchoscopy and the satisfaction of both patients and endoscopist were significantly higher in the ciprofol-remifentanil than in the propofol-remifentanil group (p < 0.05). Compared with patients in the propofol-remifentanil group, patients in the ciprofol-remifentanil group had more stable hemodynamics. The lowest oxygen saturation was significantly higher in the ciprofol-remifentanil than in the propofol-remifentanil group (p < 0.05). The numbers of patients who experienced pain on injection in the ciprofol-remifentanil group was significantly lower than the number in the propofol-remifentanil group (p < 0.01). Severity of coughing, clinically acceptable severity of coughing, incidence of intraoperative awareness, and other adverse events were all similar between the two groups (p > 0.05). Only four patients experienced grade 2 adverse events (severe hypotension in one patient in the ciprofol-remifentanil group and three patients in the propofol-remifentanil group; p > 0.05); they were treated with noradrenaline. Conclusion: Ciprofol-remifentanil was non-inferior to propofol-remifentanil with regard to successful sedation for flexible bronchoscopy, when used with pre-intravenous administration of 50μg of fentanyl. At the same time, patients' willingness to repeat flexible bronchoscopy and the satisfactions were all significantly improved.

Hospital based prospective, non-randomized descriptive study to find out the incidence of intraoperative awareness during general anaesthesia and evaluation of the risk factors causing awareness.

Hospital based prospective, non-randomized descriptive study to find out the incidence of intraoperative awareness during general anaesthesia and evaluation of the risk factors causing awareness.

Intraoperative Neuromonitoring: Electroencephalography

Intraoperative neuromonitoring using electroencephalography (EEG) enables anaesthesiologists to monitor the depth of anaesthesia. It is intended to reduce the occurrence of intraoperative wakefulness, postoperative delirium and postoperative cognitive deficits and to shorten process times in the operating room. This article shows how to interpret the raw EEG, spectrograms and processed indices for different age groups and anaesthetics and summarizes the resulting clinical benefits. While propofol and volatile anesthetics produce characteristic frontal EEG signatures with a high activity of coherent α- and δ-waves, ketamine triggers an increase in rapid γ-waves, which leads to incorrectly high indices (BIS, PSI, NI) despite deep anaesthetic levels.In children, frontal α-waves do not appear until the age of approx. 6 months and valid indices (BIS, PSI, NI) can only be derived starting at an age of approx. 12 months. Furthermore, children of preschool and elementary school age often show epileptiform discharges in the EEG during induction of anaesthesia, what is linked to emergence delirium. In adults, the intraoperative frontal α-power decreases significantly with increasing age and older patients tend to have an increased occurrence of burst suppression patterns during anaesthesia. Clinical benefits of EEG-based neuromonitoring comprise reduced doses of anaesthesia, shorter wake-up times after surgery and a lower incidence of intraoperative awareness during total intravenous anaesthesia. Moreover, anaesthesia guided by processed EEG indices can reduce the incidence of postoperative delirium and postoperative cognitive deficits in older patients. In-depth knowledge about intraoperative EEG changes that go beyond the interpretation of processed indices could lead to a further reduction in intra- and postoperative complications in the future.

Postoperative recovery of patients with differential requirements for sevoflurane after abdominal surgery: A prospective observational clinical study.

An association between animals and volatile anaesthetic requirements has been shown; however, evidence related to the postoperative outcome of human patients is lacking. Our aim was to investigate whether there is a difference in the requirement for sevoflurane among people undergoing gastrointestinal surgery.We observed 390 adult patients who underwent gastrointestinal surgery with an American Society of Anesthesiologists physical status of I or II with an expected surgery duration of > 2 hours. We used the bispectral index (BIS) to guide the regulation of end-tidal sevoflurane concentration (ETsevo). The mean ETsevo from 20 minutes after endotracheal intubation to 2 hours after the start of surgery was calculated for all patients. Differential sevoflurane requirements were identified according to ETsevo. The BIS, ETsevo, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting were compared between patients with a low requirement for sevoflurane (group L) and patients with a high requirement for sevoflurane (group H).The mean ETsevo of the 390 patients was 1.55% ± 0.26%. Based on our definition, patients with an ETsevo of < 1.29% were allocated to the low requirement group (group L; n = 69), while patients with an ETsevo of > 1.81% were allocated to the high requirement group (group H; n = 78). The ETsevo of group L was significantly lower than the ETsevo of group H (1.29% ± 0.014% vs 1.82% ± 0.017%, P < .001). There was no significant difference in the ETsevo, BIS, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting. The tracheal extubation time in the L group was significantly shorter than that in the H group. No intraoperative awareness occurred.There was a significant difference in the requirement for sevoflurane in adult patients. The tracheal extubation time in group L was significantly shorter than that in group H.

Evaluation of current anaesthesia practice by assessing awareness during anaesthesia: A prospective observational study at a tertiary care teaching hospital

Intraoperative awareness is an uncommon but extremely unfavourable occurrence affecting patients who undergo surgery under general anaesthesia. The temporary effects of awareness in some patients may be sleep disturbances, nightmares and anxiety. At times, the patients may remain fearful regarding the occurrence of awareness under anaesthesia if in future they require it. The long term effects may range from post-traumatic stress disorder to a preoccupation with death. The objective of this study was to evaluate the occurrence of intra-operative awareness in the patients with our current anaesthesia technique.1000 participants were included in this observational study, who were posted for elective or emergency surgeries or procedures under general anaesthesia. Incidence of intra-operative awareness was assessed by Brice’s Questionnaire, modified and translated according to our study design. Patients’ interview reports were classified as (a) definite awareness (b) possible awareness (c) no awareness and (d) dreaming.Out of 1000 participants, 575 (57.5%) were males and 425 (42.5%) were females. In the present study, 780 (78.0%) had elective surgery while 220 (22.0%) had emergency surgery. No intra-operative complications were seen in 844 (84.4%) patients while hypotension was seen in 77 (7.7%) patients, bleeding was seen in 47 (4.7%) and hypoxia was seen in 25 (2.5%) patients. 997 (99.7%) patients didn’t have any form of awareness during anaesthesia while two (0.2%) patients had dreaming during anaesthesia and one patient confirmed hearing voices during surgery which was considered as possible awareness according to the definition.In our study, incidence of possible awareness was found to be 0.1%. Anaesthesia experience was satisfactory among 93.7% patients. Perioperative empathetic approach towards the patients reduces the anxiety, speculations regarding surgery and anaesthesia, and this helps in minimizing the incidence of awareness during anaesthesia.

Safety and efficacy of perioperative benzodiazepine administration: study protocol for a systematic review and meta-analysis

IntroductionPerioperative benzodiazepines are used because of their anxiolytic, sedative and amnestic effects. Evidence has demonstrated an association of benzodiazepines with adverse neuropsychiatric effects. Nonetheless, because of their potential benefits, perioperative...

Bispectral index for improving intraoperative awareness and early postoperative recovery in adults.

Bispectral index for improving intraoperative awareness and early postoperative recovery in adults.

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting.

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting were investigated. Eighty patients undergoing systemic anesthesia with extracorporeal coronary artery bypass grafting in The People's Hospital of Guangxi Zhuang Autonomous Region from January 2015 to August 2017 were selected and randomly divided into the observation group (n=40) and control group (n=40). The two groups were treated with dexmedetomidine and equal volume of normal saline, respectively. Moreover, safety indexes including EEG bispectral index (BIS) at 30 min before induction of anesthesia (T0), immediately after intubation (T1), when incision was made (T2), when chest was closed (T3), when operation was completed (T4) and at 6 h after operation (T5), intraoperative circulatory system-related complications, cortisol, epinephrine and norepinephrine levels at the end of surgery as well as anesthesia recovery time and postoperative mechanical ventilation time were recorded and compared. All the patients were followed up for 1 week. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were administered at 1, 3 and 7 days after operation, and the incidence of intraoperative awareness and postoperative cognitive dysfunction was recorded. BIS value in the observation group was lower than that in the control group (P<0.05) at T1-T4 time points, and the BIS value in the observation group was higher than that in the control group (P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension and hypotension in the observation group was significantly lower than those in the control group (P<0.05). At the end of operation, levels of cortisol, epinephrine and norepinephrine in the observation group were significantly lower than those in the control group (P<0.05). Anesthesia recovery time and postoperative mechanical ventilation time in the observation group was significantly shorter than the time in the control group (P<0.05). MMSE and MoCA scores of the observation group were better than those of the control group (P<0.05). The incidence of cognitive impairment and postoperative cognitive impairment in the observation group was significantly lower than those in the control group (P<0.05). Therefore, it is concluded that dexmedetomidine can effectively reduce the incidence of postoperative cognitive impairment in patients undergoing coronary artery bypass grafting, and it is of high safety for circulatory function.

T143. Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions

Introduction To investigate the effect of the anesthesia on the quality and reliability of electrocorticography (ECOG) for localization of the epileptic focus based on literature review. Although there is plethora of literature reporting on the utility of intraoperative ECOG for localization of the epileptic focus. Less is known about the effect of the anesthetic regimen and depth of anesthesia on quality of ECOG recording. Methods Literature review primarily through PubMed and book chapters. We also implemented snow-ball strategy. We included articles in which the anesthetic regimen during ECOG for localization of epileptic focus was reported. We excluded articles where the ECOG was solely used for mapping function or in tumoral cases. Results 54 studies were identified. 80% of the studies had a prospective design. There is no consensus in regards to the ideal regimen. Dexmedetomidine and synthetic opiates appear to be the most reliable in that they have little or no effect on the spiking focus and frequency. Studies on propofol provided conflicting evidence owing to methodological differences. There are no universal definition of the gold standard of localization and outcome measures. Majority of the studies reported positive yields (83%), and (6%) reported detrimental effects in regards to reliable epileptic focus localization raising concern over publication bias. Of the 43% of studies reporting on ‘spike activation’, 5 provided specifics on site of resection and correlation with surgical outcomes. Only two studies systematically evaluated the depth of anesthesia quantitatively. Excluding awake craniotomies, there are no reports of intraoperative awareness, however this side effect was not systematically evaluated with post-operative interviews. Conclusion Available studies provide useful information about the effect of anesthesia on ECOG. Prospective studies incorporating widely-accepted standards of localization and surgical outcomes are needed. Future studies may investigate systematically the effect of depth of anesthesia and the incidence of intraoperative awareness.

BIS Monitoring on Intraoperative Awareness: A Meta-analysis.

Intraoperative awareness is a very serious complication of general anesthesia. Several studies have evaluated the potential association between bispectral index (BIS) and intraoperative awareness, however, the results obtained were controversial. Therefore, we performed a meta-analysis to further assess the association between the BIS monitoring and the incidence of intraoperative awareness. A comprehensive search was conducted to identify all eligible studies from the online literature databases published prior to Feb. 2017. A total of five studies with 17 432 cases and 16 749 controls were included. An odds ratio (OR) and a 95% confidence interval (CI) were calculated to examine the strength of the association. The results showed that in the overall analysis, the association between the BIS monitoring and the incidence of intraoperative awareness was not significant (OR=0.58, 95% CI= 0.22-1.58, P=0.29). A stratified analysis by comparing different anesthesia methods revealed that BIS monitoring group showed a lower incidence of intraoperative awareness in patients with intravenous anesthesia when compared with non-BIS monitoring group (OR=0.20, 95% CI=0.08-0.49, P=0.0004), whereas there was no statistically significant difference in the incidence of intraoperative awareness between BIS and non-BIS monitoring groups in patients with inhalation anesthesia (OR=1.13, 95% CI=0.56-2.26, P=0.73). In conclusion, our meta-analysis showed that BIS monitoring had no appreciable advantage in the reduction of the intraoperative awareness incidence in inhalation anesthesia, while showed a remarkable superiority in intravenous anesthesia.

Anaesthesia management by residents does not alter the incidence of self-reported anaesthesia awareness: A teaching hospital-based propensity score analysis

BackgroundIntraoperative awareness during general anaesthesia is rare but represents one of the major anaesthesia-related complications. Intraoperative awareness may be a result of inadequate anaesthesia management. Therefore, the incidence can be related with the experience of anaesthetists. To assess whether the incidence of intraoperative awareness is related to anaesthetists’ experience, we compared the incidence of self-reported intraoperative awareness between patients managed by anaesthesia residents or by experienced anaesthetists. MethodsThis is a retrospective review of an institutional registry containing 21,606 general anaesthesia cases. It was conducted with the ethics board approval. Propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anaesthetist managements), yielding 4940 matched patient pairs. The incidence of self-reported intraoperative awareness compared as primary outcomes. Additionally, a multivariate logistic analysis in the entire cohort, using the incidence of self-reported intraoperative awareness as dependent variable, was conducted to confirm the result of the primary outcome. ResultsIn the unmatched population, contrary to our hypothesis, the incidence of self-reported intraoperative awareness was lower in resident management compared with anaesthetist management (1.1% vs. 1.5%, P=0.028). However, after propensity score matching, there was no difference in incidences of self-reported intraoperative awareness (1.5% vs. 1.3%, 0.38). The multivariate analysis confirmed the result of the primary outcome from the matched pair analysis and showed that ASA physical status (OR=1.40, 95% CI=1.08 to 1.81), emergency case (CI=2.05, 95% CI=1.40 to 3.00), and application of postoperative analgesia (OR=0.70, 95% CI=0.50 to 0.97) were independently associated with incidence of self-reported intraoperative awareness. ConclusionIn conclusion, when supervised by an anaesthetist, resident anaesthesia management is not more likely to result in complaints about intraoperative recall than anaesthetist management.

Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery.

BackgroundAnesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep.MethodsFifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3).ResultsSix patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients.ConclusionsAnesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.

Monitoring the end-tidal concentration of sevoflurane for preventing awareness during anesthesia (MEETS-PANDA): A prospective clinical trial

ObjectiveIt was hypothesized that monitoring end-tidal sevoflurane (ETS) during endoscopic surgery could reduce the incidence of intraoperative awareness in patients undergoing general anesthesia. Herein, the incidence of intraoperative awareness and other correlative factors was recorded and compared. MethodsTwo thousand five hundred ASA I–III patients aged 18–80 years who underwent general anesthesia were randomly divided into 2 groups (n = 1250): routine care group (R) and ETS concentration group (E). ETS concentration was monitored in group E and maintained at a sevoflurane minimum alveolar concentration (MAC) of 0.7–1.3; group R was monitored using routine care, and the sevoflurane was maintained. Patients were assessed for intraoperative awareness with a questionnaire on their explicit memory 24–48 h after surgery. ResultsA total of 2532 patients were selected, and 86 patients were excluded. As for the groups, 1219 patients were assigned to group E, and 1227 patients were assigned to group R. As for intraoperative awareness, group E had 2 patients, and group R had 14. Compared with group R, the incidence of intraoperative awareness in group E was significantly lower (p = 0.003); the time-averaged ETS concentration and sevoflurane dosage were lower in group E (p < 0.05); and no significant changes were found in tracheal extubation time, intravenous general anesthetic dosage, or postoperative complication incidence in either group (p > 0.05). The incidence of intraoperative awareness was higher in women than men in group R (p < 0.05). ConclusionUsing ETS-guided anesthesia and maintaining the sevoflurane concentration (0.7–1.3 MAC) can decrease the incidence of patient awareness during endoscopic surgery.

Effects of music therapy under general anesthesia in patients undergoing abdominal surgery

ABSTRACTBackground: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness.Methods: This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient’s satisfaction, and awareness incidence during anesthesia were recorded.Results: One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10–3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10–3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10–3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant.Conclusion: Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients’ embarrassing experiences related to perioperative stress, pain, and awareness.

Abstract PR420

Background & Objectives: Even though the medical technology, anesthetic techniques, pharmacological agents and monitoring system have been ameliorated but the incidence of intraoperative awareness has still been identified (0.005-0.038%). The information about this problem on the possible protective scheme, pitfalls and management modality might differ from the last decade according to the Thai Anesthesia Incidents Study (THAI study) and Thai Anesthesia Incident Monitoring Study (THAI AIMS). Therefore, this large multicenter study supported by the Royal College of Anesthesiologists of Thailand was performed and aimed to describe the awareness incidents including the relevant across Thailand during January-December, 2015. Materials & Methods: The observational prospective study was conducted within 21 hospitals throughout Thailand. The awareness category was selected from the incident report according to Perioperative Anesthetic Adverse Events in Thailand (PAAD THAI) study database. The characteristics of awareness and the factors related were declared. Moreover, crucial sections of factors contributing to the incident, factors minimizing the situation, suggested correcting strategies, and pertinent treatment were investigated, reviewed and made a consensus by three peer reviewers. The descriptive statistics was analyzed. Results: There were 9 episodes from 2,000 incidences totally. The average age was 44.5±19.1 years with American Society of Anesthesiologists (ASA) physical status class II mainly. Eight of them received general anesthesia balanced technique with inhalation agent and one obtained total intravenous anesthesia. Fifty-five percent were monitored with endtidal gas analyzer and adjusted depth of anesthesia by an anesthesiologist who had 10.9±11.4 years experienced. Pain perception 8 (8.8%), sounds 7 (77.7%), paralysis 3(33.3%) were found during anesthetic maintenance. The incurring possibilities were anesthesia 8 (100%), patient 5 (55.5%) and system related 2 (22.2%). Although the immediate outcomes showed 2 (25%) for temporary stress and 1 (12.5%) for anxiety, the treatment and management were acceptable. The contributing factors were situational inexperience 7 (77.8%) and inappropriate patient evaluation 4 (44.4%). An awareness of anesthetic performer 9 (100%) and experienced 8 (88.8%) were defined as factors minimizing incident. The suggested corrective strategies were quality assurance activity 8 (88.8%), improved supervision 4 (44.4%) and equipment utilization 3 (33.3%) respectively. Conclusion: The intraoperative awareness incidents were report periodically, however the causes were preventable. Anesthetic component seems to be the most influence to prevent the circumstance and lessen the harmful psychological sequelae.

Awareness during general anesthesia: An Indian viewpoint.

Background and Aims:The incidence of intra-operative awareness with explicit recall in the Western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1–2% of patients at high risk for this complication. Awareness in the Indian population has never been studied; we therefore wanted to detect the incidence of awareness in patients who were at high risk of experiencing awareness during surgery in our population.Material and Methods:We conducted a prospective single-center observational study at a 600-bedded tertiary cancer care referral hospital. We recruited adult patients posted for major cancer surgery who were considered to be at high risk for awareness. These patients were interviewed at three time-points using the structured modified Brice interview questionnaire. The primary outcome studied was the incidence of definite intra-operative awareness.Results:A total of 934 patients were included in the final analysis of which none reported awareness. Using the rule of three (Hanley and Lippman-Hand) we conclude that the upper 95% confidence interval for the incidence of awareness in this population is <1 in 300 (0.33%).Conclusion:Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.

Impact of right-handedness on anaesthetic sensitivity, intra-operative awareness and postoperative mortality.

Anatomical, neurological and behavioural research has suggested differences between the brains of right- and non-right-handed individuals, including differences in brain structure, electroencephalogram patterns, explicit memory and sleep architecture. Some studies have also found decreased longevity in left-handed individuals. We therefore aimed to determine whether handedness independently affects the relationship between volatile anaesthetic concentration and the bispectral index, the incidence of definite or possible intra-operative awareness with explicit recall, or postoperative mortality. We studied 5585 patients in this secondary analysis of data collected in a multicentre clinical trial. There were 4992 (89.4%) right-handed and 593 (10.6%) non-right-handed patients. Handedness was not associated with (a) an alteration in anaesthetic sensitivity in terms of the relationship between the bispectral index and volatile anaesthetic concentration (estimated effect on the regression relationship -0.52 parallel shift; 95% CI -1.27 to 0.23, p = 0.17); (b) the incidence of intra-operative awareness with 26/4992 (0.52%) right-handed vs 1/593 (0.17%) non-right-handed (difference = 0.35%; 95% CI -0.45 to 0.63%; p = 0.35); or (c) postoperative mortality rates (90-day relative risk for non-right-handedness 1.19, 95% CI 0.76-1.86; p = 0.45). Thus, no change in anaesthetic management is indicated for non-right-handed patients.

Efficacy of bispectral index monitoring for prevention of intraoperative awareness in patients under general anesthesia: a meta-analysis

Objective To systematically review the efficacy of bispectral index (BIS) monitoring for prevention of intraoperative awareness in patients under general anesthesia.Methods The Cochrane Central Register of Controlled Trials (Central),PubMed,Medline,and EMBASE were searched for randomized controlled clinical trials involving detection of intraoperative awareness in patients in whom BIS was used or not under general anesthesia.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included the incidence of intraoperative awareness.Meta-analysis was conducted using RevMan 5.1 software.Results Five randomized controlled clinical trials involving 34181 patients were included in this meta-analysis.There were 17432 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.132％.There were 16749 cases in whom BIS was not used and the incidence of intraoperative awareness was 0.245％.There was no significant difference in the incidence of intraoperative awareness between the two groups (P ＞0.05).Further analysis was performed according to the method of anesthesia.In inhalational anesthesia,there were 13288 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.128％,and there were 13202 cases in whom BIS was not applied and the incidence of intraoperative awareness was 0.113％.There was no significant difference in the incidence of intraoperative awareness between the two groups (P ＞ 0.05).In total intravenous anesthesia,there were 4144 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.145％,and there were 3547 cases in whom BIS was not applied and the incidence of intraoperative awareness was 0.733 ％.The incidence of intraoperative awareness was significantly lower in the patients in whom BIS was applied than those in whom BIS was not applied (P ＜ 0.01).Conclusion BIS monitoring can effectively prevent the development of intraoperative awareness in patients under total intravenous anesthesia,but can not prevent the development of intraoperative awareness in patients under inhalational anesthesia. Key words: Electroencephalography ; Intraoperative complications ; Meta-analysis