Intraoperative Awareness In Children Research Articles

The Incidence of Intraoperative Awareness in Children

The Incidence of Intraoperative Awareness in Children

Detecting intraoperative awareness in children by using a special auditory intervention

Objective To determine the feasibility of using a special auditory intervention to detect intraoperative awareness in children under general anesthesia. Methods Thirty-four ASA I or II children aged 5-15 yr weighing 16-73 kg undergoing scofiosis were enrolled in this study. Intraoperative wake-up test was performed during operation. Two easily identified animal noises （60 dB, lasting 15 s） were played through head phones before induction of anesthesia and immediately after the intraoperafive wake-up test. Children were interviewed on the 1st and 5th-7th days after surgery to assess their awareness of intraoperative wake-up test and special auditory intervention. Results Four children were excluded from the study because of restlessness during the intraoperative wake-up test or their refusal to be interviewed. From the remaining 30 children,4 children were suspected to be aware of intraoperative wake-up test. Awareness was comfirmed in 3 children and suspected in one child. The incidence of awareness of intraoperative wake-up test was 10% . But only one of them could tell the animal sound played during the wake-up test. All the patients in this study had explicit recall of the animal noises played before induction of anesthesia. Conclusion Special auditory intervention can not detect intraoperative awareness in children under general anesthesia. Key words: Acoustic stimulation; Child ; Awareness

The Incidence of Intraoperative Awareness in Children: Childhood Awareness and Recall Evaluation

The Incidence of Intraoperative Awareness in Children: Childhood Awareness and Recall Evaluation

Long‐term posttraumatic effects of intraoperative awareness in children

The consequences of intraoperative awareness in children have received little empirical attention to date. Previous studies suggest that children are less likely to be distressed than adults in the short term, but long-term consequences have only been studied retrospectively. The aim of this study was to investigate posttraumatic stress symptoms in children who have experienced an awareness event. In this prospective cohort study, children who were found to have experienced intraoperative awareness in our previous study were approached for assessment for posttraumatic stress symptoms using the Trauma Symptom Checklist for Children (Alternate version; TSCC-A). Seven children were aware in the original cohort. Only four families agreed to participate and were interviewed via telephone. Only one child recalled the awareness event. No children exhibited trauma related symptoms in the clinically significant range. Although no children had clinically significant symptoms, the small numbers and failure to follow-up all children limit any conclusions with respect to true incidence of posttraumatic stress disorder in children who have had an awareness event.

The Incidence of Intraoperative Awareness in Children: Childhood Awareness and Recall Evaluation

There is a considerable discrepancy between the reported incidences of awareness under anesthesia in children (0.2%-2.7%). In this prospective, observational, cohort study we evaluated 1) the incidence of awareness during general anesthesia in children across three settings, 2) factors contributing to awareness, and 3) short-term psychological effects of awareness. Children (aged 5-15 yr) who underwent general anesthesia were included, and all perioperative data including anesthetic drugs were collected prospectively. Children were interviewed three times postoperatively using a semistructured questionnaire. All cases of possible or probable awareness were discussed with the child's care providers to confirm or refute the memories. Internal consensus among investigators across sites was reached, and these cases and a random selection of others were reviewed by three external reviewers. For the purpose of this study, possible/probable awareness was defined as cases with agreement between the internal consensus and at least two of the three external reviewers. One thousand seven hundred eighty-four children completed at least one interview. Thirty-two cases were coded as possible or probable awareness by at least one entity (i.e., either the internal consensus or one of the external reviewers). Fourteen of these cases met the definition for possible/probable awareness, making the incidence of awareness 0.8%. Six of the 14 children with awareness (43%) remembered feeling scared during their surgery and three (21%) reported hurting. Two children in this group (14%) said they would feel worse if they had to have surgery again, which was not significantly different from reports of children with no recall (15%). None of the children with awareness required psychological follow-up. Endoscopic procedures were associated with a higher risk for awareness (relative risk = 4.5 [confidence interval 1.5-13.6]). Although 0.8% of children experienced possible/probable awareness in this study, none experienced short-term psychological distress.

Intra-operative awareness in children and post-traumatic stress disorder

Intra-operative awareness in children and post-traumatic stress disorder

Intraoperative awareness during paediatric anaesthesia

BackgroundPrevious studies indicate a higher incidence of awareness during anaesthesia in children than in adults, that is, around 1% vs 0.2%. In this prospective cohort study, we determined the incidence of intraoperative awareness in children undergoing elective or emergency surgery at a university children's hospital. MethodsData from 928 consecutive paediatric patients, aged 5–18 yr, were collected prospectively over a 12 month period. Interviews using a structured questionnaire were scheduled at three time points: within 24 h after the operation, and 3–7 and 30 days after operation. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, the case was classified as a true awareness case. ResultsThe interviews generated 26 cases of suspected awareness. Six cases were judged to be true awareness, equalling a 0.6% incidence (95% confidence interval 0.03–1.40%). Auditory and sensory perceptions were the sensations most reported by these six children. Pain, anxiety, and paralysis were less often mentioned. The children in general did not report awareness as stressful. ConclusionsThe incidence of awareness in this study, in children undergoing general anaesthesia, is comparable with recent reports from other countries, and appears to be higher than that reported in adults.

Awareness in children: another two cases

Intraoperative awareness is an anesthesia complication and occurs when a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events. Awareness is well described phenomenon in adults, with an incidence of 0.1-0.2 % for low-risk surgical procedures. Recent studies have shown that awareness in children is more common than in adults. However, causes and the long-term psychological impact of awareness in children are unknown. We report on two cases of intraoperative awareness in children in an attempt to throw further light on this complex problem.

Intra‐operative awareness in children: the value of an interview adapted to their cognitive abilities

Intra-operative awareness in paediatric patients has been little studied for many years because of the difficulties in relying on children's testimony. Earlier questionnaires used to detect this complication were not adapted to children's language and memory capacities. By using a qualitative method, a semi-structured in-depth interview adapted to their cognitive abilities, we have now conducted a prospective evaluation of the incidence and risk factors for intra-operative awareness in children undergoing general anaesthesia. Data were obtained from interviews with 410 children (aged 6-16 years) which were conducted within 36 h of general anaesthesia for elective or emergency surgery. One month after surgery, 293 of these patients were interviewed again. Three independent adjudicators classified each potential case of awareness. We considered awareness to include both the 'confirmed awareness' and the 'possible awareness' cases. The accuracy of the children's recall was calculated. The relationship between their awareness and the anaesthesia management was examined. There were five cases of confirmed awareness, and six cases of possible awareness. The incidence of confirmed awareness was 1.2%, but when the possible cases were also considered, the overall incidence of this complication was as high as 2.7% (95% confidence interval, 1.4-5.0%). The only predictive factor identified was the multiple manoeuvres with which the airways were secured (odds ratio, 8.4; 95% confidence interval, 2.4-29.07%). The present study confirms the existence of intra-operative awareness in the paediatric population. The application of a semi-structured in-depth interview adapted to the cognitive capacities of the children appears to enhance the detection of awareness in this population.

Intraoperative awareness in children: myth or reality?

This review will outline old and recent data about the prevalence, causes and potential consequences of intraoperative awareness in children and give details on its detection. Recent studies have confirmed the higher incidence of intraoperative awareness in children than in adults while using modern anaesthetic techniques. To detect this complication in children, the Brice interview, commonly used in adults, has to be adapted to children's cognitive capacities, with an extended follow-up. Neither the old nor the recent studies clearly identify predictive risk factors. Children describe the same perceptions as adults during their awareness period (mainly auditory and tactile sensations), but with fewer negative thoughts. Moreover, they do not seem to be affected by this experience, as they do not have long-term psychological sequelae. The prevention of intraoperative awareness in children is the same as in adults, the major factor being awareness of this complication. Intraoperative awareness is a reality in school-aged children. A larger multicentre study and large-scale follow-up is required in order to confirm the higher incidence of awareness and identify the risk factors and long-term psychological sequelae of this complication in the paediatric population.

Psychological impact of intraoperative awareness in children

Psychological impact of intraoperative awareness in children

Intraoperative awareness in children: an observational study

Intraoperative awareness in children: an observational study