Awareness with Recall During General Anesthesia: A Cross-Sectional Study
DOI:
https://doi.org/10.36283/PJMD13-3/015Keywords:
Anaesthesia, general anaesthesia, awareness monitoring, depth of anaesthesiaAbstract
Background: Accidental awareness and recall a well-known complication of anesthesia and sedation despite advancements in monitoring, drugs, and techniques. This study aimed to determine the prevalence and factors of awareness with recall (AWR) during general anesthesia in a tertiary care hospital.
Methods: A cross-sectional study was conducted at Maqsood Medical Center Peshawar from April to October 2022, with a total of 383 patients ≥18 years, in good neurological health, and having ASA Physical Status I, II, III, IV undergoing elective general anesthesia-based procedures were included through a convenience sampling technique. Data was collected by administering the Brice questionnaire for structured interviews one hour after admission in PACU after assessing responsiveness. Data was analyzed using SPSS 26 with p<0.05 considered significant.
Results: The mean age of the study participants was 40.93+05.2 years. The Incidence of awareness was found 7(1.8%) out of which 8(2.1%) experienced pain, 7(1.8%), being touched, 7(1.8%), hearing sounds, 8(2.1%), unable to speak 8(2.1%), feeling of paralysis, 6(1.6%) experienced tube being inside the throat, 17(4.4%) experienced an abrupt increase in blood pressure, 7(1.8%) experienced sweating, and tear production and 5(1.3%) observed movement and grimacing. No specific association was found between awareness of gender and surgery type. There was a significant association between awareness and ASA classification(p=0.000) and with intraoperative pain(p=0.00), and hemodynamic changes (p=0.04).
Conclusion: In conclusion, there was an unexpectedly high prevalence of anesthetic awareness with recall. During surgery, patients typically experience pain, difficulty in communication, and paralysis.
Keywords: Analgesia, Anesthesia, Operative Surgical Procedure, Metacognition.
References
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesthesia & analgesia. 2021;89(3):652–658. DOI: 10.1097/00000539-199909000-00022
Leslie K, Chan MT, Myles PS, Forbes A, McCulloch TJ. Posttraumatic stress disorder in aware patients from the B-aware trial. Anesthesia & analgesia. 2010;110(3):823-828. DOI: 10.1213/ANE.0b013e3181b8b6ca
Samuelsson P, Brudin L, Sandin RH. Late psychological symptoms after awareness among consecutively included surgical patients. The Journal of the American Society of Anesthesiologists. 2007 ;106(1):26-32. DOI: 10.1097/00000542-200701000-00009
Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesthesia & Analgesia. 1999 ;88(5):1085-1091. DOI: 10.1097/00000539-199905000-00023
MM G. Learning and memory during general anesthesia: an update. Anesthesiology. 1997;87:387-410. DOI: 10.1097/00000542-199708000-00027
Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. The Lancet. 2000;355(9205):707-171. DOI: 10.1016/S0140-6736(99)11010-9
Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesthesia & Analgesia. 2004;99(3):833-839. DOI: 10.1213/01.ANE.0000130261.90896.6C
Samuelsson P, Brudin L, Sandin RH. Late psychological symptoms after awareness among consecutively included surgical patients. The Journal of the American Society of Anesthesiologists. 2007;106(1):26-32. DOI: 10.1097/00000542-200701000-00009
Kim MC, Fricchione GL, Akeju O. Accidental awareness under general anaesthesia: Incidence, risk factors, and psychological management. BJA education. 2021;21(4):154. DOI: 10.1016/j.bjae.2020.12.001
Abed H, Reilly D, Burke M, Daly B. Patients with head and neck cancers' oral health knowledge, oral health‐related quality of life, oral health status, and adherence to advice on discharge to primary dental care: A prospective observational study. Special Care in Dentistry. 2019;39(6):593-602. DOI: 10.1111/scd.12418
Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, et al. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–544. DOI: 10.1016/j.annemergmed.2020.10.012
Tasbihgou SR, Vogels MF, Absalom AR. Accidental awareness during general anaesthesia–a narrative review. Anaesthesia. 2018;73(1):112-122. DOI: 10.1111/anae.14124
Linassi F, Zanatta P, Tellaroli P, Ori C, Carron M. Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens. Br J Anaesth. 2018;121(1):198–209. DOI: 10.1016/j.bja.2018.02.019
Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesthesia & Analgesia. 2004;99(3):833-839. DOI: 10.1213/01.ANE.0000130261.90896.6C
Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. The Lancet. 2000;355(9205):707-711. DOI: 10.1016/S0140-6736(99)11010-9
Xu L, Wu AS, Yue Y. The incidence of intra‐operative awareness during general anesthesia in China: a multi‐center observational study. Acta Anaesthesiologica Scandinavica. 2009;53(7):873-882. DOI: 10.1111/j.1399-6576.2009.02016.x
Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. British journal of anesthesia. 1970;42(6):535-542. DOI: 10.1093/bja/42.6.535
Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C. Anesthesia awareness and the bispectral index. New England journal of medicine. 2008;358(11):1097-108. DOI: 10.1056/NEJMoa0707361
Samuelsson P, Brudin L, Sandin RH. Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness. Acta anaesthesiologica scandinavica. 2008;52(6):805-809. DOI: 10.1111/j.1399-6576.2008.01634.x
Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. The lancet. 2004;363(9423):1757-1763. DOI: 10.1016/S0140-6736(04)16300-9
Szostakiewicz KM, Tomaszewski D, Rybicki Z, Rychlik A. Intraoperative awareness during general anaesthesia: results of the observational survey. Anaesthesiology intensive therapy. 2014;46(1):23-28. DOI: 10.5603/AIT.2014.0005
Cascella M, Bimonte S, Amruthraj NJ. Awareness during emergence from anesthesia: Features and future research directions. World Journal of Clinical Cases. 2020;8(2):245. doi: 10.12998/wjcc.v8.i2.245
Bergman IJ, Kluger MT, Short TG. Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic Incident Monitoring Study. Anaesthesia. 2002;57(6):549-556. DOI: 10.1046/j.1365-2044.2002.02565.x
Pandit JJ, Cook TM, Jonker WR, O'Sullivan E. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British journal of anaesthesia. 2013;110(4):501-509. DOI: 10.1111/anae.12190
Cheng VY, Martin LJ, Elliott EM, Kim JH, Mount HT, Taverna FA, Roder JC, MacDonald JF, Bhambri A, Collinson N, Wafford KA. α5GABAA receptors mediate the amnestic but not sedative-hypnotic effects of the general anesthetic etomidate. Journal of Neuroscience. 2006;26(14):3713-3730. DOI: 10.1523/JNEUROSCI.5024-05.2006
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
How to Cite
