Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period.

Autor: Deis AS; Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA., Schnetz MP; Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA., Ibinson JW; Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA.; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, USA.; Department of Anesthesiology, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA., Vogt KM; Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA. vogtkm@upmc.edu.; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA. vogtkm@upmc.edu.; Center for the Neural Basis of Cognition, Pittsburgh, USA. vogtkm@upmc.edu.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2020 Mar 09; Vol. 20 (1), pp. 62. Date of Electronic Publication: 2020 Mar 09.
DOI: 10.1186/s12871-020-00974-3
Abstrakt: Background: Awareness with recall under general anesthesia remains a rare but important issue that warrants further study.
Methods: We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics.
Results: The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case.
Conclusions: Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.
Databáze: MEDLINE
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