To sleep, perchance to dream? NOT!
MBA, Department of Anesthesiology, Emory University School of Medicine, 49 Jesse Hill Jr. Dr., SE, Atlanta, GA 30303. .Anesthesia and analgesia (Impact Factor: 3.08). 03/2009; 108(2):391-2. DOI:10.1213/ane.0b013e31818ddfb1
- Anesthesia & Analgesia 06/2005; 100(5):1544; author reply 1545. · 3.30 Impact Factor
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ABSTRACT: Patients who are given general anaesthesia are not guaranteed to remain unconscious during surgery. Knowledge about the effectiveness of current protective measures is scarce, as is our understanding of patients' responses to this complication. We did a prospective case study to assess conscious awareness during anaesthesia. 11785 patients who had undergone general anaesthesia were interviewed for awareness on three occasions: before they left the post-anaesthesia care unit, and 1-3 days and 7-14 days after the operation. We identified 18 cases of awareness and one case of inadvertent muscle blockade that had occurred before unconsciousness. Incidence of awareness was 0.18% in cases in which neuromuscular blocking drugs were used, and 0.10% in the absence of such drugs. 17 cases of awareness were identified at the final interview, but no more than 11 would have been detected if an interview had been done only when the patients left the post-anaesthesia care unit. Four non-paralysed patients recalled intraoperative events, but none had anxiety during wakefulness or had delayed neurotic symptoms. This finding contrasts with anaesthesia with muscle relaxants, during which 11 of 14 patients had pain, anxiety, or delayed neurotic symptoms. After repeated discussion and information, the delayed neurotic symptoms resolved within 3 weeks in all patients. Analysis of individual cases suggests that a reduced incidence of recall of intraoperative events would not be achieved by monitoring of end-tidal anaesthetic gas concentration or by more frequent use of benzodiazepines. The inability to prevent awareness by conventional measures may advocate monitoring of cerebral activity by neurophysiological techniques. However, the sensitivity of such techniques is not known, and in the light of our findings, at least 861 patients would need to be monitored to avoid one patient from suffering due to awareness during relaxant anaesthesia.The Lancet 03/2000; 355(9205):707-11. · 39.06 Impact Factor
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ABSTRACT: Failure of general anesthesia to render a patient insensate, termed "awareness," is estimated to affect between 40,000 and 140,000 patients in the US each year. This study investigated the occurrence of post-traumatic stress disorder (PTSD) in subjects who reported a past episode of intraoperative awareness. We inquired about intraoperative and postoperative experiences and studied the relationship between various surgical experiences and currently meeting the diagnosis of PTSD. Sixteen postawareness subjects and 10 postgeneral anesthesia controls completed the Clinician Administered PTSD Scale (CAPS), a standardized clinical rating scale for PTSD, and a questionnaire about peri-operative experiences. Nine of 16 subjects (56.3%), a mean of 17.9 postoperative years, and no controls met diagnostic criteria for current PTSD (X(2)= 8.6, df = 1, P<.01). Common intraoperative experiences included an inability to communicate, helplessness, terror, and pain. Postawareness patients had significant postoperative distress related to feeling unable to communicate, unsafe, terrified, abandoned and betrayed. Perioperative dissociative experiences predicted having current PTSD. Being conscious during surgery is a traumatic event that may result in developing chronic PTSD. Further studies should include prospective designs of prevalence and long-term psychological, social, and overall health effects, and ways of preventing and treating awareness-induced PTSD.General Hospital Psychiatry 08/1998; 23(4):198-204. · 2.98 Impact Factor
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