Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

Department of Anesthesia, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China.
Chinese medical journal (Impact Factor: 1.05). 08/2005; 118(14):1190-4.
Source: PubMed


Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5% - 23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occurred and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.
Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report about patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.
The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P > 0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P > 0.05). Awareness easily occurred before bypass grafting or CPB.
Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the incidence of awareness of patients under CPB.

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Available from: Yun Yue, Oct 07, 2015
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    • "Surgical procedures typically identified as belonging to this category are cardiac, obstetric and multiple trauma surgeries [28]. Patients undergoing cardiopulmonary bypass have reported an awareness incidence from 1.1-23% [33,34]. The incidence of awareness related to obstetric anesthesia ranges from 0.4-1.3% "
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    ABSTRACT: Anesthesia awareness is defined as both consciousness and recall of surgical events. New research has been conducted out to test this phenomenon. However, testing methods have not proven reliable, including those using devices based on electroencephalographic techniques to detect and prevent intraoperative awareness. The limitations of a standard intraoperative brain monitor reflect our insufficient understanding of consciousness. Moreover, patients who experience an intraoperative awareness can develop serious post-traumatic stress disorders that should not be overlooked. In this review, we introduce the incidence of intraoperative awareness during general anesthesia and discuss the mechanisms of consciousness, as well as risk factors, various monitoring methods, outcome and prevention of intraoperative awareness.
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  • L Xu · A-S Wu · Y Yue
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    ABSTRACT: The incidence of awareness in patients undergoing general anesthesia is 0.1-0.2% in Western countries. The medical literatures about awareness during general anesthesia are still rare in China, but some previous studies have reported a higher incidence (1.4-6%) of intra-operative awareness. To find out the reason why the incidence reported in China is much higher than that in Western countries, we performed a prospective, multicenter, non-randomized observational study to determine the true incidence of intra-operative awareness in China. This is a prospective, non-randomized descriptive cohort study that was conducted at 25 academic medical centers in China. Eleven thousand one hundred and eighty-five patients were interviewed by research staff for evaluation of awareness at the first and fourth day after general anesthesia with muscle relaxation. An independent blinded committee evaluated the responses and determined whether awareness occurred. Necessary data were collected for a binary logistic regression analysis. Data from 11,101 patients were presented. Forty-six cases (0.41%) were reported as definite awareness and 47 additional cases (0.41%) as possible awareness. Three hundred and fifty-five patients (3.19%) had dreams during general anesthesia. Awareness was associated with increased American Society of Anesthesiologists (ASA) physical status, a previous anesthesia, and anesthesia methods of total intravenous anesthesia. The incidence of intra-operative awareness in China is approximately 0.41%, two to three times higher than that widely cited in Western countries. Inappropriately light anesthesia, and the population proportion of surgery and general anesthesia in China may account for the difference. ( Identifier, NCT00693875.).
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    ABSTRACT: Rhythms on electroencephalography (EEG) are known to slow with cardiopulmonary bypass (CPB), however electroencephalographic bicoherence analysis, one of the methods to examine EEG synchronization, which is necessary for the understanding of the network regulation involved, has been poorly examined in this period. Subjects comprised 11 patients scheduled to undergo heart surgery under extracorporeal circulation. Anesthesia was maintained by intravenous administration of propofol combined with remifentanil, using a bispectral index (BIS) monitor to keep an identical BIS value (target BIS value, 40-45). Raw EEG signals were collected through the BIS monitor. Approximate entropy, bicoherence and power spectrum were analyzed before and after CPB, in addition to other EEG parameters. In the late hypothermic CPB period, both 95% spectral edge frequency and approximate entropy decreased, notwithstanding a lack of significant difference in BIS index. Bicoherence growths in delta-theta and alpha areas decreased simultaneously. In the late CPB period, although BIS value is unchanged, EEG often expresses a slow EEG rhythm accompanied by disproportional de-synchronous characteristics. CPB caused the EEG de-synchronous features, which are not quantified by the BIS algorithm. It has the possibility to increase the vulnerability of nociceptive perception.
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