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Awareness during anesthesia in children: a prospective cohort study
Andrew J Davidson1, Grace H Huang, Caroline Czarnecki
1*Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia; †Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia; ‡Clinical Epidemiology and Biostatistics Unit, The Royal Children's Hospital, Parkville, Victoria, Australia; and §Department of Psychology, The Royal Children's Hospital, Parkville, Victoria, Australia.
Anesthesia and Analgesia
|February 25, 2005
Summary
Children undergoing general anesthesia have a 0.8% risk of intraoperative awareness, similar to adults. This study highlights the need for anesthesiologists to consider awareness in pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Neuroscience
Background:
- Routine adult anesthesia carries a 0.1%-0.2% risk of intraoperative awareness.
- Limited recent data exists on awareness incidence in pediatric populations.
- Pharmacological differences and anesthetic techniques may alter awareness risk in children.
Purpose of the Study:
- To prospectively determine the incidence of intraoperative awareness in children aged 5-12 years undergoing general anesthesia.
- To assess potential risk factors and patient outcomes associated with pediatric anesthesia awareness.
- To inform anesthesiologists about the possibility of awareness during pediatric anesthesia.
Main Methods:
- Prospective cohort study involving 864 children (5-12 years) undergoing general anesthesia.
- Awareness assessment conducted through interviews on three separate occasions post-anesthesia.
- Suspected awareness reports were adjudicated by four independent experts to confirm true awareness cases.
Main Results:
- An incidence of 0.8% (95% CI, 0.3%-1.7%) true awareness was observed in the pediatric cohort.
- Only one aware child received neuromuscular blockers, contrasting with 12% in the non-aware group.
- No aware children reported distress, and behavioral disturbance differences between aware and non-aware groups were not substantial.
Conclusions:
- Children, like adults, are at risk for intraoperative awareness during general anesthesia.
- The exact causes of awareness in children remain to be elucidated.
- Anesthesiologists should maintain vigilance for potential intraoperative awareness in pediatric patients.