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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.
Insights
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.
Abstract:
During routine adult anesthesia, the risk of awareness is 0.1%-0.2%. No recent studies have reported the incidence in children. Altered pharmacology and differing anesthesia techniques suggest that the incidence may differ in children. In this prospective cohort study, we determined the incidence of awareness during anesthesia in children. Eight-hundred-sixty-four children aged 5-12 yr who had undergone general anesthesia at The Royal Children's Hospital were interviewed on 3 occasions to determine the incidence of awareness. The awareness assessment was nested within a larger study of behavior change after anesthesia. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, a case was classified as true awareness. Twenty-eight reports were generated. There were 7 cases of true awareness, for an incidence of 0.8% (95% confidence interval, 0.3%-1.7%). Only one aware child received neuromuscular blockers, compared with 12% in the nonaware group. No aware child reported distress, and no substantial difference was detected in behavior disturbance between aware (20%) and nonaware (16%) children. The data provide some evidence that, like adults, children are also at risk of intraoperative awareness. Although the cause remains unclear, anesthesiologists should be alerted to the possibility of awareness in children.
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