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Monitoring consciousness in the pediatric patient: not just a small adult
1Department of Anesthesiology, School of Medicine, Jikei University, 3-25-8 Nishi Shinbashi, Minato-Ku, Tokyo 105-8461, Japan. uezono@jikei.ac.jp
Insights
Intraoperative awareness, or memory of surgery, is more common in children (0.8%) than adults (0.2%). Current monitoring methods are ineffective for pediatric patients, necessitating further research.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Intraoperative awareness (postoperative memory of surgical events) occurs in approximately 0.2% of adult surgical patients.
- A recent study found a significantly higher incidence of 0.8% in children aged 5-12 years.
- Unlike adults, the psychological and medico-legal sequelae in children are typically minor.
Purpose of the Study:
- To investigate the incidence of intraoperative awareness in pediatric surgical patients.
- To evaluate the effectiveness of current monitoring technologies for detecting intraoperative awareness in children.
- To highlight the need for further research in pediatric anesthesiology.
Main Methods:
- Review of a large-scale prospective study from a single institution.
- Analysis of intraoperative awareness incidence in children aged 5-12 years.
- Comparison with existing data on adult intraoperative awareness.
Main Results:
- The incidence of intraoperative awareness in pediatric patients (5-12 years) was found to be 0.8%.
- Sequelae of awareness in children were reported as relatively minor compared to adults.
- No current monitor has demonstrated effectiveness in detecting intraoperative awareness in pediatric patients.
Conclusions:
- Intraoperative awareness is a more frequent event in children than previously estimated.
- Effective monitoring for intraoperative awareness in pediatric patients is currently lacking.
- Further research is crucial to determine optimal monitoring strategies and clinical practice guidelines for pediatric anesthesiology.
Abstract:
Intraoperative awareness, defined as postoperative memory for intraoperative events, is believed to occur about 0.2% of the time in a general adult surgical population. A recent large-scale prospective study from a single institution revealed a strikingly high incidence (0.8%) of intraoperative awareness in children aged 5-12 years although the sequelae of awareness during surgery in children were reported to be relatively minor. This contrasts with awareness in adult patients, for whom this complication often causes psychological trauma, thus having medico-legal implications. Various monitors to detect intraoperative awareness have been used with varying success in adults. To date, however, no monitor has been shown to be effective in detecting intraoperative awareness during surgery in pediatric patients. Further research is required to clarify the rates of intraoperative awareness in the pediatric population as well as the need for monitoring this event during the clinical practice of pediatric anesthesiology.
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