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Intraoperative awareness in children: myth or reality?
Irène Iselin-Chaves1, Ursula Lopez, Walid Habre
1Paediatric Anaesthesia Unit, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Insights
Intraoperative awareness is more common in children than adults. While children experience awareness similarly to adults, they show fewer negative thoughts and no long-term psychological effects.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Neuroscience
Background:
- Intraoperative awareness (IA) is a rare but significant complication during anesthesia.
- Understanding IA in pediatric patients is crucial due to potential psychological impacts.
Purpose of the Study:
- To review current data on the prevalence, causes, and consequences of IA in children.
- To detail methods for detecting IA in pediatric populations.
Main Methods:
- Review of existing literature on intraoperative awareness in children.
- Analysis of data on incidence, risk factors, and detection methods.
Main Results:
- Recent studies indicate a higher incidence of IA in children compared to adults, even with modern anesthesia.
- The Brice interview requires adaptation for children; predictive risk factors remain unclear.
- Children report sensory perceptions (auditory, tactile) during IA with fewer negative thoughts and no apparent long-term psychological sequelae.
Conclusions:
- Intraoperative awareness is a recognized event in school-aged children.
- Further multicenter studies are needed to confirm incidence, identify risk factors, and assess long-term effects in pediatric patients.
Purpose Of Review:
This review will outline old and recent data about the prevalence, causes and potential consequences of intraoperative awareness in children and give details on its detection.
Recent Findings:
Recent studies have confirmed the higher incidence of intraoperative awareness in children than in adults while using modern anaesthetic techniques. To detect this complication in children, the Brice interview, commonly used in adults, has to be adapted to children's cognitive capacities, with an extended follow-up. Neither the old nor the recent studies clearly identify predictive risk factors. Children describe the same perceptions as adults during their awareness period (mainly auditory and tactile sensations), but with fewer negative thoughts. Moreover, they do not seem to be affected by this experience, as they do not have long-term psychological sequelae. The prevention of intraoperative awareness in children is the same as in adults, the major factor being awareness of this complication.
Summary:
Intraoperative awareness is a reality in school-aged children. A larger multicentre study and large-scale follow-up is required in order to confirm the higher incidence of awareness and identify the risk factors and long-term psychological sequelae of this complication in the paediatric population.
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