Intraoperative awareness in children: myth or reality?

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 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.

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.