Awareness and memory function during paediatric anaesthesia
J Andrade1, C Deeprose, I Barker
1School of Psychology, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. j.andrade@plymouth.ac.uk
Insights
Intraoperative awareness during pediatric anesthesia occurred in 1.1% of children, with no evidence of memory priming. This study highlights a higher incidence in children compared to adults, emphasizing the need for careful anesthetic management.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Previous research suggests higher awareness during anesthesia in children than adults.
- This study is the first large-scale assessment of intraoperative awareness in pediatric anesthesia using the isolated forearm technique.
- It is also the first large-scale study on memory function during pediatric anesthesia.
Purpose of the Study:
- To assess the incidence of intraoperative awareness in children undergoing anesthesia.
- To evaluate memory function (implicit and explicit) during pediatric anesthesia.
- To investigate behavioral changes associated with anesthesia in children.
Main Methods:
- 184 children (5-18 years) underwent the modified isolated forearm technique during volatile anesthesia.
- Bispectral index monitoring was performed in a subset of patients.
- Implicit memory was tested via word identification, and explicit memory via structured interview post-anesthesia.
Main Results:
- No child exhibited explicit recall of intraoperative events or implicit memory for presented words.
- The incidence of intraoperative awareness was 1.1% (2 out of 184 children).
- One child reported discomfort; neither of the two aware children showed implicit memory or adverse behavioral changes.
Conclusions:
- The incidence of intraoperative awareness in children is significantly higher (approx. 8x) than in adults based on postoperative recall.
- Unlike adults, no evidence of preserved memory priming was found in children during anesthesia.
- Findings underscore the importance of monitoring and managing awareness during pediatric anesthesia.
Background:
Previous research indicates a much higher incidence of awareness during anaesthesia in children than in adults. The present study is the first large-scale, intraoperative assessment of awareness during paediatric anaesthesia using the isolated forearm technique, and the first large-scale study of memory function during paediatric anaesthesia.
Methods:
One hundred and eighty-four children, 5-18 yr, underwent the isolated forearm technique during the first 17 min of surgery while receiving volatile anaesthesia. The isolated forearm technique was modified to accommodate brief or no paralysis. Bispectral index was monitored in a subset of 54 patients. Sixteen neutral words were played 20 times during surgery and, on recovery, implicit memory for these words was tested with a word identification task. Explicit memory for the surgical period was tested with a structured interview. Behavioural changes were assessed with age-appropriate questionnaires.
Results:
No child had explicit recall of intraoperative events on recovery, and there was no evidence of implicit memory for words presented during anaesthesia. Two of 184 children made unambiguous and verified responses on the modified isolated forearm technique, an incidence of intraoperative awareness of 1.1%. One of these children reported that he was uncomfortable and not completely unconscious during surgery. Neither child had implicit memory for the neutral words, or adverse behaviour change.
Conclusions:
The incidence of awareness during surgery in children is approximately eight times that measured in adults by postoperative recall. In contrast to adults, there is no evidence for preserved memory priming during anaesthesia.
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