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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Detecting awareness in children by using an auditory intervention
Andrew J Davidson1, Suzette J Sheppard, Anneke L Engwerda
1Department of Anaesthesia, Royal Children's Hospital, Melbourne, Australia. andrew.davidson@rch.org.au
Insights
This study found a low incidence of intraoperative awareness in children undergoing anesthesia, using auditory stimuli to assess awareness. The findings suggest awareness is less common in children than previously reported.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Neuroscience
Background:
- Intraoperative awareness in children is difficult to assess accurately.
- A lack of specific measurement tools hinders understanding of awareness incidence and causes in pediatric patients.
- Previous reports suggest a higher incidence of awareness in children compared to adults.
Purpose of the Study:
- To determine the incidence and timing of intraoperative awareness in children.
- To utilize auditory stimuli as a method for assessing awareness during anesthesia in pediatric patients.
- To establish a reliable method for identifying awareness in children under anesthesia.
Main Methods:
- Auditory stimuli (animal noises) were played to 539 children (aged 5-12) during anesthesia.
- Children were interviewed on post-anesthetic days 1 and 3 to assess awareness.
- Awareness was confirmed by consensus among four adjudicators based on structured interviews.
Main Results:
- Out of 500 children interviewed, one case of awareness was confirmed.
- The confirmed case of awareness occurred despite the child not reporting hearing the auditory stimulus.
- Thirty-five reports were sent for adjudication, indicating a low rate of potential awareness events.
Conclusions:
- The incidence of intraoperative awareness in this pediatric study is lower than previously reported.
- The study provides a novel method for assessing awareness in children during anesthesia.
- Further research may refine the understanding of awareness mechanisms in pediatric anesthesia.
Background:
The incidence of awareness has been reported to be higher in children than in adults. Accurately assessing awareness in children is difficult, and the lack of a specific measure of awareness makes it difficult to determine exactly how many and why children are aware. The aim of this study was to determine the incidence and timing of awareness in children by using auditory stimuli applied during anesthesia.
Methods:
Three easily identified animal noises were played repeatedly through headphones during three specific phases of anesthesia in 539 children aged 5-12 yr. Children were not told that this would happen. Awareness was determined with a structured interview on days 1 and 3 after the anesthetic. All positive responses were sent to four adjudicators for assessment, and awareness was defined as having occurred if all adjudicators agreed that the child was aware.
Results:
Five hundred children were interviewed at least once after the anesthetic. Thirty-five reports were sent to the adjudicators, and one child was classified as aware. This child was deemed to be aware even though he did not report hearing an animal.
Conclusions:
The incidence of awareness in this study is less than reported previously.
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