Accidental awareness during anesthesia in children

Area of Science:

• Anesthesiology
• Pediatric Anesthesia
• Patient Safety

Background:

• Accidental awareness during general anesthesia (AAGA) is a recognized complication.
• Understanding AAGA in pediatric populations is crucial for improving patient care.
• Previous studies have provided insights into AAGA, but specific pediatric data requires further exploration.

Purpose of the Study:

• To review the current understanding of accidental awareness during general anesthesia in children.
• To analyze the incidence, characteristics, and contributing factors of AAGA in pediatric patients.
• To provide guidance on managing and potentially preventing AAGA in children.

Main Methods:

• Educational review of existing literature and data.
• Analysis of findings from the 5th National Audit Project (NAP5) concerning AAGA.
• Examination of spontaneous reports and direct questioning data for incidence estimation.

Main Results:

• Incidence estimates for pediatric AAGA range significantly, from 1 in 135 (direct questioning) to 1 in 51,500 (spontaneous reporting).
• AAGA experiences are highly variable, often linked to procedure type and anesthetic technique, not age.
• Approximately 50% of AAGA events were distressing, typically lasting under 5 minutes, with neuromuscular blockade and pain being key distress factors. Most cases (70%) occurred during induction or emergence.

Conclusions:

• The value of depth of anesthesia monitoring in preventing pediatric AAGA is uncertain but may be beneficial in specific anesthetic techniques (e.g., TIVA with NMB).
• Sympathetic reception of AAGA reports from children is essential.
• A generic protocol for managing distressed patients experiencing AAGA is presented.