The Study of Intraoperative Consciousness after Tracheal Intubation

Area of Science:

• Anesthesiology
• Neuroscience
• Critical Care Medicine

Background:

• Intubation can lead to intraoperative awareness in up to 25% of patients.
• The isolated forearm technique (IFT) offers a method to assess consciousness via verbal commands.
• Assessing awareness during general anesthesia remains a critical challenge.

Purpose of the Study:

• To evaluate the incidence of intraoperative consciousness using the IFT in patients undergoing general anesthesia.
• To determine the frequency of postoperative recall after intubation.
• To establish the utility of IFT in detecting awareness during a key phase of anesthesia induction.

Main Methods:

• 132 adult patients undergoing general anesthesia were enrolled.
• The isolated forearm technique was employed, with a tourniquet applied to one arm.
• Verbal commands were issued pre- and post-intubation, with responses assessed via isolated forearm movement and TOF stimulation.

Main Results:

• No patients demonstrated a positive IFT response, indicating no intraoperative awareness.
• Postoperative interviews revealed no explicit recall of awareness.
• 10.7% of patients reported pleasant dreams, and 43% cited pain as the worst aspect of surgery.

Conclusions:

• Intraoperative consciousness following intubation under standard general anesthesia is infrequent.
• The isolated forearm technique may be a valuable tool for monitoring awareness.
• Postoperative recall of awareness appears uncommon in this patient cohort.