On the Intraoperative Awareness General Anesthesia
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Published
Oct 31, 2023
Abstract
General anesthesia is a crucial component of modern medical practice, enabling surgeons to perform complex procedures and ensuring patient comfort. However, within the realm of general anesthesia, a rare but significant phenomenon called intraoperative awareness has garnered attention. Intraoperative awareness refers to the state of partial or complete consciousness experienced by some patients during surgery, despite being under anesthesia. This article aims to explore the concept of general anesthesia and intraoperative awareness, shedding light on its prevalence, causes, impact, and management strategies. Understanding this phenomenon is vital for healthcare professionals to improve patient outcomes and enhance the safety of surgical procedures.
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Keywords
General Anesthesia, Intraoperative Awareness, Risk Factors, Health Effect, Prevention Techniques
References
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3. Wynn-Hebden A, Bouch DC. Anaesthesia for the obese patient. BJA Educ 2020; 20(11):388-395. DOI: https://doi.org/10.1016/j.bjae.2020.07.003
4. Mitchell M. Patient anxiety and conscious surgery. J Perioper Pract 2009; 19(6):168-173. DOI: https://doi.org/10.1177/175045890901900601
5. Brown EN, Purdon PL, Van Dort CJ. General anesthesia and altered states of arousal: A systems neuroscience analysis. Annu Rev Neurosci 2011; 34:601-628. DOI: https://doi.org/10.1146/annurev-neuro-060909-153200
6. Garcia PS, Kolesky SE, Jenkins A. General anesthetic actions on GABA(A) receptors. Curr Neuropharmacol 2010; 8(1):2-9. DOI: https://doi.org/10.2174/157015910790909502
7. Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol 2010; 59(1):3-8. DOI: https://doi.org/10.4097/kjae.2010.59.1.3
8. Hudetz AG. General anesthesia and human brain connectivity. Brain Connect 2012; 2(6):291-302. DOI: https://doi.org/10.1089/brain.2012.0107
9. Cook D, Simons DJ. Neuromuscular Blockade. [Updated 2022 Sep 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538301/
10. Smith G, D’Cruz JR, Rondeau B, et al. General Anesthesia for Surgeons. [Updated 2023 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493199/
11. Siddiqui BA, Kim PY. Anesthesia Stages. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557596/
12. Chung HS. Awareness and recall during general anesthesia. Korean J Anesthesiol 2014; 66(5):339-345. DOI: https://doi.org/10.4097/kjae.2014.66.5.339
13. Bischoff P, Rundshagen I. Awareness under general anesthesia. Dtsch Arztebl Int 2011; 108(1-2):1-7. DOI: https://doi.org/10.3238/arztebl.2011.0001
14. Cascella M, Bimonte S, Di Napoli R. Delayed emergence from anesthesia: What we know and how we act. Local Reg Anesth 2020; 13:195-206. DOI: https://doi.org/10.2147/LRA.S230728
15. Bektaş M, Çakan T, Kırdemir P, Engin M, Başar H. Detection method of intraoperative awareness: A randomized comparative study. Turk J Med Sci 2022; 52(6):1997-2003. DOI: https://doi.org/10.55730/1300-0144.5548
16. Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O’Connor K, O’Sullivan EP, Paul RG, Palmer JH, Plaat F, Radcliffe JJ, Sury MR, Torevell HE, Wang M, Hainsworth J, Pandit JJ; Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: Patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth 2014; 113(4):560-574. DOI: https://doi.org/10.1093/bja/aeu314
17. Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology 2008; 109(5):905-17. DOI: https://doi.org/10.1097/ALN.0b013e3181895bc1
18. Ho VP, Schiltz NK, Reimer AP, Madigan EA, Koroukian SM. High-risk comorbidity combinations in older patients undergoing emergency general surgery. J Am Geriatr Soc 2019; 67(3):503-510. DOI: https://doi.org/10.1111/jgs.15682
19. Braithwaite HE, Payne T, Duce N, Lim J, McCulloch T, Loadsman J, Leslie K, Webster AC, Gaskell A, Sanders RD. Impact of female sex on anaesthetic awareness, depth, and emergence: A systematic review and meta-analysis. Br J Anaesth 2023; 131(3):510-522. DOI: https://doi.org/10.1016/j.bja.2023.06.042
20. Kim D, Lee S, Pyeon T, Jeong S. Use of triazolam and alprazolam as premedication for general anesthesia. Korean J Anesthesiol 2015; 68(4):346-351. DOI: https://doi.org/10.4097/kjae.2015.68.4.346
21. Rayan AA, Hemdan SE, Shetaia AM. Root cause analysis of blunders in anesthesia. Anesth Essays Res 2019; 13(2):193-198. DOI: https://doi.org/10.4103/aer.AER_47_19
22. Gulenay M, Mathai JK. Depolarizing Neuromuscular Blocking Drugs. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532996/
23. Staheli B, Rondeau B. Anesthetic Considerations in the Geriatric Population. [Updated 2023 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK572137/
24. Ayoğlu H, Ayoğlu FN. Occupational risks for anaesthesiologists and precautions. Turk J Anaesthesiol Reanim 2021; 49(2):93-99. DOI: https://doi.org/10.5152/TJAR.2020.219
25. Srivastava P, Shetty P, Shetty S, Upadya M, Nandan A. Impact of noise in operating theater: A surgeon’s and anesthesiologist’s perspective. J Pharm Bioallied Sci. 2021; 13(Suppl 1):S711-S715. DOI: https://doi.org/10.4103/jpbs.JPBS_656_20
26. Al-Kadi MI, Reaz MB, Ali MA. Evolution of electroencephalogram signal analysis techniques during anesthesia. Sensors (Basel). 2013; 13(5):6605-6635. DOI: https://doi.org/10.3390/s130506605
27. Medical Advisory Secretariat. Bispectral index monitor: An evidence-based analysis. Ont Health Technol Assess Ser 2004; 4(9):1-70.
28. Richardson M, Moulton K, Rabb D, Rabb D, Kindopp S, Pishe T, Yan C, Akpinar I, Tsoi B, Chuck A. Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Mar. (CADTH Health Technology Assessment, No. 142.) 1, Introduction. Available at: https://www.ncbi.nlm.nih.gov/books/NBK362376/
29. Zhang M, Duan J, Chen Y, Zhang C. Application of intraoperative electromyography intelligent monitoring in orthopedic surgery under general anesthesia. Contrast Media Mol Imaging 2023; 2023:1484802. DOI: https://doi.org/10.1155/2023/1484802
30. Cascella M. Mechanisms underlying brain monitoring during anesthesia: Limitations, possible improvements, and perspectives. Korean J Anesthesiol 2016; 69(2):113-120. DOI: https://doi.org/10.4097/kjae.2016.69.2.113
31. Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry 2001; 23(4):198-204. DOI: https://doi.org/10.1016/s0163-8343(01)00142-6
32. Aceto P, Perilli V, Lai C, Sacco T, Ancona P, Gasperin E, Sollazzi L. Update on post-traumatic stress syndrome after anesthesia. Eur Rev Med Pharmacol Sci 2013; 17(13):1730-1737.
33. Coghill RC. Individual differences in the subjective experience of pain: New insights into mechanisms and models. Headache. 2010; 50(9):1531-1535. DOI: https://doi.org/10.1111/j.1526-4610.2010.01763.x
34. Luo M, Song B, Zhu J. Sleep Disturbances after general anesthesia: Current perspectives. Front Neurol 2020; 11:629. DOI: https://doi.org/10.3389/fneur.2020.00629
35. Amornyotin S. Sedation and monitoring for gastrointestinal endoscopy. World J Gastrointest Endosc. 2013; 5(2):47-55. DOI: https://doi.org/10.4253/wjge.v5.i2.47
36. Lundstrøm LH, Duez CH, Nørskov AK, Rosenstock CV, Thomsen JL, Møller AM, Strande S, Wetterslev J. Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents. Cochrane Database Syst Rev 2017; 5(5):CD009237. DOI: https://doi.org/10.1002/14651858.CD009237.pub2
37. Pathan H, Williams J. Basic opioid pharmacology: An update. Br J Pain 2012; 6(1):11-16. DOI: https://doi.org/10.1177/2049463712438493
38. Ghelardini C, Di Cesare Mannelli L, Bianchi E. The pharmacological basis of opioids. Clin Cases Miner Bone Metab 2015; 12(3):219-221. DOI: https://doi.org/10.11138/ccmbm/2015.12.3.219
39. Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30(3):209-220. DOI: https://doi.org/10.1111/pan.13809
40. Topor B, Oldman M, Nicholls B. Best practices for safety and quality in peripheral regional anaesthesia. BJA Educ 2020; 20(10):341-347. DOI: https://doi.org/10.1016/j.bjae.2020.04.007
41. Cascella M, Bimonte S, Amruthraj NJ. Awareness during emergence from anesthesia: Features and future research directions. World J Clin Cases 2020; 8(2):245-254. DOI: https://doi.org/10.12998/wjcc.v8.i2.245
42. O’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 33. Available at: https://www.ncbi.nlm.nih.gov/books/NBK2637/
43. Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7(7):CD006732. DOI: https://doi.org/10.1002/14651858.CD006732.pub4
2. Sandhu K, Dash H. Awareness during anaesthesia. Indian J Anaesth. 2009; 53(2):148-157.
3. Wynn-Hebden A, Bouch DC. Anaesthesia for the obese patient. BJA Educ 2020; 20(11):388-395. DOI: https://doi.org/10.1016/j.bjae.2020.07.003
4. Mitchell M. Patient anxiety and conscious surgery. J Perioper Pract 2009; 19(6):168-173. DOI: https://doi.org/10.1177/175045890901900601
5. Brown EN, Purdon PL, Van Dort CJ. General anesthesia and altered states of arousal: A systems neuroscience analysis. Annu Rev Neurosci 2011; 34:601-628. DOI: https://doi.org/10.1146/annurev-neuro-060909-153200
6. Garcia PS, Kolesky SE, Jenkins A. General anesthetic actions on GABA(A) receptors. Curr Neuropharmacol 2010; 8(1):2-9. DOI: https://doi.org/10.2174/157015910790909502
7. Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol 2010; 59(1):3-8. DOI: https://doi.org/10.4097/kjae.2010.59.1.3
8. Hudetz AG. General anesthesia and human brain connectivity. Brain Connect 2012; 2(6):291-302. DOI: https://doi.org/10.1089/brain.2012.0107
9. Cook D, Simons DJ. Neuromuscular Blockade. [Updated 2022 Sep 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538301/
10. Smith G, D’Cruz JR, Rondeau B, et al. General Anesthesia for Surgeons. [Updated 2023 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493199/
11. Siddiqui BA, Kim PY. Anesthesia Stages. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557596/
12. Chung HS. Awareness and recall during general anesthesia. Korean J Anesthesiol 2014; 66(5):339-345. DOI: https://doi.org/10.4097/kjae.2014.66.5.339
13. Bischoff P, Rundshagen I. Awareness under general anesthesia. Dtsch Arztebl Int 2011; 108(1-2):1-7. DOI: https://doi.org/10.3238/arztebl.2011.0001
14. Cascella M, Bimonte S, Di Napoli R. Delayed emergence from anesthesia: What we know and how we act. Local Reg Anesth 2020; 13:195-206. DOI: https://doi.org/10.2147/LRA.S230728
15. Bektaş M, Çakan T, Kırdemir P, Engin M, Başar H. Detection method of intraoperative awareness: A randomized comparative study. Turk J Med Sci 2022; 52(6):1997-2003. DOI: https://doi.org/10.55730/1300-0144.5548
16. Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O’Connor K, O’Sullivan EP, Paul RG, Palmer JH, Plaat F, Radcliffe JJ, Sury MR, Torevell HE, Wang M, Hainsworth J, Pandit JJ; Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: Patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth 2014; 113(4):560-574. DOI: https://doi.org/10.1093/bja/aeu314
17. Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology 2008; 109(5):905-17. DOI: https://doi.org/10.1097/ALN.0b013e3181895bc1
18. Ho VP, Schiltz NK, Reimer AP, Madigan EA, Koroukian SM. High-risk comorbidity combinations in older patients undergoing emergency general surgery. J Am Geriatr Soc 2019; 67(3):503-510. DOI: https://doi.org/10.1111/jgs.15682
19. Braithwaite HE, Payne T, Duce N, Lim J, McCulloch T, Loadsman J, Leslie K, Webster AC, Gaskell A, Sanders RD. Impact of female sex on anaesthetic awareness, depth, and emergence: A systematic review and meta-analysis. Br J Anaesth 2023; 131(3):510-522. DOI: https://doi.org/10.1016/j.bja.2023.06.042
20. Kim D, Lee S, Pyeon T, Jeong S. Use of triazolam and alprazolam as premedication for general anesthesia. Korean J Anesthesiol 2015; 68(4):346-351. DOI: https://doi.org/10.4097/kjae.2015.68.4.346
21. Rayan AA, Hemdan SE, Shetaia AM. Root cause analysis of blunders in anesthesia. Anesth Essays Res 2019; 13(2):193-198. DOI: https://doi.org/10.4103/aer.AER_47_19
22. Gulenay M, Mathai JK. Depolarizing Neuromuscular Blocking Drugs. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532996/
23. Staheli B, Rondeau B. Anesthetic Considerations in the Geriatric Population. [Updated 2023 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK572137/
24. Ayoğlu H, Ayoğlu FN. Occupational risks for anaesthesiologists and precautions. Turk J Anaesthesiol Reanim 2021; 49(2):93-99. DOI: https://doi.org/10.5152/TJAR.2020.219
25. Srivastava P, Shetty P, Shetty S, Upadya M, Nandan A. Impact of noise in operating theater: A surgeon’s and anesthesiologist’s perspective. J Pharm Bioallied Sci. 2021; 13(Suppl 1):S711-S715. DOI: https://doi.org/10.4103/jpbs.JPBS_656_20
26. Al-Kadi MI, Reaz MB, Ali MA. Evolution of electroencephalogram signal analysis techniques during anesthesia. Sensors (Basel). 2013; 13(5):6605-6635. DOI: https://doi.org/10.3390/s130506605
27. Medical Advisory Secretariat. Bispectral index monitor: An evidence-based analysis. Ont Health Technol Assess Ser 2004; 4(9):1-70.
28. Richardson M, Moulton K, Rabb D, Rabb D, Kindopp S, Pishe T, Yan C, Akpinar I, Tsoi B, Chuck A. Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Mar. (CADTH Health Technology Assessment, No. 142.) 1, Introduction. Available at: https://www.ncbi.nlm.nih.gov/books/NBK362376/
29. Zhang M, Duan J, Chen Y, Zhang C. Application of intraoperative electromyography intelligent monitoring in orthopedic surgery under general anesthesia. Contrast Media Mol Imaging 2023; 2023:1484802. DOI: https://doi.org/10.1155/2023/1484802
30. Cascella M. Mechanisms underlying brain monitoring during anesthesia: Limitations, possible improvements, and perspectives. Korean J Anesthesiol 2016; 69(2):113-120. DOI: https://doi.org/10.4097/kjae.2016.69.2.113
31. Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry 2001; 23(4):198-204. DOI: https://doi.org/10.1016/s0163-8343(01)00142-6
32. Aceto P, Perilli V, Lai C, Sacco T, Ancona P, Gasperin E, Sollazzi L. Update on post-traumatic stress syndrome after anesthesia. Eur Rev Med Pharmacol Sci 2013; 17(13):1730-1737.
33. Coghill RC. Individual differences in the subjective experience of pain: New insights into mechanisms and models. Headache. 2010; 50(9):1531-1535. DOI: https://doi.org/10.1111/j.1526-4610.2010.01763.x
34. Luo M, Song B, Zhu J. Sleep Disturbances after general anesthesia: Current perspectives. Front Neurol 2020; 11:629. DOI: https://doi.org/10.3389/fneur.2020.00629
35. Amornyotin S. Sedation and monitoring for gastrointestinal endoscopy. World J Gastrointest Endosc. 2013; 5(2):47-55. DOI: https://doi.org/10.4253/wjge.v5.i2.47
36. Lundstrøm LH, Duez CH, Nørskov AK, Rosenstock CV, Thomsen JL, Møller AM, Strande S, Wetterslev J. Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents. Cochrane Database Syst Rev 2017; 5(5):CD009237. DOI: https://doi.org/10.1002/14651858.CD009237.pub2
37. Pathan H, Williams J. Basic opioid pharmacology: An update. Br J Pain 2012; 6(1):11-16. DOI: https://doi.org/10.1177/2049463712438493
38. Ghelardini C, Di Cesare Mannelli L, Bianchi E. The pharmacological basis of opioids. Clin Cases Miner Bone Metab 2015; 12(3):219-221. DOI: https://doi.org/10.11138/ccmbm/2015.12.3.219
39. Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30(3):209-220. DOI: https://doi.org/10.1111/pan.13809
40. Topor B, Oldman M, Nicholls B. Best practices for safety and quality in peripheral regional anaesthesia. BJA Educ 2020; 20(10):341-347. DOI: https://doi.org/10.1016/j.bjae.2020.04.007
41. Cascella M, Bimonte S, Amruthraj NJ. Awareness during emergence from anesthesia: Features and future research directions. World J Clin Cases 2020; 8(2):245-254. DOI: https://doi.org/10.12998/wjcc.v8.i2.245
42. O’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 33. Available at: https://www.ncbi.nlm.nih.gov/books/NBK2637/
43. Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7(7):CD006732. DOI: https://doi.org/10.1002/14651858.CD006732.pub4
How to Cite
Burokiene, V. Y. (2023). On the Intraoperative Awareness General Anesthesia. Science Insights, 43(4), 1087–1096. https://doi.org/10.15354/si.23.re806
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