This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.
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Definition
Postoperative recall of sensory perception during general anesthesia (no consensus definition available).
Importance
- intraoperative awareness is more common in children (0.5-1.0%) compared to adults (0.1-0.2%)
- it may occur in non-paralyzed children without signs of inadequate anesthesia
- does not seem to be associated with distress or post-traumatic stress disorders
- the reasons for the high incidence in children are not known
Consequences
- unknown, may have major implications on social life
Risk factors include
- drugs (neuromuscular blockade, thiopental, TIVA)
- patients (female gender, age (younger adults), obesity, previous awareness, possibly difficult airway management)
- subspecialties (obstetric, trauma, cardio-thoracic, neurosurgical)
- organizational (out-of-hours surgery, junior anesthetist)
Prevention
- identify risk factors
- proper information preoperatively
- consider the use of neuro-monitoring in patients with risk factors – particularly if previous awareness
Treatment
- administer benzodiazepines if awareness is suspected
- if serious psychological problems occur (flash-backs, nightmares, new anxiety states and depression) the child should be referred to psychological service
Key references
- Sury M. Accidental awareness during anesthesia in children. Pediatric Anesthesia 2016; 26: 468.
- Malviya S et al. The incidence of intraoperative awareness in children: childhood awareness and recall evaluation. Anesth Analg 2009; 109: 1421-7
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- No Fear / No Awareness
- Normovolemia
- Normotension
- Normal Heart Rate
- Normoxemia
- Normocapnia
- Normonatremia
- Normoglycemia
- Normothermia
- No Postoperative Discomfort:
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