Safetots.org

Safe Anesthesia for Every Child

No Awareness (10Ns)

This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.

←  previous (No Fear)      |       next (Normovolemia)  →

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

  1. Sury M. Accidental awareness during anesthesia in children. Pediatric Anesthesia 2016; 26: 468.
  2. Malviya S et al. The incidence of intraoperative awareness in children: childhood awareness and recall evaluation. Anesth Analg 2009; 109: 1421-7

More on Safetots.org

Review all 10N

Explore