Intraoperative Awareness

Occurence of a patient becoming conscious during a procedure performed under GENERAL ANESTHESIA and subsequently having recall of these events. (From Anesthesiology 2006, 104(4): 847-64.)

Also Known As:

Networked: 119 relevant articles (6 outcomes, 13 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Postoperative Nausea and Vomiting (PONV)
2.	Post-Traumatic Stress Disorders (PTSD)
3.	Amnesia (Dissociative Amnesia)
4.	Delayed Emergence from Anesthesia
5.	Myocardial Ischemia (Ischemic Heart Diseases)

Experts

1.	Mashour, George A: 7 articles (08/2011 - 12/2008)
2.	Avidan, Michael S: 4 articles (08/2011 - 03/2008)
3.	Jacobsohn, Eric: 3 articles (08/2011 - 03/2008)
4.	Nagata, Osamu: 3 articles (04/2005 - 11/2002)
5.	Ozaki, Makoto: 3 articles (04/2005 - 11/2002)
6.	Villafranca, Alex: 2 articles (08/2011 - 01/2009)
7.	O'Connor, Michael: 2 articles (08/2011 - 01/2009)
8.	Glick, David: 2 articles (08/2011 - 01/2009)
9.	Palanca, Ben J: 2 articles (08/2011 - 01/2009)
10.	Burnside, Beth A: 2 articles (08/2011 - 03/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Intraoperative Awareness:

1.	Nitrous Oxide (Laughing Gas)IBA 09/01/2004 - "However, recent studies have shown that omitting nitrous oxide can also be a risk factor because of an increased susceptibility to intraoperative awareness. " 09/01/2005 - "Perhaps the greatest argument for the continued use of nitrous oxide is that it reduces the incidence of recall of intraoperative awareness. " 02/01/1996 - "Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials." 07/01/2005 - "Half MAC (minimal alveolar concentration) of volatile anesthetics has been commonly used with nitrous oxide for cesarean section which could occur intraoperative awareness. " 10/01/1993 - "During propofol-nitrous oxide (N2O) anesthesia, volatile anesthetics are frequently administered to treat signs of inadequate anesthesia and to decrease the possibility of intraoperative awareness. "
2.	Midazolam (Versed)FDA LinkGeneric 04/01/1996 - "This study suggests that a midazolam plasma concentration of 150 ng/mL is sufficient to provide satisfactory hemodynamic control and to avoid intraoperative awareness." 09/01/1996 - "The study was discontinued prematurely, as six patients unexpectedly experienced intraoperative awareness with recall (4/21 = 19.1% of patients with PLAC vs 2/69 = 2.9% of patients in the midazolam groups, P < 0.04). " 09/01/1996 - "Despite careful modulation of the propofol infusion rate, six patients unexpectedly experienced intraoperative awareness with recall, with the lowest incidence occurring in those groups where patients had received midazolam." 01/01/2015 - "However, the probability of awareness during anesthesia is lower with propofol-remifentanil than with midazolam-fentanyl." 12/01/1990 - "Since intraoperative awareness is not infrequently observed under balanced anaesthetic regimens employing benzodiazepines for suppression of consciousness, we studied the effect of intravenous induction of general anaesthesia using the benzodiazepines midazolam, diazepam and flunitrazepam on mid-latency auditory evoked potentials and auditory evoked neuronal 30-40 Hz oscillation. "
3.	Inhalation AnestheticsIBA 03/13/2008 - "We did not reproduce the results of previous studies that reported a lower incidence of anesthesia awareness with BIS monitoring, and the use of the BIS protocol was not associated with reduced administration of volatile anesthetic gases. " 01/01/2014 - "Emergence delirium, postoperative delirium, postoperative cognitive dysfunction, and intraoperative awareness can develop in association with use of inhalation anesthetics and intravenously administered anesthetics."
4.	5'-palmitoyl cytarabine (PLAC)IBA 09/01/1996 - "The study was discontinued prematurely, as six patients unexpectedly experienced intraoperative awareness with recall (4/21 = 19.1% of patients with PLAC vs 2/69 = 2.9% of patients in the midazolam groups, P < 0.04). "
5.	Propofol (Diprivan)FDA LinkGeneric 06/01/2001 - "BIS monitoring allows for propofol titration that leads to a mean reduction of 32.6% in consumption, shortening the time until eye opening without causing intraoperative awareness or reducing patient satisfaction." 08/01/1992 - "One episode each of intraoperative awareness and delayed eye opening occurred in the propofol group. " 11/01/2002 - "[Two cases of intraoperative awareness during intravenous anesthesia with propofol in morbidly obese patients]." 10/01/2002 - "This case indicates that even if appropriate dose of propofol is administrated, intraoperative awareness may occur especially with inadequate analgesia." 10/01/2002 - "[Intraoperative awareness during propofol anesthesia with epidural anesthesia]."
6.	Anesthetics (Anesthetic Agents)IBA 01/01/2012 - "The ability to detect intraoperative awareness is currently suboptimal because the mechanism employed by anesthetic drugs to impair consciousness remains poorly understood. " 10/01/2007 - "We reviewed the AIMS records of 3 anesthetics in which intraoperative awareness was felt to have probably occurred. " 09/01/2003 - "Inhalational anesthetics analyzer as a method to detect anesthesia machine failures and prevent intraoperative awareness. " 04/01/2011 - "Use of the BIS monitor results in less use of hypnotic anesthetic drugs, decreased time to extubation, decreased incidence of nausea and vomiting, and decreased intraoperative awareness. " 07/01/2005 - "Half MAC (minimal alveolar concentration) of volatile anesthetics has been commonly used with nitrous oxide for cesarean section which could occur intraoperative awareness. "
7.	Fentanyl (Sublimaze)FDA LinkGeneric 08/01/2007 - "On the other hand, all patients anesthetized with propofol-fentanyl performed smoothly, and no patient experienced intraoperative awareness. " 11/01/2002 - "We experienced two cases of intraoperative awareness during intravenous anesthesia with propofol and fentanyl in morbidly obese patients. " 04/01/1981 - "Intraoperative awareness during high-dose fentanyl--oxygen anesthesia." 07/01/1983 - "Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia." 08/01/2007 - "Patients anesthetized with nitrous oxide-sevoflurane-fentanyl did not perform smoothly in the wake-up test because of restless or delayed emergence from anesthesia, and two of them experienced intraoperative awareness. "
8.	OxygenIBA 09/01/1996 - "Cardiac morbidity (postoperative myocardial ischemia, postoperative myocardial infarction, and perioperative sympathoadrenal stress response), respiratory morbidity (postextubation apnea, alveolar-arterial oxygen gradient, pulmonary shunting, oxygen consumption, atelectasis, and reintubation), hemodynamic values and vasoactive medication requirements, intraoperative awareness, postoperative cognitive function, 30 day mortality, and intensive care unit and hospital lengths of stay were compared between the two groups. " 11/01/2005 - "The adverse events were oxygen desaturation (31.9:10000), cardiac arrest (30.8:10000), death within 24 hr. (28.3:10000), difficult intubation (22.5:10000),re-intubation (19.4:10000), unplanned ICU admission (7.2:10000), coma/cva/convulsion (4.8:10000), equipment malfunction/failure (3.4:10000), suspected myocardial ischemia or infarction (2.7:10000), awareness during anesthesia (3.8:10000), late detected esophageal intubation (4.1:10000), failed intubation (3.1:10000), anaphylaxis or anaphylactoid reaction (2.1:10000), nerve injury (2:10000), pulmonary aspiration (2.7:10000), drug error (1.3:10000), hazard to anesthesia personnel (1.5:10000), unplanned hospital admission (0.1:10000), total spinal block (1.3:10000) and mismatch blood transfusion (0.18:10000) Respiratory adverse events were common anesthesia direct related events. " 07/01/1992 - "Intraoperative awareness with propofol-oxygen total intravenous anesthesia for microlaryngeal surgery." 04/01/1981 - "Intraoperative awareness during high-dose fentanyl--oxygen anesthesia." 07/01/1983 - "Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia."
9.	sevoflurane (Ultane)FDA LinkGeneric 06/01/2011 - "We found the use of BIS monitoring for titrating sevoflurane concentration in a narcoleptic patient is useful for preventing not only oversedation but also intraoperative awareness caused by the preoperative medication." 10/01/2006 - "[Awareness during anesthesia with sevoflurane: a case report]." 11/01/1998 - "The electrophysiological data indicate that intraoperative awareness phenomena should be suppressed with sevoflurane 1.5-2.0 vol.%. " 06/01/2006 - "He did not exhibit any signs of drug tolerance or intraoperative awareness during prolonged remifentanil-based anesthesia using propofol or sevoflurane as adjuvants. " 08/01/2007 - "Patients anesthetized with nitrous oxide-sevoflurane-fentanyl did not perform smoothly in the wake-up test because of restless or delayed emergence from anesthesia, and two of them experienced intraoperative awareness. "
10.	IsofluraneFDA LinkGeneric 05/01/2002 - "High risk of intraoperative awareness during cardiopulmonary bypass with isoflurane administration via diffusion membrane oxygenators." 02/01/1995 - "To avoid intraoperative awareness and postoperative respiratory depression from high-dose opioid anesthesia, propofol (P), or isoflurane (I) has been combined with moderate-dose opioid with varying results. " 07/01/2010 - "We compared the effects of a dexmedetomidine-bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with superficial isoflurane anaesthesia (<0.05 maximum alveolar concentration) in patients undergoing thoracic surgery with one-lung ventilation (OLV). " 09/01/1984 - "Sixty patients undergoing elective laparotomy were randomly divided into six groups of ten patients each: Group I was given 0.65 MAC nitrous oxide (66 per cent inspired) and 0.65 MAC isoflurane (0.75 per cent end-expired); Group II was given 0.65 MAC nitrous oxide and 1-1.2 MAC isoflurane (1.2-1.4 per cent end-expired); Group III was given the same anaesthetic management as patients in Group I but with the addition of fentanyl (2 micrograms X kg-1) before the skin incision and 1/8 of the initial dose every 15 minutes during surgery; Group IV was treated as patients in Group I with an additional infusion of lidocaine (30 micrograms X kg-1 X min-1); Groups V and VI were given 0.65 MAC of nitrous oxide and fentanyl, 7.5 and 15 micrograms X kg-1, respectively, before skin incision with 1/8 of the initial dose every 15 minutes during the operation; diazepam, 5 mg IV each hour of surgery, was given to prevent intraoperative awareness. "

Therapies and Procedures

1.	Anesthesia 01/01/2009 - "Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients." 08/01/2012 - "Monitors evaluating the hypnotic component of anesthesia by analyzing the electroencephalogram (EEG) may help to decrease the incidence of intraoperative awareness with recall. " 10/01/2009 - "Their use may help to prevent insufficient anesthesia, which can lead to intraoperative awareness with recall, as well as anesthetic overdose, which may be associated with adverse events. " 11/01/1994 - "In spite of the ever-growing pharmacologic arsenal available for induction and maintenance of anesthesia, to our knowledge no treatment regimen exists that will provide full protection against intraoperative awareness. " 05/01/2013 - "Because of the low cost and safety of noise reduction, as well as the catastrophic implications of intraoperative awareness, further studies to explore the effects of auditory stimuli on awareness and anesthesia are warranted."
2.	General Anesthesia 03/01/2012 - "It is recommended to minimize neuromuscular blocker administration during general anesthesia for the efficacy of operating room utilization and potential hazards of unintended awareness during anesthesia. " 11/01/1991 - "Various studies on intraoperative awareness show that explicit memory is widely eliminated during general anesthesia. " 05/01/2012 - "The intraoperative awareness is an adverse event in the general anesthesia, and may occur in approximately 20,000 cases per year, which justifies the study of the risk factors for this event. " 01/01/2015 - "Intraoperative awareness is an unwanted outcome that consists of an explicit recall of events during a surgical procedure performed under general anesthesia. " 07/01/2014 - "We conducted a matched cohort design with 9 subjects after intraoperative awareness with recall during general anesthesia. "
3.	Coronary Artery Bypass (Coronary Artery Bypass Surgery) 02/01/2003 - "In this prospective, randomized study, we compared hemodynamics, oxygenation, possible intraoperative awareness, and costs in 62 patients undergoing first-time elective coronary artery bypass grafting at 2 different levels of anesthesia. " 03/01/1996 - "The aim of this clinical report is to describe a case of unintentional intraoperative awareness during sufentanil anaesthesia in a patient undergoing elective aortocoronary bypass grafting. "
4.	Cesarean Section (Caesarean Section) 10/01/2013 - "Intraoperative awareness--comparison of its incidence in women undergoing general anaesthesia for caesarean section and for gynaecological procedures." 06/01/1993 - "The authors base their remark on a few cases of awareness which have been reported in their hospital and on the history a patient who experienced intraoperative awareness during cesarean section. " 03/01/2008 - "One of the hazards of general anesthesia for cesarean section (C/S) is the risk of intraoperative awareness with or without recall of the event. " 01/01/2004 - "Trauma patients have reported the highest incidence of intraoperative awareness (11%-43%) followed by patients undergoing cardiac surgery (1.14%) and patients undergoing Cesarean section (0.9%). " 12/01/2009 - "The use of low concentrations of volatile anaesthetics with avoidance of opioids may induce intraoperative awareness and adverse haemodynamic responses during Caesarean section. "
5.	Consciousness Monitors 08/01/2010 - "An electroencephalogram (EEG)-based level-of-consciousness monitor can help minimize intraoperative awareness as well as the effects of over-sedation. " 10/01/2007 - "Intraoperative awareness--a three year prospective study using bispectral index monitor (BIS)." 08/01/2010 - "Bispectral index monitor prevented intraoperative awareness during partial cardiopulmonary bypass."