Ambulkar Reshma P, Agarwal Vandana, Ranganathan Priya, Divatia Jigeeshu V
Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2016 Oct-Dec;32(4):453-457. doi: 10.4103/0970-9185.173363.
The incidence of intra-operative awareness with explicit recall in the Western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1-2% of patients at high risk for this complication. Awareness in the Indian population has never been studied; we therefore wanted to detect the incidence of awareness in patients who were at high risk of experiencing awareness during surgery in our population.
We conducted a prospective single-center observational study at a 600-bedded tertiary cancer care referral hospital. We recruited adult patients posted for major cancer surgery who were considered to be at high risk for awareness. These patients were interviewed at three time-points using the structured modified Brice interview questionnaire. The primary outcome studied was the incidence of definite intra-operative awareness.
A total of 934 patients were included in the final analysis of which none reported awareness. Using the rule of three (Hanley and Lippman-Hand) we conclude that the upper 95% confidence interval for the incidence of awareness in this population is <1 in 300 (0.33%).
Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.
据报道，在西方世界，普通外科手术人群中术中知晓并有明确回忆的发生率在0.1%至0.2%之间，而该并发症高危患者的发生率高达1%-2%。印度人群中的术中知晓情况从未被研究过；因此，我们希望检测我们人群中手术期间有术中知晓高危风险患者的知晓发生率。
我们在一家拥有600张床位的三级癌症护理转诊医院进行了一项前瞻性单中心观察性研究。我们招募了计划接受重大癌症手术且被认为有术中知晓高危风险的成年患者。使用结构化改良布赖斯访谈问卷在三个时间点对这些患者进行访谈。研究的主要结局是明确的术中知晓发生率。
共有934例患者纳入最终分析，其中无人报告有术中知晓情况。使用三法则（汉利和利普曼-汉德法），我们得出该人群中术中知晓发生率的95%置信区间上限<300分之一（0.33%）。
麻醉下知晓是一种令人痛苦的并发症，有可能产生长期心理后果，应尽一切努力预防。不过令人欣慰的是，我们在印度有术中知晓高危风险的癌症患者中的数据表明这种情况并不常见。
