Deis Amanda S, Schnetz Michael P, Ibinson James W, Vogt Keith M
Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, UPMC Montefiore, Suite 467, Pittsburgh, PA, 15213, USA.
BMC Anesthesiol. 2020 Mar 9;20(1):62. doi: 10.1186/s12871-020-00974-3.
Awareness with recall under general anesthesia remains a rare but important issue that warrants further study.
We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics.
The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case.
Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.
全身麻醉下存在知晓并伴有回忆仍然是一个罕见但重要的问题，值得进一步研究。
我们报告了从647,000例全身麻醉的电子麻醉记录中提供者报告的不良事件数据中识别出的7例知晓病例。
识别出的病例数量较少表明存在报告不足的偏差。这个小系列中出现的主题可以作为重要提醒，提醒麻醉提供者确保为每位患者提供足够的麻醉。我们识别出的大多数麻醉知晓病例的共性包括：肥胖、使用全静脉麻醉、使用神经肌肉阻滞剂，以及缺乏处理后的脑电图（EEG）监测或记录的高意识深度指数值。在一个病例中观察到一个有趣的现象，即给予了足够剂量的麻醉且无技术问题，采用了处理后的EEG监测，并且指数值表明整个病例中意识深度足够。
术后即刻由提供者报告的不良事件数据可能对检测术中知晓病例不敏感。尽管从我们的数据中不能确凿地确定因果关系，但在这一系列全身麻醉下伴有回忆的知晓病例中识别出的主题为麻醉提供者提供了重要提醒，要在监测麻醉深度和剂量方面保持警惕，尤其是在使用全静脉麻醉时。
