Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Br J Anaesth. 2023 Feb;130(2):e217-e224. doi: 10.1016/j.bja.2022.04.010. Epub 2022 May 23.
Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18-40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes.
This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation.
Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [OR]=2.7; 95% confidence interval [CI], 1.1-7.6; P=0.022) and was decreased with continuous anaesthesia before laryngoscopy (OR=0.43; 95% CI, 0.20-0.96; P=0.041). Responses were more likely to occur after a command to respond (and not to nonsense, 13 subjects) than after a nonsense statement (and not to command, four subjects, P=0.049).
Connected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to reduce the incidence of connected consciousness. Further research is required to understand sex-related differences in the risk of connected consciousness.
通过对指令的反应来评估的连接意识，至少出现在 5%的全身麻醉程序中，在年轻人中可能更为常见。我们的主要目标是确定在 18-40 岁的年轻人中气管插管后出现连接意识的发生率。次要目标是评估这些反应的性质，确定相关的危险因素，并确定它们与术后结果的关系。
这是一项国际多中心前瞻性队列研究，使用孤立前臂技术在气管插管后不久评估连接意识。
在 344 名入组的受试者中，338 名完成了研究（平均年龄，30 [标准差，6.3] 岁；232 [69%] 为女性）。在 338 名受试者中有 37 名（11%）在插管后出现反应。女性（13%，31/232）比男性（6%，6/106）更常出现反应。在逻辑回归中，女性的反应风险增加（比值比[OR]=2.7；95%置信区间[CI]，1.1-7.6；P=0.022），而在喉镜检查前持续麻醉时风险降低（OR=0.43；95% CI，0.20-0.96；P=0.041）。与听到无意义的陈述（而非指令，4 名受试者）相比，在听到指令并作出反应（而非无意义的陈述，13 名受试者）后更有可能出现反应（P=0.049）。
在年轻成年人中，插管后有 11%出现连接意识，女性的风险增加。在麻醉诱导和气管插管之间应考虑持续暴露于麻醉以降低连接意识的发生率。需要进一步研究以了解连接意识风险的性别差异。
