The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatiz...The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatizing state known as anesthesia awareness might develop. What is the probability that a patient can be awake, conscious, and able to hear the surroundings and experience excruciating pain but be immobilized to communicate it during surgery? According to estimates, there are 1 to 2 cases for every 1000 patients who experience this phenomenon and retain various sensory information after general anesthesia was applied. Even with seemingly effective anesthetic care, emerging consciousness states during anesthesia are reported and often come with various degrees of memory loss mechanisms. Some researchers and the experiments covered in this paper suggest anesthesia is merely a memory loss or poorly understood neurological form of amnesia induced during the event itself and not a loss of consciousness per se during the traumatic event, as suggested by studies described in this article. In some instances, the agony may be unbearable, with long-term neuropsychiatric effects such as post-traumatic stress disorder. Although the neurobiological phenomenon of consciousness regained during anesthesia is still poorly understood, these continuously reported events carry significant medical and legal ramifications. The numerous contributing elements that may increase the risk of intraoperative raised levels of consciousness are gathered, analyzed, and discussed in this research study. Preventive methods for both preinduction and intraoperative usage, as well as corrective actions to take after such occurrences, are also discussed.展开更多
The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or...The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.展开更多
<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative se...<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative setting and the resulting sequelae of symptoms consistent with post-traumatic stress disorder using the first-hand experience of a patient with awareness during anesthesia. <b>Aim:</b> This case report aims to identify and describe the symptomatic sequelae of perioperative awareness events and the importance of close patient follow-up and management. <b>Case Presentation:</b> A 34-year-old female developed uncontrolled tonsillar hemorrhage 2 days after successful adenotonsillectomy that necessitated bedside intubation. During regular clinic follow-up, the patient presented with symptoms suggestive of post-traumatic stress disorder (PTSD) secondary to recall events while under anesthesia. <b>Conclusion:</b> The contributory factors predisposing to perioperative awareness in the surgical environment need to be understood and avoided as much as possible. When awareness is suspected or known to have occurred the patient needs to be assisted through the post-op period and guided through the psychological sequelae that follow.展开更多
文摘The condition of pharmacologically induced unconsciousness that renders a patient unresponsive to uncomfortable surgical stimuli is known as general anesthesia. When it is used for surgery, a fairly rare but traumatizing state known as anesthesia awareness might develop. What is the probability that a patient can be awake, conscious, and able to hear the surroundings and experience excruciating pain but be immobilized to communicate it during surgery? According to estimates, there are 1 to 2 cases for every 1000 patients who experience this phenomenon and retain various sensory information after general anesthesia was applied. Even with seemingly effective anesthetic care, emerging consciousness states during anesthesia are reported and often come with various degrees of memory loss mechanisms. Some researchers and the experiments covered in this paper suggest anesthesia is merely a memory loss or poorly understood neurological form of amnesia induced during the event itself and not a loss of consciousness per se during the traumatic event, as suggested by studies described in this article. In some instances, the agony may be unbearable, with long-term neuropsychiatric effects such as post-traumatic stress disorder. Although the neurobiological phenomenon of consciousness regained during anesthesia is still poorly understood, these continuously reported events carry significant medical and legal ramifications. The numerous contributing elements that may increase the risk of intraoperative raised levels of consciousness are gathered, analyzed, and discussed in this research study. Preventive methods for both preinduction and intraoperative usage, as well as corrective actions to take after such occurrences, are also discussed.
文摘The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.
文摘<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative setting and the resulting sequelae of symptoms consistent with post-traumatic stress disorder using the first-hand experience of a patient with awareness during anesthesia. <b>Aim:</b> This case report aims to identify and describe the symptomatic sequelae of perioperative awareness events and the importance of close patient follow-up and management. <b>Case Presentation:</b> A 34-year-old female developed uncontrolled tonsillar hemorrhage 2 days after successful adenotonsillectomy that necessitated bedside intubation. During regular clinic follow-up, the patient presented with symptoms suggestive of post-traumatic stress disorder (PTSD) secondary to recall events while under anesthesia. <b>Conclusion:</b> The contributory factors predisposing to perioperative awareness in the surgical environment need to be understood and avoided as much as possible. When awareness is suspected or known to have occurred the patient needs to be assisted through the post-op period and guided through the psychological sequelae that follow.
