A retrospective review of 647,009 general anesthetics identified only 7 cases of intraoperative awareness (0.0011%), indicating that provider-reported adverse event data in the early postoperative period is highly insensitive.
Observational (n=647,009)
Yes
Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting intraoperative awareness, but cases often share commonalities like obesity, TIVA use, and neuromuscular blockade.
Abstract Background Awareness with recall under general anesthesia remains a rare but important issue that warrants further study. Methods 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. Results 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. Conclusions 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.
Deis et al. (2020) conducted an observational in Intraoperative awareness with recall (AWR) (n=647,009). General anesthesia was evaluated on Incidence of intraoperative awareness with recall (AWR) under general anesthesia. A retrospective review of 647,009 general anesthetics identified only 7 cases of intraoperative awareness (0.0011%), indicating that provider-reported adverse event data in the early postoperative period is highly insensitive.