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Intraoperative awareness began as early as after ether anesthesia was applied to the clinic.
In 1945, Lancet magazine discussed a new problem caused by muscle relaxants—intraoperative awareness; because it may cause great physical and mental trauma to patients, it is very difficult in developed countries.
I have been paid attention to and read through major anesthesia authoritative books, and found that there are still very few systematic explanations on this issue.
This may be related to the incidence rate of only 0.
2% (different surgeries vary greatly), and there are relatively few related studies.
Looking up related knowledge, I tried to concisely summarize this problem.
What is intraoperative knowledge? To form postoperative knowledge, two conditions are necessary, namely, intraoperative memory and postoperative recall or wakefulness; intraoperative memory is divided into explicit memory and implicit memory, the latter is also called unconscious Memory requires hypnosis to remember; recall refers to keeping a clear memory of what happened during anesthesia (that is, the extraction of explicit memory during surgery), and the state of awakening can be understood as the extraction of implicit memory during or after surgery.
The physiological and psychological basis of knowing is the whole process of the brain's explicit memory (storage) and recall (retrieval).
Because the current general anesthesia is basically a compound anesthesia, that is, a variety of drugs with different effects are used at the same time.
Sedation of forgetfulness, analgesia, and muscle relaxation are the main three parts.
If there is intraoperative awareness, it means that the effect of sedation and forgetting has disappeared, and the effect of muscle relaxation and analgesia may still exist.
In such a situation, the patient may be conscious and can hear the sounds of the surrounding environment, but cannot control any movement of the limbs, including, for example, opening eyes and coughing.
At the same time, with or without the perception of pain.
The incidence of different operations and different anesthesia methods, the incidence is very different, the combined incidence rate known in conventional surgical anesthesia is 0.
2%.
(1) The use of muscle relaxants is twice the incidence of patients who do not use muscle relaxants.
(2) Very few cases are reported when the concentration of strong inhalation anesthetics is >1%.
(3) Propofol combined with fentanyl is completely intravenous anesthesia, and the awareness rate is 0.
3%.
(4) Cardiac surgery (1%), general anesthesia and cesarean section (2%-12%), craniocerebral surgery and trauma surgery are the most common operations, and trauma surgery can reach 11%-43%.
The best way for the diagnosis known during the operation to determine the presence of explicit memory during the operation is to follow up after the operation.
Follow-up is performed when the patient just regains consciousness.
Most patients are in a state of lethargy at this time, and the results are unreliable.
It is generally considered that a 24-hour postoperative visit is more appropriate.
At present, the follow-up is mainly carried out according to the method proposed by Brice and Moerman.
All patients should be asked: (1) What is the last thing you remember before going to bed in the operating room? ⑵What is the first thing you remember when you are sober? ⑶ Can you remember anything that happened during the operation? ⑷Are you dreaming? ⑸What is the most unpleasant thing you remember during surgery and anesthesia? After the above questions, the patient can recall anything that happened from induction of anesthesia to the end of anesthesia and recovery of consciousness, which can be determined as explicit memory, that is, intraoperative knowledge occurs! The key is prevention.
For intraoperative knowledge, prevention should be the most important, and it is what we anesthesiologists can do.
Ghoneim proposed ten preventive measures in 2000.
This article combines all the content that has been seen, extracts and integrates the most suitable clinical ones: (1) Identify the operations with a high incidence of awareness, and inform patients in advance of the occurrence of intraoperative awareness possibility.
(2) Check the anesthesia delivery system, it is best to monitor the anesthetic concentration.
There have been many reports of patients becoming aware of the occurrence due to leakage or exhaustion of ether.
(3) Use preoperative medication with anterograde amnesia, and add it in time when light anesthesia is needed during the operation.
Benzodiazepines and scoline choline are known to have better effects.
(4) All operating room personnel should avoid inappropriate jokes, discuss other patients or irrelevant topics, and refrain from commenting on patients.
Studies have found that accidents during the operation or comments about the patient’s body can be memorized verbatim after the operation.
Under sufficient depth of anesthesia, the auditory cognitive process may still exist, and bad impressions or harmful comments can be remembered by the patient.
If it is manifested as an explicit memory, the patient may litigate and cause medical disputes.
If it is manifested as an implicit memory, it may Cause psychological trauma.
(5) Use as little or no muscle relaxants as possible.
When adding muscle relaxants, you should first determine whether the depth of anesthesia is sufficient.
(6) Monitoring the depth of anesthesia.
EEG Bispectral Index (BIS) and Auditory Evoked Potential Index (AAI), both of which can effectively monitor the depth of anesthesia.
Studies have reported that under clinically satisfactory intravenous anesthesia, the BIS is maintained between 40-60, the process of hearing information in the brain can still occur, and there is still implicit memory; inhalation anesthetics can eliminate the intra-mold when BIS<50 Implicit memory, but intravenous anesthetics cannot.
Auditory evoked potential (AEP) is the last disappearance and the earliest recovery during the induction of general anesthesia, and the disappearance of hearing is gradually inhibited with the deepening of anesthesia.
Therefore, it is possible to use AEP monitoring to reflect the depth of anesthesia and the state of wakefulness.
The auditory evoked potential index (AAI) is a dimensionless variable, ranging from 100 to 0, 100 in the fully awakened state, and 0 in the non-auditory potential activity state.
Clinically, the AAI is generally 80-90 in the awake state, and 15-40 in the general anesthesia state.
AAI<40 can predict the disappearance of consciousness more reliably.
The use of AAI to guide the disappearance of implicit memory may be more convincing than BIS.
At the same time, AAI is more sensitive than BIS to instruct the change from unconscious to conscious.
Studies have shown that wearing earplugs to patients during surgery can reduce the incidence of awareness.
(7) Carefully pay attention to the operation process and be familiar with the operation progress.
When the operation enters the period of obvious noxious stimulation, the depth of anesthesia must be ensured.
Adverse Consequences and Treatment In 1997, Ghoneim et al.
reviewed the consequences known during the operation.
The two most common complaints of patients were hearing various events during the operation, feeling of weakness or paralysis, with or without pain.
Patients can especially recall conversations about their poor medical condition.
Postoperative reports are mainly about disturbed sleep, nightmares, anxiety, etc.
Most patients may not have sequelae for too long, but there are still a few who develop traumatic neurological syndromes or even mental disorders.
Early detection, explanation, apology, and psychological help will generally lead to a better ending.
"Read the full text" gives you a movie about knowing during surgery, I hope you can empathize with it! What should I pay attention to during general anesthesia during pregnancy? The past and present of controlled low central venous pressure
In 1945, Lancet magazine discussed a new problem caused by muscle relaxants—intraoperative awareness; because it may cause great physical and mental trauma to patients, it is very difficult in developed countries.
I have been paid attention to and read through major anesthesia authoritative books, and found that there are still very few systematic explanations on this issue.
This may be related to the incidence rate of only 0.
2% (different surgeries vary greatly), and there are relatively few related studies.
Looking up related knowledge, I tried to concisely summarize this problem.
What is intraoperative knowledge? To form postoperative knowledge, two conditions are necessary, namely, intraoperative memory and postoperative recall or wakefulness; intraoperative memory is divided into explicit memory and implicit memory, the latter is also called unconscious Memory requires hypnosis to remember; recall refers to keeping a clear memory of what happened during anesthesia (that is, the extraction of explicit memory during surgery), and the state of awakening can be understood as the extraction of implicit memory during or after surgery.
The physiological and psychological basis of knowing is the whole process of the brain's explicit memory (storage) and recall (retrieval).
Because the current general anesthesia is basically a compound anesthesia, that is, a variety of drugs with different effects are used at the same time.
Sedation of forgetfulness, analgesia, and muscle relaxation are the main three parts.
If there is intraoperative awareness, it means that the effect of sedation and forgetting has disappeared, and the effect of muscle relaxation and analgesia may still exist.
In such a situation, the patient may be conscious and can hear the sounds of the surrounding environment, but cannot control any movement of the limbs, including, for example, opening eyes and coughing.
At the same time, with or without the perception of pain.
The incidence of different operations and different anesthesia methods, the incidence is very different, the combined incidence rate known in conventional surgical anesthesia is 0.
2%.
(1) The use of muscle relaxants is twice the incidence of patients who do not use muscle relaxants.
(2) Very few cases are reported when the concentration of strong inhalation anesthetics is >1%.
(3) Propofol combined with fentanyl is completely intravenous anesthesia, and the awareness rate is 0.
3%.
(4) Cardiac surgery (1%), general anesthesia and cesarean section (2%-12%), craniocerebral surgery and trauma surgery are the most common operations, and trauma surgery can reach 11%-43%.
The best way for the diagnosis known during the operation to determine the presence of explicit memory during the operation is to follow up after the operation.
Follow-up is performed when the patient just regains consciousness.
Most patients are in a state of lethargy at this time, and the results are unreliable.
It is generally considered that a 24-hour postoperative visit is more appropriate.
At present, the follow-up is mainly carried out according to the method proposed by Brice and Moerman.
All patients should be asked: (1) What is the last thing you remember before going to bed in the operating room? ⑵What is the first thing you remember when you are sober? ⑶ Can you remember anything that happened during the operation? ⑷Are you dreaming? ⑸What is the most unpleasant thing you remember during surgery and anesthesia? After the above questions, the patient can recall anything that happened from induction of anesthesia to the end of anesthesia and recovery of consciousness, which can be determined as explicit memory, that is, intraoperative knowledge occurs! The key is prevention.
For intraoperative knowledge, prevention should be the most important, and it is what we anesthesiologists can do.
Ghoneim proposed ten preventive measures in 2000.
This article combines all the content that has been seen, extracts and integrates the most suitable clinical ones: (1) Identify the operations with a high incidence of awareness, and inform patients in advance of the occurrence of intraoperative awareness possibility.
(2) Check the anesthesia delivery system, it is best to monitor the anesthetic concentration.
There have been many reports of patients becoming aware of the occurrence due to leakage or exhaustion of ether.
(3) Use preoperative medication with anterograde amnesia, and add it in time when light anesthesia is needed during the operation.
Benzodiazepines and scoline choline are known to have better effects.
(4) All operating room personnel should avoid inappropriate jokes, discuss other patients or irrelevant topics, and refrain from commenting on patients.
Studies have found that accidents during the operation or comments about the patient’s body can be memorized verbatim after the operation.
Under sufficient depth of anesthesia, the auditory cognitive process may still exist, and bad impressions or harmful comments can be remembered by the patient.
If it is manifested as an explicit memory, the patient may litigate and cause medical disputes.
If it is manifested as an implicit memory, it may Cause psychological trauma.
(5) Use as little or no muscle relaxants as possible.
When adding muscle relaxants, you should first determine whether the depth of anesthesia is sufficient.
(6) Monitoring the depth of anesthesia.
EEG Bispectral Index (BIS) and Auditory Evoked Potential Index (AAI), both of which can effectively monitor the depth of anesthesia.
Studies have reported that under clinically satisfactory intravenous anesthesia, the BIS is maintained between 40-60, the process of hearing information in the brain can still occur, and there is still implicit memory; inhalation anesthetics can eliminate the intra-mold when BIS<50 Implicit memory, but intravenous anesthetics cannot.
Auditory evoked potential (AEP) is the last disappearance and the earliest recovery during the induction of general anesthesia, and the disappearance of hearing is gradually inhibited with the deepening of anesthesia.
Therefore, it is possible to use AEP monitoring to reflect the depth of anesthesia and the state of wakefulness.
The auditory evoked potential index (AAI) is a dimensionless variable, ranging from 100 to 0, 100 in the fully awakened state, and 0 in the non-auditory potential activity state.
Clinically, the AAI is generally 80-90 in the awake state, and 15-40 in the general anesthesia state.
AAI<40 can predict the disappearance of consciousness more reliably.
The use of AAI to guide the disappearance of implicit memory may be more convincing than BIS.
At the same time, AAI is more sensitive than BIS to instruct the change from unconscious to conscious.
Studies have shown that wearing earplugs to patients during surgery can reduce the incidence of awareness.
(7) Carefully pay attention to the operation process and be familiar with the operation progress.
When the operation enters the period of obvious noxious stimulation, the depth of anesthesia must be ensured.
Adverse Consequences and Treatment In 1997, Ghoneim et al.
reviewed the consequences known during the operation.
The two most common complaints of patients were hearing various events during the operation, feeling of weakness or paralysis, with or without pain.
Patients can especially recall conversations about their poor medical condition.
Postoperative reports are mainly about disturbed sleep, nightmares, anxiety, etc.
Most patients may not have sequelae for too long, but there are still a few who develop traumatic neurological syndromes or even mental disorders.
Early detection, explanation, apology, and psychological help will generally lead to a better ending.
"Read the full text" gives you a movie about knowing during surgery, I hope you can empathize with it! What should I pay attention to during general anesthesia during pregnancy? The past and present of controlled low central venous pressure
