1
|
Dubost C, Humbert P, Oudre L, Labourdette C, Vayatis N, Vidal PP. Quantitative assessment of consciousness during anesthesia without EEG data. J Clin Monit Comput 2020; 35:993-1005. [PMID: 32661827 DOI: 10.1007/s10877-020-00553-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
Assessing the depth of anesthesia (DoA) is a daily challenge for anesthesiologists. The best assessment of the depth of anesthesia is commonly thought to be the one made by the doctor in charge of the patient. This evaluation is based on the integration of several parameters including epidemiological, pharmacological and physiological data. By developing a protocol to record synchronously all these parameters we aim at having this evaluation made by an algorithm. Our hypothesis was that the standard parameters recorded during anesthesia (without EEG) could provide a good insight into the consciousness level of the patient. We developed a complete solution for high-resolution longitudinal follow-up of patients during anesthesia. A Hidden Markov Model (HMM) was trained on the database in order to predict and assess states based on four physiological variables that were adjusted to the consciousness level: Heart Rate (HR), Mean Blood Pressure (MeanBP) Respiratory Rate (RR), and AA Inspiratory Concentration (AAFi) all without using EEG recordings. Patients undergoing general anesthesia for hernial inguinal repair were included after informed consent. The algorithm was tested on 30 patients. The percentage of error to identify the actual state among Awake, LOC, Anesthesia, ROC and Emergence was 18%. This protocol constitutes the very first step on the way towards a multimodal approach of anesthesia. The fact that our first classifier already demonstrated a good predictability is very encouraging for the future. Indeed, this first model was merely a proof of concept to encourage research ways in the field of machine learning and anesthesia.
Collapse
Affiliation(s)
- Clément Dubost
- Begin Military Hospital, Saint-Mandé, France. .,Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.
| | - Pierre Humbert
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Laurent Oudre
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.,L2TI, Université Paris 13, Villetaneuse, France
| | - Christophe Labourdette
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Nicolas Vayatis
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Pierre-Paul Vidal
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.,Institute of Information and Control, Hangzhou Dianzi University, Zhejiang, China
| |
Collapse
|
2
|
Cascella M, Bimonte S, Amruthraj NJ. Awareness during emergence from anesthesia: Features and future research directions. World J Clin Cases 2020; 8:245-254. [PMID: 32047772 PMCID: PMC7000929 DOI: 10.12998/wjcc.v8.i2.245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/17/2019] [Accepted: 01/01/2020] [Indexed: 02/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Marco Cascella
- Anesthesia Section, Department of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | - Sabrina Bimonte
- Anesthesia Section, Department of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-Fondazione Pascale, Napoli 80100, Italy
| | | |
Collapse
|
3
|
Lai HC, Wu KL, Wu ZF, Lai MF, Huang YH, Tseng WC, Chen JY. A 10-year retrospective analysis on the incidence of anesthesia awareness with recall in adult patients under total intravenous anesthesia. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/1011-4564.282530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
4
|
Lai HC, Wu KL, Wu ZF, Lai MF, Huang YH, Tseng WC, Chen JY. A 10-year retrospective analysis on the incidence of anesthesia awareness with recall in adult patients under total intravenous anesthesia. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_224_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Kuo PJ, Lee CL, Wang JH, Hsieh SY, Huang SC, Lam CF. Inhalation of volatile anesthetics via a laryngeal mask is associated with lower incidence of intraoperative awareness in non-critically ill patients. PLoS One 2017; 12:e0186337. [PMID: 29073151 PMCID: PMC5658000 DOI: 10.1371/journal.pone.0186337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/01/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Increased incidence of intraoperative awareness was reported in critically ill patients during major operations, particularly under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). However, the incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention. METHODS AND RESULTS This retrospective matched case-control study was conducted between January 2009 to December 2014. Surgical patients (ASA physical status I-III) whom reported intraoperative awareness during this study period were interviewed and their medical records were reviewed. The potential risk factors for awareness were compared with the non-case matched controls, who were randomly selected from the database. A total of 61436 patients were included and 16 definite cases of intraoperative awareness were identified. Patients who received ETGA and TIVA had significantly higher incidence of developing awareness compared to those who were anesthetized using laryngeal masks (LMA) (P = 0.03). Compared with the matched controls (n = 80), longer anesthesia time was associated with increased incidence of awareness (odds ratio 2.04; 95% CI 1.30-3.20, per hour increase). Perioperative use of muscle relaxant was also associated with increased incidence of awareness, while significantly lower incidence of awareness was found in patients who were anesthetized with volatile anesthetics. CONCLUSIONS The overall incidence of awareness was 0.023% in the ASA≤ III surgical patients who received general anesthesia. Anesthesia with a laryngeal mask under spontaneous ventilation and supplemented with volatile anesthetics may be the preferred anesthesia technique in generally healthy patients in order to provide a lower risk of intraoperative awareness.
Collapse
Affiliation(s)
- Pei-Jen Kuo
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chia-Ling Lee
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Jen-Huang Wang
- Department of Medical Research, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Shiu-Ying Hsieh
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Shian-Che Huang
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
- Department of Anesthesiology, E-Da Hospital/E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Abstract
The purpose of the study was to investigate the effects of total intravenous anesthesia (TIVA) and combined of intravenous and inhaled anesthesia (CIIA) on intraoperative awareness in surgical patients.A total of 678 patients were recruited in the CIIA group, while TIVA group included 566 patients. The clinical characteristics and the occurrence of intraoperative awareness were compared between the groups. Mini-Mental State Examination, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 tests were performed to estimate cognitive and psychological functions of the patients. In addition, logistic regression analysis was applied to identify the risk factors for intraoperative awareness in surgical patients.In CIIA group, 3 patients (0.44%) were confirmed with intraoperative awareness, while 11 patients (1.94%) in TIVA group underwent intraoperative awareness. The occurrence rate of intraoperative awareness was significantly higher in VITA group than that in the CIIA group (P = .029). Awareness classification demonstrated that intraoperative awareness mainly included auditory, tactile, and pain perceptions. Moreover, 4 patients showed distress after operation. Patients with intraoperative awareness exhibited poor performance in cognitive and psychological tests (P < .001 for all). Logistic regression analysis demonstrated that CIIA (odds ratio [OR] = 0.198, 95% confidence interval [CI] = 0.047-0.827), age (OR = 0.951, 95% CI = 0.908-0.997), midazolam application (OR = 0.158, 95% CI = 0.034-0.736), awareness history (OR = 10.131, 95% CI = 2.206-45.517), and duration of surgery (OR = 1.016, 95% CI = 1.001-1.032) were significantly associated with intraoperative awareness.Intraoperative awareness can significantly influence the cognitive and psychological functions of surgical patients. CIIA and midazolam application may lower the risk of intraoperative awareness.
Collapse
MESH Headings
- Adult
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Anesthesia, General/psychology
- Anesthesia, Inhalation/adverse effects
- Anesthesia, Inhalation/psychology
- Anesthesia, Intravenous/adverse effects
- Anesthesia, Intravenous/psychology
- Anesthetics, Inhalation/administration & dosage
- Anesthetics, Inhalation/adverse effects
- Female
- Humans
- Intraoperative Awareness/psychology
- Logistic Models
- Male
- Methyl Ethers/administration & dosage
- Methyl Ethers/adverse effects
- Middle Aged
- Operative Time
- Postoperative Complications/chemically induced
- Postoperative Complications/psychology
- Postoperative Period
- Propofol/administration & dosage
- Propofol/adverse effects
- Sevoflurane
- Stress, Psychological/chemically induced
- Stress, Psychological/psychology
- Treatment Outcome
Collapse
|
7
|
Cascella M, Fusco R, Caliendo D, Granata V, Carbone D, Muzio MR, Laurelli G, Greggi S, Falcone F, Forte CA, Cuomo A. Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery. Oncotarget 2017; 8:79248-79256. [PMID: 29108303 PMCID: PMC5668036 DOI: 10.18632/oncotarget.17238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022] Open
Abstract
Background Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.
Collapse
Affiliation(s)
- Marco Cascella
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Roberta Fusco
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Caliendo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Vincenza Granata
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Domenico Carbone
- Department of Emergency Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italia
| | - Maria Rosaria Muzio
- Division of Infantile Neuropsychiatry, UOMI, Maternal and Infant Health, Torre del Greco, Napoli, Italia
| | - Giuseppe Laurelli
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Stefano Greggi
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Francesca Falcone
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Cira Antonietta Forte
- Psychology, Division of Pain Medicine, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Arturo Cuomo
- Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| |
Collapse
|