Self-reported awareness during general anesthesia in pediatric patients: A study from Wake Up Safe.
Paediatr Anaesth 2021;
31:676-685. [PMID:
33709457 DOI:
10.1111/pan.14176]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND
Awareness under general anesthesia occurs rarely, but can result in emotional trauma. Although well-studied in adults, there is a paucity of data on unintentional awareness in children.
AIMS
This case series examines instances of self-reported awareness registered with Wake Up Safe, a patient safety organization that maintains a database of adverse events in pediatric anesthesia.
METHODS
Cases of self-reported intraoperative awareness submitted to Wake Up Safe from January 1, 2010 to May 31, 2020 were reviewed for circumstances, causative factors, and level of harm.
RESULTS
Fourteen cases of self-reported intraoperative awareness out of 555 360 cases in patients aged 5-20 years were noted during the study period. Overall incidence of awareness was 2.52 (95% CI: 1.38-4.23) cases per 100 000 patients, or approximately 1:40 000. Self-reported intraoperative awareness was more frequently associated with cardiac and gastrointestinal endoscopic procedures. Incidence for cardiac procedures was 20.34 (95% CI: 8.18-41.90) cases per 100 000 patients. Incidence for gastrointestinal endoscopic procedures was 7.74 (95% CI: 1.60-22.62) cases per 100 000 patients. Most patients were assessed to have suffered harm.
CONCLUSIONS
Self-reported intraoperative awareness is a rare complication in pediatric patients that has implications for harm. Compared to awareness cases elicited by a questionnaire method, cases of self-reported awareness during general anesthesia may represent those that have a greater impact. A preoperative discussion of intraoperative awareness should be considered for procedures that carry a higher likelihood of awareness in order to mitigate harm.
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