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Awareness Monitoring in Children

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Book cover Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice

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Abstract

Several recent studies have demonstrated that children may be at greater risk of awareness than adults [1–6]. The reasons why children are more likely to be aware are unknown. It is difficult to know how to prevent awareness in children without a clear understanding of what is causing it. While there is some evidence that depth- of-anesthesia monitors may decrease the risk of awareness in adults, there is no direct evidence to suggest that they do so in children.

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References

  1. Blusse van Oud-Alblas HJ, van Dijk M, Liu C et al. (2009) Intraoperative awareness during pediatric anesthesia. Br J Anaesth 102(1):104–110

    Article  Google Scholar 

  2. Davidson AJ, Huang GH, Czarnecki C et al. (2005) Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 100(3):653–661, table of contents

    Article  PubMed  Google Scholar 

  3. Davidson AJ, Sheppard SJ, Engwerda AL et al. (2008) Detecting awareness in children by using an auditory intervention. Anesthesiology 109(4):619–624

    Article  PubMed  Google Scholar 

  4. Lopez U, Habre W, Laurencon M et al. (2007) Intra-operative awareness in children: the value of an interview adapted to their cognitive abilities. Anesthesia 62(8):778–89

    Article  CAS  Google Scholar 

  5. Malviya S, Galinkin JL, Bannister CF et al. (2009) The incidence of intraoperative awareness in children: childhood awareness and recall evaluation. Anesth Analg 109(5):1421–1427

    Article  PubMed  Google Scholar 

  6. Davidson AJ, Smith KR, Blusse van Oud-Alblas HJ et al. (2011) Awareness in children: a secondary analysis of five cohort studies. Anesthesia 66(6):446–454

    Article  CAS  Google Scholar 

  7. Engelhardt T, Petroz GC, McCheyne A et al. (2007) Awareness during pediatric anesthesia: what is the position of European pediatric anesthesiologists? Paediatr Anaesth 17(11):1066–1070

    PubMed  Google Scholar 

  8. Hobbs AJ, Bush GH, Downham DY (1988) Peri-operative dreaming and awareness in children. Anesthesia 43(7):560–562

    Article  CAS  Google Scholar 

  9. McKie BD, Thorp EA (1973) Awareness and dreaming during anesthesia in a pediatric hospital. Anaesth Intensive Care 1(5):407–414

    PubMed  CAS  Google Scholar 

  10. O’Sullivan EP, Childs D, Bush GH (1988) Peri-operative dreaming in pediatric patients who receive suxamethonium. Anesthesia 43(2):104–106

    Article  Google Scholar 

  11. Brice DD, Hetherington RR, Utting JE (1970) A simple study of awareness and dreaming during anesthesia. Br J Anaesth 42(6):535–542

    Article  PubMed  CAS  Google Scholar 

  12. Samuelsson P, Brudin L, Sandin RH (2007) Late psychological symptoms after awareness among consecutively included surgical patients. Anesthesiology 106(1):26–32

    Article  PubMed  Google Scholar 

  13. Schwender D, Kunze-Kronawitter H, Dietrich P et al. (1998) Conscious awareness during general anesthesia: patients’ perceptions, emotions, cognition and reactions. Br J Anaesth 80(2):133–139

    Article  PubMed  CAS  Google Scholar 

  14. Osterman JE, van der Kolk BA (1998) Awareness during anesthesia and posttraumatic stress disorder. Gen Hosp Psychiatry 20(5):274–281

    Article  PubMed  CAS  Google Scholar 

  15. Blusse Vano-Ahj, Bosenberg AT, Tibboel D (2008) Awareness in children: another two cases. Paediatr Anaesth

    Google Scholar 

  16. Bonke B, Van Dam ME, Van Kleff JW et al. (1992) Implicit memory tested in children during inhalation anesthesia. Anesthesia 47(9):747–749

    Article  CAS  Google Scholar 

  17. Kalff AC, Bonke B, Wolters G et al. (1995) Implicit memory for stimuli presented during inhalation anesthesia in children. Psychol Rep 77(2):371–375

    Article  PubMed  CAS  Google Scholar 

  18. Rich JB, Yaster M, Brandt J (1999) Anterograde and retrograde memory in children anesthetized with propofol. J Clin Exp Neuropsychol 21(4):535–546

    Article  PubMed  CAS  Google Scholar 

  19. Byers GF, Muir JG (1997) Detecting wakefulness in anaesthetised children. Can J Anaesth 44(5 Pt 1):486–488

    Article  PubMed  CAS  Google Scholar 

  20. Andrade J, Deeprose C, Barker I (2008) Awareness and memory function during pediatric anesthesia. Br J Anaesth 100(3):389–396

    Article  PubMed  CAS  Google Scholar 

  21. Sandin RH, Enlund G, Samuelsson P et al. (2000) Awareness during anesthesia: a prospective case study. Lancet 355(9205):707–711

    Article  PubMed  CAS  Google Scholar 

  22. Moerman N, Bonke B, Oosting J (1993) Awareness and recall during general anesthesia. Facts and feelings. Anesthesiology 79(3):454–464

    Article  CAS  Google Scholar 

  23. Myles PS, Williams DL, Hendrata M et al. (2000) Patient satisfaction after anesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84(1):6–10

    Article  PubMed  CAS  Google Scholar 

  24. Domino KB, Posner KL, Caplan RA et al. (1999) Awareness during anesthesia: a closed claims analysis. Anesthesiology 90(4):1053–1061

    Article  PubMed  CAS  Google Scholar 

  25. Errando CL, Sigl JC, Robles M et al. (2008) Awareness with recall during general anesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth

    Google Scholar 

  26. Davis PJ (2005) Goldilocks: the pediatric anesthesiologist’s dilemma. Anesthesia & Analgesia 100(3):650–652

    Article  Google Scholar 

  27. Lerman J, Sikich N, Kleinman S et al. (1994) The pharmacology of sevoflurane in infants and children. Anesthesiology 80(4):814–824

    Article  PubMed  CAS  Google Scholar 

  28. Brosnan RJ, Pypendop BH, Barter LS et al. (2006) Pharmacokinetics of inhaled anesthetics in green iguanas (Iguana iguana) Am J Vet Res 67(10):1670–1674

    Article  PubMed  CAS  Google Scholar 

  29. Eger EI (2001) 2nd Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake. Anesth Analg 93(4):947–953

    Article  PubMed  CAS  Google Scholar 

  30. Inomata S, Kihara S, Miyabe M et al. (2002) The hypnotic and analgesic effects of oral cloni- dine during sevoflurane anesthesia in children: a dose–response study. Anesth Analg 94(6):1479–1483

    PubMed  CAS  Google Scholar 

  31. Mapleson WW (1996) Effect of age on MAC in humans: a meta-analysis. Br J Anaesth 76(2):179–185

    Article  PubMed  CAS  Google Scholar 

  32. Kihara S, Inomata S, Yaguchi Y et al. (2000) The awakening concentration of sevoflurane in children. Anesth Analg 91(2):305–308

    PubMed  CAS  Google Scholar 

  33. Katoh T, Suguro Y, Ikeda T et al. (1993) Influence of age on awakening concentrations of sevoflurane and isoflurane. Anesth Analg 76(2):348–352

    PubMed  CAS  Google Scholar 

  34. Davidson AJ, Huang GH, Rebmann CS et al. (2005) Performance of entropy and Bispectral Index as measures of anesthesia effect in children of different ages. Br J Anaesth 95(5):674–679

    Article  PubMed  CAS  Google Scholar 

  35. Wodey E, Tirel O, Bansard JY et al. (2005) Impact of age on both BIS values and EEG bis- pectrum during anesthesia with sevoflurane in children. British Journal of Anesthesia 94(6):810–820

    Article  CAS  Google Scholar 

  36. Tirel O, Wodey E, Harris R et al. (2008) Variation of bispectral index under TIVA with propofol in a pediatric population. Br J Anaesth 100(1):82–87

    Article  PubMed  CAS  Google Scholar 

  37. Tirel O, Wodey E, Harris R et al. (2006) The impact of age on bispectral index values and EEG bispectrum during anesthesia with desflurane and halothane in children. Br J Anaesth 96(4):480–485

    Article  PubMed  CAS  Google Scholar 

  38. Tsuruta S, Satsumae T, Mizutani T et al. (2011) Minimum alveolar concentrations of sevoflurane for maintaining bispectral index below 50 in children. Paediatr Anaesth 221(11):1124–1127

    Article  Google Scholar 

  39. Wennervirta J, Ranta SO, Hynynen M (2002) Awareness and recall in outpatient anesthesia. Anesth Analg 95(1):72–77, table of contents

    Google Scholar 

  40. Lennmarken C, Bildfors K, Enlund G et al. (2002) Victims of awareness. Acta Anaesthesiol Scand 46(3):229–231

    Article  PubMed  CAS  Google Scholar 

  41. Ranta SO, Laurila R, Saario J et al. (1998) Awareness with recall during general anesthesia: incidence and risk factors. Anesth Analg 86(5):1084–1089

    PubMed  CAS  Google Scholar 

  42. Leslie K, Chan MT, Myles PS et al. (2010) Posttraumatic stress disorder in aware patients from the B-aware trial. Anesth Analg 110(3):823–828

    Article  PubMed  Google Scholar 

  43. Phelan L, Stargatt R, Davidson AJ (2009) Long-term posttraumatic effects of intraoperative awareness in children. Paediatr Anaesth 19(12):1152–1156

    Article  PubMed  Google Scholar 

  44. Lopez U, Habre W, Van der Linden M et al. (2008) Intra-operative awareness in children and post-traumatic stress disorder. Anesthesia 63(5):474–481

    Article  CAS  Google Scholar 

  45. Avidan MS, Zhang L, Burnside BA et al. (2008) Anesthesia awareness and the bispectral index. N Engl J Med 358(11):1097–1108

    Article  PubMed  CAS  Google Scholar 

  46. Avidan MS, Jacobsohn E, Glick D et al. (20011) Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med 365(7):591–600

    Google Scholar 

  47. Bourgeois E, Sabourdin N, Louvet N et al. (2012) Minimal alveolar concentration of sevoflu- rane inhibiting the reflex pupillary dilatation after noxious stimulation in children and young adults. Br J Anaesth 108(4):648–654

    Article  PubMed  CAS  Google Scholar 

  48. Constant I, Nghe MC, Boudet L et al. (2006) Reflex pupillary dilatation in response to skin incision and alfentanil in children anaesthetized with sevoflurane: a more sensitive measure of noxious stimulation than the commonly used variables. Br J Anaesth 96(5):614–619

    Article  PubMed  CAS  Google Scholar 

  49. Myles PS, Leslie K, McNeil J et al. (2004) Bispectral index monitoring to prevent awareness during anesthesia: the B-Aware randomised controlled trial. Lancet 363(9423):1757–1763

    Article  PubMed  CAS  Google Scholar 

  50. Weber F, Kriek N, Blusse van Oud-Alblas HJ (2010) The effects of mivacurium-induced neuromuscular block on Bispectral Index and Cerebral State Index in children under propofol anesthesia - a prospective randomized clinical trial. Paediatr Anaesth 20(8):697–703

    Article  PubMed  Google Scholar 

  51. Messner M, Beese U, Romstock J et al. (2003) The bispectral index declines during neuro- muscular block in fully awake persons. Anesth Analg 97(2):488–491 table of contents

    Google Scholar 

  52. Davidson AJ, Czarnecki C (2004) The Bispectral Index in children: comparing isoflurane and halothane. Br J Anaesth 92(1):14–17

    Article  PubMed  CAS  Google Scholar 

  53. Davidson A (2004) The correlation between bispectral index and airway reflexes with sevoflurane and halothane anesthesia. Paediatr Anaesth 14(3):241–246

    Article  PubMed  Google Scholar 

  54. Edwards JJ, Soto RG, Bedford RF (2005) Bispectral Index values are higher during halothane vs. sevoflurane anesthesia in children, but not in infants. Acta Anaesthesiol Scand 49(8):1084–1087

    Article  PubMed  CAS  Google Scholar 

  55. Constant I, Leport Y, Richard P et al. (2004) Agitation and changes of Bispectral Index and electroencephalographic-derived variables during sevoflurane induction in children: clonidine premedication reduces agitation compared with midazolam. Br J Anaesth 92(4):504–511

    Article  PubMed  CAS  Google Scholar 

  56. Kim HS, Oh AY, Kim CS et al. (2005) Correlation of bispectral index with end-tidal sevoflurane concentration and age in infants and children. Br J Anaesth 95(3):362–366

    Article  PubMed  CAS  Google Scholar 

  57. Valkenburg AJ, de Leeuw TG, Tibboel D et al. (2009) Lower bispectral index values in children who are intellectually disabled. Anesth Analg 109(5):1428–1433

    Article  PubMed  Google Scholar 

  58. Davidson AJ, Sale SM, Wong C et al. (2008) The electroencephalograph during anesthesia and emergence in infants and children. Paediatr Anaesth 18(1):60–70

    PubMed  Google Scholar 

  59. McKeever S, Johnston L, Davidson AJ (2012) An observational study exploring amplitude- integrated electroencephalogram and spectral edge frequency during pediatric anesthesia. Anaesth Intensive Care 40(2):275–284

    PubMed  CAS  Google Scholar 

  60. Davidson AJ, McCann ME, Devavaram P et al. (2001) The differences in the bispectral index between infants and children during emergence from anesthesia after circumcision surgery. Anesth Analg 93(2):326–330

    PubMed  CAS  Google Scholar 

  61. Denman WT, Swanson EL, Rosow D, et al. (2000) Pediatric evaluation of the bispectral index (BIS) monitor and correlation of BIS with end-tidal sevoflurane concentration in infants and children. Anesth Analg 90(4):872–877

    Article  PubMed  CAS  Google Scholar 

  62. Davidson AJ, Kim MJ, Sangolt GK (2004) Entropy and bispectral index during anesthesia in children. Anesthesia & Intensive Care 32(4):485–493

    CAS  Google Scholar 

  63. McCann ME, Bacsik J, Davidson A et al. (2002) The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers. Paediatr Anaesth 12(6):519–525

    Article  PubMed  Google Scholar 

  64. Brosius KK, Bannister CF et al. (2002) Oral midazolam premedication in preadolescents and adolescents. Anesth Analg 94(1):31–36

    PubMed  CAS  Google Scholar 

  65. Brosius KK, Bannister CF (2001) Effect of oral midazolam premedication on the awakening concentration of sevoflurane, recovery times and bispectral index in children. Paediatr Anaesth 11(5):585–590

    Article  PubMed  CAS  Google Scholar 

  66. Whyte SD, Booker PD (2004) Bispectral index during isoflurane anesthesia in pediatric patients. Anesth Analg 98(6):1644–1649

    Article  PubMed  CAS  Google Scholar 

  67. Park HJ, Kim YL, Kim CS et al. (2007) Changes of bispectral index during recovery from general anesthesia with 2% propofol and remifentanil in children. Paediatr Anaesth 17(4):353–357

    Article  PubMed  Google Scholar 

  68. Munoz HR, Cortinez LI, Ibacache ME et al. (2006) Effect site concentrations of propofol producing hypnosis in children and adults: comparison using the bispectral index. Acta Anaesthesiol Scand 50(7):882–887

    Article  PubMed  CAS  Google Scholar 

  69. Degoute CS, Macabeo C, Dubreuil C et al. (2001) EEG bispectral index and hypnotic component of anesthesia induced by sevoflurane: comparison between children and adults. Br J Anaesth 86(2):209–212

    Article  PubMed  CAS  Google Scholar 

  70. Rigouzzo A, Girault L, Louvet N et al. (2008) The relationship between bispectral index and propofol during target-controlled infusion anesthesia: a comparative study between children and young adults. Anesth Analg 106(4):1109–1116, table of contents

    Google Scholar 

  71. Klockars JG, Hiller A, Ranta S et al. (2006) Spectral entropy as a measure of hypnosis in children. Anesthesiology 104(4):708–717

    Article  PubMed  Google Scholar 

  72. Klockars JG, Hiller A, Munte S et al. (2012) Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance. Anesthesiology 116(2):340–351

    Article  PubMed  CAS  Google Scholar 

  73. Weber F, Hollnberger H, Gruber M et al. (2004) Narcotrend depth of anesthesia monitoring in infants and children. Can J Anaesth 51(8):855–856

    Article  PubMed  Google Scholar 

  74. Weber F, Gruber M, Taeger K (2005) The correlation of the Narcotrend Index and classical electroencephalographic parameters with endtidal desflurane concentrations and hemodynamic parameters in different age groups. Paediatr Anaesth 15(5):378–384

    Article  PubMed  Google Scholar 

  75. Weber F, Hollnberger H, Gruber M et al. (2005) The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children. Paediatr Anaesth 15(9):727–732

    Article  PubMed  Google Scholar 

  76. Wallenborn J, Kluba K, Olthoff D (2007) Comparative evaluation of Bispectral Index and Narcotrend Index in children below 5 years of age. Paediatr Anaesth 17(2):140–147

    Article  PubMed  Google Scholar 

  77. Munte S, Klockars J, van Gils M et al. (2009) The Narcotrend index indicates age-related changes during propofol induction in children. Anesth Analg 109(1):53–59

    Article  PubMed  Google Scholar 

  78. Weber F, Bein T, Hobbhahn J et al. (2004) Evaluation of the Alaris Auditory Evoked Potential Index as an indicator of anesthetic depth in preschool children during induction of anesthesia with sevoflurane and remifentanil. Anesthesiology 101(2):294–298

    Article  PubMed  CAS  Google Scholar 

  79. Ironfield CM, Davidson AJ (2007) AEP-monitor/2 derived, composite auditory evoked potential index (AAI-1.6) and bispectral index as predictors of sevoflurane concentration in children. Paediatr Anaesth 17(5):452–459

    Article  PubMed  Google Scholar 

  80. Disma N, Lauretta D, Palermo F, et al. (2007) Level of sedation evaluation with Cerebral State Index and A-Line Arx in children undergoing diagnostic procedures. Paediatr Anaesth 17(5):445–451

    Article  PubMed  Google Scholar 

  81. McKeever S, Johnston L, Davidson A (2012) A review of the utility of EEG depth of anesthesia monitors in the pediatric intensive care environment. Intensive Crit Care Nurs 2012

    Google Scholar 

  82. Minardi C, Sahillioglu E, Astuto M, Colombo M, Ingelmo PM (2012) Sedation and analgesia in pediatric intensive care. Curr Drug Targets 13(7):936–943

    Article  PubMed  CAS  Google Scholar 

  83. Sammartino M, Volpe B, Sbaraglia F et al. (2010) Capnography and the bispectral index- their role in pediatric sedation: a brief review. Int J Pediatr 2010:828347

    PubMed  Google Scholar 

  84. Kawaraguchi Y, Fukumitsu K, Kinouchi K et al. (2003) [Bispectral index (BIS) in infants anesthetized with sevoflurane in nitrous oxide and oxygen]. Masui 52(4):389–393

    PubMed  Google Scholar 

  85. Bannister CF, Brosius KK, Sigl JC et al. (2001) The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesth Analg 92(4):877–881

    Article  PubMed  CAS  Google Scholar 

  86. Hayashi K, Shigemi K, Sawa T (2012) Neonatal electroencephalography shows low sensitivity to anesthesia. Neurosci Lett 517(2):87–91

    Article  PubMed  CAS  Google Scholar 

  87. Davidson AJ (2012) Neurotoxicity and the need for anesthesia in the newborn: does the emperor have no clothes? Anesthesiology 116(3):507–509

    Article  PubMed  Google Scholar 

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  1. Anesthesia Department, Royal Children’s Hospital, Flemington Road, Parkville, Victoria, Australia

    Andrew J. Davidson

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Correspondence to Andrew J. Davidson .

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  1. Anesthesia and Intensive Care, Pediatric Anesthesia and Intensive Care Section, and Postgraduate School, University of Catania, AOU Policlinico-Vittorio Emanuele, Catania, Italy

    Marinella Astuto

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Davidson, A.J. (2013). Awareness Monitoring in Children. In: Astuto, M. (eds) Pediatric Anesthesia, Intensive Care and Pain: Standardization in Clinical Practice. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Milano. https://doi.org/10.1007/978-88-470-2685-8_13

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