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Late Psychological Symptoms after Awareness among Consecutively Included Surgical Patients
Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Departments of Anesthesiology and Intensive Care, County Hospital, Kalmar, Sweden.
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Departments of Clinical Physiology, County Hospital, Kalmar, Sweden.
Departments of Anesthesiology and Intensive Care, County Hospital, Kalmar, Sweden, and Department of Physiology and Pharmacology, Section of Anesthesiology, Karolinska Institutet, Stockholm, Sweden.
2007 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 106, no 1, 26-32 p.Article in journal (Refereed) Published
Abstract [en]

Background: Awareness during general anesthesia can cause late psychological symptoms. Selection bias may have affected the results in previous retrospective studies. The authors used prospective consecutive collection to recruit patients with previous awareness.

Methods: In a cohort of 2,681 consecutive patients scheduled to undergo general anesthesia, 98 considered themselves to have been aware during previous surgery. Six patients died before inclusion, and another 13 were excluded (4 cases of stoke or dementia, 7 declined to participate, and 2 could not be located). Seventy-nine patients were interviewed by telephone, and medical records were checked in uncertain cases. The interview followed a structured protocol, including seven late symptoms (anxiety, chronic fear, nightmares, flashbacks, indifference, loneliness, and lack of confidence in future life). Three persons independently assessed the interviews for classification, to determine whether awareness had occurred.

Results: Four cases were performed using regional anesthesia, and another 29 were not considered as awareness by the assessors. Therefore, the final analyses included 46 patients. Twenty (43%) had experienced pain, and 30 (65%) described acute emotional reactions during the awareness episode. Fifteen (33%) patients had experienced late psychological symptoms afterward. In 6 of those cases, the symptoms lasted for more than 2 months, and 1 patient had a diagnosis of post-traumatic stress disorder. Acute emotional reactions were significantly related to late psychological symptoms (P < 0.05).

Conclusion: The method for recruiting awareness cases in studies on late psychological symptoms may affect the result. The authors found fewer and milder problems, despite a similar degree of initial problems as in previous studies.

Place, publisher, year, edition, pages
2007. Vol. 106, no 1, 26-32 p.
National Category
Anesthesiology and Intensive Care
URN: urn:nbn:se:liu:diva-15404DOI: 10.1097/00000542-200701000-00009OAI: diva2:114122
Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2014-01-21Bibliographically approved
In thesis
1. Awareness and Dreaming during Anaesthesia: Incidence and Importance
Open this publication in new window or tab >>Awareness and Dreaming during Anaesthesia: Incidence and Importance
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The definition of awareness used consistently in this thesis is: Explicit recall of intraoperative events during general anaesthesia. Since there is no objective method to detect awareness, the patients must be interviewed after anaesthesia. The form and timing of the interview is crucial. To rely on spontaneous disclosure of awareness episodes is not sufficient. The total number of awareness-victims is considerable although the incidence may seem modest. A number of these patients look upon the awareness experience as the worst experience in their life. Suffering can include pain, mental distress and delayed psychological symptoms. However, the experience of awareness is not uniform and not all patients suffer.

A comprehensible definition for dreaming during anaesthesia is: Any recalled experience, excluding awareness, which occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Some findings point in the direction that dreaming during anaesthesia may be related to light or insufficient anaesthesia, but other findings do not. Some patients find dreaming during anaesthesia distressing, but generally the overall impression is that consequences of dreaming during anaesthesia seem to be small and of minor importance to the majority of patients.

In this thesis I have found the following:The incidence of awareness is approximately 0.2% when neuromuscular blocking drugs are used and awareness also exists without these drugs, albeit to a lesser extent. These findings represent standard practice in an adult population at normal risk. 50% of awareness cases may have delayed recall of awareness.

Using a consecutive inclusion design we found initial awareness suffering comparable to previous studies, but a lower incidence and less pronounced severity of late psychological symptoms. The incidences found among the awareness-victims in our study were; experience of pain 46%, immediate mental distress 65%, any late psychological symptom 33%, and PTSD below 10%.

A memory of an intraoperative dream after general anaesthesia is not an early interpretation of delayed awareness, indicating that no routine follow up of dreaming-only patients is indicated.

Dreams reported after anesthesia are generally not related to insufficient anesthesia defined as high BIS, and should not be regarded as near awareness.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 53 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1082
National Category
Anesthesiology and Intensive Care
urn:nbn:se:liu:diva-15408 (URN)978‐91‐7393‐786‐3 (ISBN)
Public defence
2008-12-06, Eken, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 11:00 (Swedish)
Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2009-08-21Bibliographically approved

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