Awareness During Anesthesia and The Need to Address It
The unexpected and explicit recollection of sensory perception when under general anesthesia is known as intraoperative consciousness. According to Cardinale et al. (2019), one of the unexpected complications while performing surgical procedures is unintentional awareness during general anesthesia (UAGA), which occurs when patients maintain consciousness and explicit remembrance while undergoing treatment. The use of “neuromuscular blocking agents (NMBs),” emergency operations, obstetric and cardiothoracic surgery, obesity, age, and prolonged operating time are all risk factors for intraoperative awareness (Cardinale et al., 2019, p. 98). According to Huh et al. (2020), awareness during anesthesia happens in 1 in 1000 to 2000 patients each year, with individuals regaining consciousness intermittently or remaining cognizant throughout the surgery. While this complication is infrequent, the clinical signs and potential serious psychological implications necessitate a thorough knowledge of the occurrence. The unexpected and explicit recollection of sensory perception when under general anesthesia is known as intraoperative consciousness. Patients who are going to undergo anesthesia frequently worry that they will recall what happened during the procedure.
It is critical to do research on workable solutions to reduce the likelihood that the patient would wake up while under anesthesia. Pre-operative control and intra-operative management are two categories of preventive strategies for avoiding awareness, according to (Cascella & De Blasio, 2022). To give a critical field of examination that overlaps study topics in general anesthetic research and neurology, research synthesis is required (Cascella & De Blasio, 2022). It is necessary not only to raise awareness about the problem, but also to investigate ways that can help anesthetists prevent consciousness during anesthesia. Anesthesia mechanisms, anesthetic effects on awareness/memory, and the usage of equipment such as bispectral index (BIS) monitors may be synthesized to explore strategies to better avoid consciousness during anesthesia.
Methods of Investigation
The investigation was based on whether the use of BIS monitoring on adult patients undergoing surgical procedures reduces the chances of unintended awareness as compared to the standard monitoring procedures. CINAHL Plus and PubMed were the resources used to look for existing information on BIS monitoring and anesthetic consciousness. Phrases like “BIS Monitoring,” “Anesthesia Awareness,” “Preventing Anesthesia Awareness,” and “BIS Monitoring and Anesthesia Awareness” were searched for in both databases. The search keywords produced few results in the CINAHL Plus database. The advanced search function was utilized to separate terms in a way that resulted in more articles.
The important terms were divided into three search bars. The search was confined to peer-reviewed publications, the Journal Subset set to the USA, and the year of publication range set from 2012 to 2022 using the advanced search function. The main search term was “BIS Monitoring and Anesthesia Awareness.” This term generated the most articles that were related to the use of BIS monitoring and its usage in lowering anesthetic consciousness in the OR. The search was also focused on clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews. The inclusion criteria restricted the publications to patients undergoing surgical operations under anesthesia, patients in the OR, and patients whose depth of anesthesia was monitored via BIS monitoring. The papers omitted BIS monitoring that was not employed in an operating room context, such as in intensive care units. A total of ten papers addressed the PICOT topic. Statistical analysis, meta-analysis, randomized controlled trials, randomized comparative efficacy trials, systematic reviews, and observational studies were among the article categories.
Findings
Major Strengths and Weaknesses
The main outcome of the study was that BIS-guided anesthesia when compared to clinical indicators, may lower the chance of intraoperative consciousness and speed up early recovery in patients having general anesthetic surgery. Additionally, there was no appreciable difference between BIS monitoring and non-BIS monitoring in the frequency of anesthetic consciousness, nor was there a correlating relationship between BIS monitoring and the frequency of intraoperative awareness (Gao et al., 2018). The key flaw was that, while identifying a significant number of studies that were suitable, there was no evidence of the usefulness of utilizing BIS to determine the level of anesthesia.
Proposed Solution
Awareness during anesthesia is for sure a problem without a solution. However, little, if not much can be done to minimize or reduce the chances of waking up during general anesthesia or rather alerting the practitioners. The possible solution is for patients to advise the hospital to come up with monitoring technology that can alert the anesthesiologists if the patient is on the verge of waking up. Although the technology is already in existence, previous studies have highlighted its ineffectiveness of the technology. In the study, Cascella et al., (2020) note that researchers assigned approximately half of 2,463 patients to a monitored group; the others received standard care. Only two reports of anesthesia awareness occurred in the monitored group, compared with 11 in the standard care group ((Gelfand et al., 2016).). Therefore, efforts and resources have to be pulled together to facilitate the effectiveness of the technology.
References
Cardinale, J. P., Gillespie, N., & Germond, L. (2019). Complications of general anesthesia. In Catastrophic Perioperative Complications and Management (pp. 95-103). Springer, Cham. Web.
Cascella, M., & De Blasio, E. (2022). Features and Management of Acute and Chronic Neuro Covid (pp. 137-158). Springer. Web.
Cascella, M., Bimonte, S., & Amruthraj, N. J. (2020). Awareness during emergence from anesthesia: Features and future research directions.World Journal of Clinical Cases, 8(2), 245. Web.
Gao, W.-wei, He, Y.-hong, Liu, L., Yuan, Q., Wang, Y.-feng, & Zhao, B. (2018). Bis monitoring on intraoperative awareness: A meta-analysis.Current Medical Science, 38(2), 349–353. Web.
Gelfand, M. E., Gabriel, R. A., Gimlich, R., Beutler, S. S., & Urman, R. D. (2016). Practice patterns in the intraoperative use of BISPECTRAL Index Monitoring.Journal of Clinical Monitoring and Computing, 31(2), 281–289. Web.
Huh, H., Park, S.-H., Yu, J. H., Hong, J., Lee, M. J., Cho, J. E., Lim, C. H., Lee, H. W., Kim, J. B., Yang, K.-S., & Yoon, S. Z. (2020). Quantifying the depth of anesthesia based on Brain Activity Signal modeling.Medicine, 99(5). Web.