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PEDIATRIC ANESTHESIOLOGY

The Incidence of Intraoperative Awareness in Children: Childhood Awareness and Recall Evaluation

Shobha Malviya, MD^*, Jeffrey L. Galinkin, MD, FAAP, Carolyn F. Bannister, MD, FAAP, Constance Burke, BSN, RN^*, Jeannie Zuk, PhD, RN, Mark Popenhagen, PsyD, Samatha Brown, RN, and Terri Voepel-Lewis, MSN, RN^*

From the *Department of Anesthesiology at University of Michigan Health Systems, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; and Emory University, Atlanta, Georgia.

Address correspondence and reprint requests to Shobha Malviya, MD, F3900 C. S. Mott Hospital, SPC 5211, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5211. Address e-mail to smalviya{at}umich.edu.

Abstract

BACKGROUND: There is a considerable discrepancy between the reported incidences of awareness under anesthesia in children (0.2%–2.7%). In this prospective, observational, cohort study we evaluated 1) the incidence of awareness during general anesthesia in children across three settings, 2) factors contributing to awareness, and 3) short-term psychological effects of awareness.

METHODS: Children (aged 5–15 yr) who underwent general anesthesia were included, and all perioperative data including anesthetic drugs were collected prospectively. Children were interviewed three times postoperatively using a semistructured questionnaire. All cases of possible or probable awareness were discussed with the child's care providers to confirm or refute the memories. Internal consensus among investigators across sites was reached, and these cases and a random selection of others were reviewed by three external reviewers. For the purpose of this study, possible/probable awareness was defined as cases with agreement between the internal consensus and at least two of the three external reviewers.

RESULTS: One thousand seven hundred eighty-four children completed at least one interview. Thirty-two cases were coded as possible or probable awareness by at least one entity (i.e., either the internal consensus or one of the external reviewers). Fourteen of these cases met the definition for possible/probable awareness, making the incidence of awareness 0.8%. Six of the 14 children with awareness (43%) remembered feeling scared during their surgery and three (21%) reported hurting. Two children in this group (14%) said they would feel worse if they had to have surgery again, which was not significantly different from reports of children with no recall (15%). None of the children with awareness required psychological follow-up. Endoscopic procedures were associated with a higher risk for awareness (relative risk = 4.5 [confidence interval 1.5–13.6]).

CONCLUSIONS: Although 0.8% of children experienced possible/probable awareness in this study, none experienced short-term psychological distress.