Background
Author | Country | Year | Incidence (%) |
---|---|---|---|
NON-CARDIAC SURGERY | |||
Myles, et al. [9] | Australia | 2000 | 0.10 |
Akavipat, et al. [10] | Thailand | 2009 | 1.05 |
Sebel, et al. [11] | U.S.A. | 2004 | 0.13 |
Sandin, et al. [12] | Sweden | 2000 | 0.16 |
Xu, et al. [2] | China | 2009 | 0.41 |
CARDIAC SURGERY | |||
Maunuksela [16] | – | 1977 | 5.0 |
Goldmann, et al. [3] | – | 1987 | 23 |
Gordon, et al. [15] | South Africa | 1994 | 1.1 |
Wang Yun, et al. [17] | China | 2005 | 6 |
Xu, et al. [2] | China | 2009 | 6 |
Qian Wang, et al. [4] | China | 2013 | 3.0 |
Methods
Patient population
Conduct of the study
Statistical analysis
Results
Patients
Occurrence of intraoperative awareness
Number | Gender and age | Surgery | Reported events | Michigan awareness classification |
---|---|---|---|---|
1 | M/67 | CABG | Formication; perception of central line placement; mild pain | Class 3 |
2 | M/73 | Bentall procedure | Precordial stabs; nausea | Class 2D |
3 | M/64 | CABG | Operation on the chest | Class 2 |
4 | M/30 | Repair of aneurysm of aortic sinus, repair of VSD | Perception of central line placement | Class 2 |
5 | F/53 | MVR | Placement of nasal thermometer | Class 2 |
6 | M/23 | Modified Morrow procedure | A surgeon making explanations in a Tangshan accent | Class 1 |
7 | M/65 | Wheat procedure and CABG | Dreaming things back in decades ago; lower extremity operation | Class 2 |
8 | M/66 | CABG | Intubation | Class 2 |
9 | M/40 | Repair of aneurysm of aortic sinus | Intubation; operation, electroshock on heart | Class 2 |
10 | M/67 | CABG | Intubation, feeling nausea twice | Class 2D |
11 | M/60 | CABG | Scalpel incision; voice from doctors | Class 2 |
12 | M/60 | CABG | Intubation; internal jugular vein catheterization | Class 2 |
13 | M/65 | CABG | Sensation of operation on chest and lower limb | Class 2 |
14 | M/66 | Resection of atrial myxoma, TVP | Feelings of bugs-like crawling on the chest | Class 2 |
15 | M/38 | ASD repair, TVP | Sensation of sounds from the respirator | Class 1 |
16 | M/56 | CABG | Heard the surgeons’ talking | Class 1 |
17 | F/45 | MVR, TVP | Heard the sounds of electric scalpel, like “chi, chi” | Class 1 |
18 | F/18 | ASD repair | Intubation; nausea; discomfort on the back | Class 2D |
19 | F/59 | MVR, TVP | Operation | Class 2 |
20 | M/49 | CABG | Water dripping-like sounds of the machine; sensation of intubation and a severe feeling of nausea | Class 2D |
21 | F/56 | CABG | Sensation of the operation; severe pain, being unable to move | Class 5 |
22 | M/55 | Correction of aberrant of pulmonary artery, TVP | Sounds of the machine in the operation room | Class 1 |
23 | M/34 | Replacement of aortic root and ascending aorta | Sounds of a scalpel and scissor | Class 1 |
24 | F/51 | Replacement of ascending aorta | Heard the surgeon talking about the electric defibrillations, of which only the third time worked | Class 1 |
25 | F/60 | MVR, AVR, TVP | Heard the surgeon said the operation was well finished; intubation; felt nausea twice | Class 2D |
26 | F/50 | MVP | Dreaming, cannot afford details; heard the surgeon’s talking; central line placement | Class 2 |
27 | M/58 | CABG | Lower limb operation | Class 2 |
28 | M/74 | CABG | Intubation; felt nausea; sensation of the operation on the chest | Class 2D |
29 | M/62 | CABG | Operation on chest with burning heat | Class 2 |
30 | F/30 | Repair of ASD, TVP | Sounds like sawing wood | Class 1 |
31 | F/31 | Repair of ASD, TVP | Voice, such as “pass the scalpel to me” | Class 1 |
32 | M/43 | Modified Morrow procedure | Operation on chest; severe pain, wanting for more anesthetics | Class 3D |
33 | M/60 | CABG | Felt awake for a long time and felt like breathing with effort | Class 1D |
34 | M/52 | Bentall procedure | Heard “chi-chi” like sounds | Class 1 |
35 | M/46 | MVR, AVR, TVP | Heard the surgeon said the operation will be finished in an hour; heard the “dong-dong” like sounds | Class 1 |
36 | M/37 | MVR | Dreaming of receiving cardiac surgery; sensed the central line placement | Class 2 |
37 | F/48 | MVR, TVP, and PDA repair | Scissors cutting on the chest; mild pain | Class 3 |
38 | M/60 | CABG | Operation on chest and lower limb | Class 2 |
39 | M/41 | CABG | Something dragged down from the chest; unable to move; central line placement | Class 4 |
40 | M/59 | MVR, CABG | “chi-chi” sound | Class 1 |
41 | M/34 | CABG | Dreaming of the lifetime in high school; heard the surgeon said the operation was almost finished | Class 1 |
42 | F/58 | CABG | Heard the surgeon said 5 bypass grafts were done, and the 2 nurses had done a great job | Class 1 |
43 | M/40 | AVR | Intubation; unable to move; afraid | Class 4D |
44 | M/57 | CABG | Chest stuffy, unable to speak | Class 4D |
45 | M/56 | Replacement of descending aorta | Intubation; nausea | Class 2D |
46 | M/54 | CABG | Heard the surgeon said the operation was well done; felt his chest stabbed 4–5 times. | Class 2 |
Risk factors for intraoperative awareness
Characteristic | No awareness or possible awareness | Confirmed awareness |
P Value |
---|---|---|---|
Age-no. (%) | – | – | 0.026*
|
< 60 year old | 1137 (60.7) | 36 (1.9) | – |
> 60 year old | 691 (36.9) | 10 (0.5) | – |
Male-no. (%) | 1212 (66.3) | 33 (73.9) | 0.28 |
Height-cm | 165.7 ± 8.7 | 166.1 ± 8.1 | 0.80 |
Weight-kg | 68.0 ± 12.4 | 67.7 ± 12.9 | 0.88 |
BMI | 24.8 ± 6.5 | 24.4 ± 3.7 | 0.67 |
Blood group-no. (%) | – | – | 0.34 |
A | 511 (28.1) | 16 (34.8) | – |
B | 607 (33.4) | 18 (39.1) | – |
AB | 188 (10.4) | 2 (4.3) | – |
O | 510 (28.4) | 10 (21.7) | – |
Existing risk factors-no. (%) | – | – | – |
Smoking | 824 (45.1) | 21 (47.8) | 0.72 |
Alcohol consumption | 236 (12.9) | 5 (10.9) | 0.68 |
Hypertension | 860 (47.1) | 15 (32.6) | 0.052 |
Hyperlipidemia | 705 (38.6) | 11 (23.9) | 0.043*
|
Diabetes mellitus | 342 (18.7) | 6 (13.0) | 0.33 |
Chronic kidney disease | 13 (0.7) | 1 (2.2) | 0.30 |
Chronic liver disease | 21 (1.2) | 0 (0) | 1.00 |
Cerebrovascular events | 39 (2.1) | 1 (2.2) | 1.00 |
Chronic obstructive pulmonary disease | 43 (2.4) | 0 (0) | 0.62 |
History of general anesthesia | 411 (22.5) | 6 (13.0) | 0.13 |
History of cardiac infarction | 320 (17.5) | 7 (15.2) | 0.68 |
ASA status-no. / total no. (%) | – | – | 0.48 |
I | 11 (0.61) | 1 (2.2) | – |
II | 533 (29.5) | 16 (34.8) | – |
III | 1167 (64.5) | 27 (58.7) | – |
IV | 97 (5.4) | 2 (4.3) | – |
NYHA grade | – | – | 0.53 |
Lower than Grade 1 | 510 (27.9) | 9 (20.0) | – |
Grade 1 | 177 (9.7) | 7 (15.2) | – |
Grade 2 | 779 (42.7) | 21 (45.7) | – |
Grade 3 | 340 (18.6) | 9 (20.0) | – |
Grade 4 | 20 (1.1) | 0 (0) | – |
Ejection fraction (%) | 61.2 ± 8.7 | 62.3 ± 7.6 | 0.40 |
Duration of surgery-min | 225.2 ± 82.4 | 195.0 ± 52.0 | 0.013*
|
Cardiopulmonary Bypass-no. (%) | 1321 (72.3) | 30 (68.2) | 0.95 |
Duration of CPB-min | 106.2 ± 47.4 | 91.2 ± 40.0 | 0.071 |
Aortic clamping time-min | 71.7 ± 32.1 | 62.6 ± 33.3 | 0.11 |
B | S.E. | Wald | df |
P value | OR | 95 % CI for OR | ||
---|---|---|---|---|---|---|---|---|
Lower | Upper | |||||||
Hyperlipidemia | −0.504 | 0.358 | 1.984 | 1 | 0.159 | 0.604 | 0.300 | 1.218 |
Age | −0.623 | 0.369 | 2.854 | 1 | 0.091 | 0.536 | 0.260 | 1.105 |
Duration of Operation | −0.006 | 0.002 | 5.593 | 1 | 0.018 | 0.094 | 0.990 | 0.999 |
Constant | −1.650 | 0.623 | 7.006 | 1 | 0.008 | 0.192 | – |