Incidence of Connected Consciousness after Tracheal Intubation: A Prospective, International, Multicenter Cohort Study of the Isolated Forearm Technique
[en] Background: The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Methods: Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. Results: The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Conclusions: Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.
Disciplines :
Anesthésie & soins intensifs
Auteur, co-auteur :
Sanders, R. D.; Department of Anesthesiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WN, United States
Gaskell, A.; Department of Anaesthesia, Waikato Clinical School, University of Auckland, Hamilton, New Zealand
Raz, A.; Department of Anesthesiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WN, United States, Department of Anesthesia, Rambam Healthcare Campus, Haifa, Israel
Winders, J.; Department of Anaesthesia, Waikato Clinical School, University of Auckland, Hamilton, New Zealand
Stevanovic, A.; Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
Rossaint, R.; Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
Boncyk, C.; Department of Anesthesiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WN, United States
DEFRESNE, Aline ; Centre Hospitalier Universitaire de Liège - CHU > Service d'anesthésie - réanimation
TRAN, Gabriel ; Centre Hospitalier Universitaire de Liège - CHU > Service d'anesthésie - réanimation
Tasbihgou, S.; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Meier, S.; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Vlisides, P. E.; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
Fardous, H.; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
Hess, A.; Department of Anesthesiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WN, United States
Bauer, R. M.; Department of Anesthesiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WN, United States, Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, United States
Absalom, A.; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Mashour, G. A.; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
BONHOMME, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Coburn, M.; Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
Sleigh, J.; Department of Anaesthesia, Waikato Clinical School, University of Auckland, Hamilton, New Zealand
Incidence of Connected Consciousness after Tracheal Intubation: A Prospective, International, Multicenter Cohort Study of the Isolated Forearm Technique
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