[en] Background: Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18e40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes. Methods: This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation. Results: Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [OR adjusted ]¼2.7; 95% confidence interval [CI], 1.1e7.6; P¼0.022) and was decreased with continuous anaesthesia before laryngoscopy (OR adjusted ¼0.43; 95% CI, 0.20e0.96; P¼0.041). Responses were more likely to occur after a command to respond (and not to nonsense, 13 subjects) than after a nonsense statement (and not to command, four subjects, P¼0.049). Conclusions: Connected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to
Disciplines :
Anesthesia & intensive care
Author, co-author :
Lennertz, Richard; Department of Anesthesiology, University of Wisconsin, Madison, USA
Pryor, Kane; Department of Anesthesiology, Weill Cornell Medicine, New York, USA
Raz, Aeyal; Department of Anesthesiology, Rambam Health Care Center
Parker, Maggie; Department of Anesthesiology, University of Wisconsin, Madison, USA
BONHOMME, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Schuller, Peter; Department of Anaesthesia, Cairns Hospital, Australia
Schneider, Gerhard; School of Medicine, Department of Anaesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
Moore, Matt; Department of Anesthesiology, University of Auckland, Auckland
Coburn, Mark; Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
Root, James; Department of Anesthesiology, Weill Cornell Medicine, New York, USA ; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
Emerson, Jacqueline; Department of Anesthesiology, Weill Cornell Medicine, New York, USA
Hohmann, Alexandra; Department of Anesthesiology, Weill Cornell Medicine, New York, USA
Azaria, Haya; Department of Anesthesiology, Rambam Health Care Center
Golomb, Neta; Department of Anesthesiology, Rambam Health Care Center
DEFRESNE, Aline ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Montupil, Javier ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Pilge, Stefanie; School of Medicine, Department of Anaesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
Obert, David; School of Medicine, Department of Anaesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
Van Waart, Hanna; Department of Anesthesiology, University of Auckland, Auckland
Seretny, Marta; Department of Anesthesiology, University of Auckland, Auckland
Rossaint, Rolf; Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
Kowark, Ana; Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
Blair, Alexander; Department of Anesthesiology, University of Wisconsin, Madison, USA
Krause, Bryan; Department of Anesthesiology, University of Wisconsin, Madison, USA
Proekt, Alex; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
Kelz, Max; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
Sleigh, Jamie; Department of Anaesthesiology, Waikato Clinical Campus, 13 Specialty of Anaesthetics, University of Auckland, Hamilton ; University of Sydney, Camperdown, Australia
Gaskell, Amy; Department of Anaesthesiology, Waikato Clinical Campus, 13 Specialty of Anaesthetics, University of Auckland, Hamilton ; University of Sydney, Camperdown, Australia
Sanders, Robert; Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
Sebel, P.S., Bowdle, T.A., Ghoneim, M.M., et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 99 (2004), 833–839.
Ghoneim, M.M., Block, R.I., Dhanaraj, V.J., Todd, M.M., Choi, W.W., Brown, C.K., Auditory evoked responses and learning and awareness during general anesthesia. Acta Anaesthesiol Scand 44 (2000), 133–143.
Sandin, R.H., Enlund, G., Samuelsson, P., Lennmarken, C., Awareness during anaesthesia: a prospective case study. Lancet 355 (2000), 707–711.
Avidan, M.S., Jacobsohn, E., Glick, D., et al. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med 365 (2011), 591–600.
Mashour GA, Pryor K. Consciousness, memory, and anesthesia. In: MA Gropper, NH Cohen, LI Eriksson, LA Fleisher, K Leslie, JP Wiener-Kronish, eds. Miller's anesthesia, 9th Edn. Philadelphia: Elsevier, p. 250–266.
Sanders, R.D., Gaskell, A., Raz, A., et al. Incidence of connected consciousness after tracheal intubation: a prospective, international, multicenter cohort study of the isolated forearm technique. Anesthesiology 126 (2017), 214–222.
Tunstall, M.E., Detecting wakefulness during general anaesthesia for caesarean section. Br Med J, 1, 1977, 1321.
Russell, I.F., The ability of bispectral index to detect intra-operative wakefulness during isoflurane/air anaesthesia, compared with the isolated forearm technique. Anaesthesia 68 (2013), 1010–1020.
Linassi, F., Zanatta, P., Tellaroli, P., Ori, C., Carron, M., Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens. Br J Anaesth 121 (2018), 198–209.
Rowley, P., Boncyk, C., Gaskell, A., et al. What do people expect of general anaesthesia?. Br J Anaesth 118 (2017), 486–488.
Osterman, J.E., Hopper, J., Heran, W.J., Keane, T.M., van der Kolk, B.A., Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry 23 (2001), 198–204.
Myles, P.S., McLeod, A.D., Hunt, J.O., Fletcher, H., Sex differences in speed of emergence and quality of recovery after anaesthesia: cohort study. BMJ 322 (2001), 710–711.
Buchanan, F.F., Myles, P.S., Cicuttini, F., Effect of patient sex on general anaesthesia and recovery. Br J Anaesth 106 (2011), 832–839.
Gan, T.J., Glass, P.S., Sigl, J., et al. Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men. Anesthesiology 90 (1999), 1283–1287.
Pandit, J.J., Andrade, J., Bogod, D.G., et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth 113 (2014), 549–559.
Domino, K.B., Posner, K.L., Caplan, R.A., Cheney, F.W., Awareness during anesthesia: a closed claims analysis. Anesthesiology 90 (1999), 1053–1061.
Harris, P.A., Taylor, R., Minor, B.L., et al. The REDCap Consortium: building an international community of software platform partners. J Biomed Inform, 95, 2019, 103208.
Light, L.L., Kennison, R., Prull, M.W., La Voie, D., Zuelling, A., One-trial associative priming of nonwords in young and older adults. Psychol Aging 11 (1996), 417–430.
Bradley, M.M., Lang, P.J., Affective Norms for English Words (ANEW): instruction manual and affective ratings., 1999, University of Florida Technical Report C-1, Center for Research in Psychophysiology.
Coltheart, M., The MRC psycholinguistic database. Q J Exp Psychol A 33 (1981), 497–505.
Brice, D.D., Hetherington, R.R., Utting, J.E., A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 42 (1970), 535–542.
Gaudreau, J.-D., Gagnon, P., Harel, F., Tremblay, A., Roy, M.-A., Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage 29 (2005), 368–375.
Pleym, H., Spigset, O., Kharasch, E.D., Dale, O., Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 47 (2003), 241–259.
Kodaka, M., Suzuki, T., Maeyama, A., Koyama, K., Miyao, H., Gender differences between predicted and measured propofol CP50 for loss of consciousness. J Clin Anesth 18 (2006), 486–489.
Li, Y., Wu, F., Xu, J., Influence of age and sex on pharmacodynamics of propofol in neurosurgical patients: model development. Acta Pharmacol Sin 27 (2006), 629–634.
Linassi, F., Obert, D.P., Maran, E., et al. Implicit memory and anesthesia: a systematic review and meta-analysis. Life, 11, 2021, 850.
