Fatores de risco para o despertar intraoperatório

Rogean Rodrigues Nunes; Victor Camarão Porto; Vivianne Trevia Miranda; Nayanna Quezado de Andrade; Lara Moreira Mendes Carneiro

doi:10.1590/S0034-70942012000300009

Review Article

Fatores de risco para o despertar intraoperatório

Risk factor for intraoperative awareness

Rogean Rodrigues Nunes; Victor Camarão Porto; Vivianne Trevia Miranda; Nayanna Quezado de Andrade; Lara Moreira Mendes Carneiro

http://dx.doi.org/10.1590/S0034-70942012000300009 Braz J Anesthesiol, vol.62, n3, p.369-374, 2012

PDF

Downloads: 1

Resumo

JUSTIFICATIVA E OBJETIVOS: O despertar intraoperatório, evento adverso na anestesia geral, pode ocorrer em cerca de 20.000 casos por ano, o que em si justifica o estudo dos fatores de risco deste evento. O objetivo deste estudo foi fazer uma revisão sobre o tema com a finalidade de diminuir a incidência do despertar intraoperatório e das sequelas psicológicas decorrentes deste incidente, que podem resultar em síndrome de estresse pós-traumático com repercussões negativas sobre o desempenho social, psíquico e funcional do paciente cirúrgico. CONTEÚ;DO: Foi realizada revisão sobre o despertar intraoperatório, avaliando suas diferentes fases durante anestesia geral, sonhos, vigília, memória explicita e implícita, assim como análise, consequências e prevenção dos principais fatores relacionados ao mesmo. CONCLUSÕES: A diminuição na incidência do despertar durante anestesia está ligada ao melhor desempenho cientifico e técnico do anestesiologista, envolvendo questões como a monitoração, a compreensão sobre os componentes da atividade anestésica, drogas hipnóticas, analgésicas, bloqueadores neuromusculares, controle de reflexos autonômicos e motores, além dos fatores de risco envolvidos neste evento.

Palavras-chave

anestesia, complicações, consciência intraoperatória, estresse pós-traumático, técnicas de medição, eletroencefalografia

Abstract

BACKGROUND AND OBJECTIVES: The intraoperative awareness is an adverse event in the general anesthesia, and may occur in approximately 20,000 cases per year, which justifies the study of the risk factors for this event. The objective of this study was to review this subject in order to reduce the incidence of intraoperative awareness and psychological sequelae incurring from this incident, which may result in post-traumatic stress disorder with negative repercussions on the surgical patient social, psychic and functional development. CONTENT: It was conducted a review of the intraoperative awareness assessing its different phases during general anesthesia such as dreaming, wakefulness, explicit and implicit memory, as well as the analysis, consequences and prevention of its main related factors. CONCLUSIONS: The reduction of awareness incidence during anesthesia is related to the anesthesiologist improved scientific and technical performance, involving issues such as monitoring, comprehension of the anesthesia activity components, hypnotic and analgesic drugs, neuromuscular blocking agents, autonomic and motor reflex control, in addition to the risk factors involved in this event.

Keywords

anesthesia, electroencephalography, intraoperative awareness, stress disorders, post-traumatic

References

Khan MF, Samad K, Shamim F. Awareness during anesthesia-an update. MEJ Anesth. 2008;19(4):723-736.

Orser BA. Depth of anesthesia monitor and the frequency of intraoperative awareness. N Engl J Med. 2008;358(11):1189-1191.

Practice advisory for intraoperative awareness and brain function monitoring: a report by the American Society of Anesthesiologists Task Force on intraoperative awareness. Anesthesiology. 2006;104(4):847-864.

Izquierdo I. Memória. 2002:22-24.

Tunstall ME. Detecting wakefulness during general anaesthesia for caesarean section. Br Med J. 1977;21:1321.

Charles HM. Awareness during anesthesia. Can J Anesth. 1999;46(5):R80-R87.

Myles PS, Williams DL, Hendrata M. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84(1):6-10.

Ghoneim MM, Block RI, Haffarnan M. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg. 2009;108(2):527-535.

Hutchinson R. Awareness during surgery. British Journal of Anaesthesia. 1960;33:463-469.

Mashour GA, Esaki RK, Tremper KK. A novel classification instrument for intraoperative awareness events. Anesth Analg. 2010;110(3):813-815.

Avidan MS, Zhang L, Burnside BA. Anesthesia awareness and the bispectral index. N Engl J Med. 2008;358(11):1097-1108.

Sebel BS, Bowdle A, Ghoneim MM. The incidence of awareness during anesthesia: a multicentrer United States Study. Anesth Analg. 2004;99(3):833-839.

Ghoneim MM. The trauma of awareness: history, clinical features, risk factors and cost. Anesth Analg. 2010;110(3):666-667.

Hoymork SC, Raeder J. Why do women wake up faster than men from propofol anaesthesia?. British Journal of Anaesthesia. 2005;95(5):627-633.

Mashour GA, Wang LYJ, Turner CR. A retrospective study of intraoperative awareness with methodological implications. Anesth Analg. 2009;108(2):521-526.

Pollard RJ, Coyle JP, Gilbert RL. Intraoperative awareness in a regional medical system. Anesthesiology. 2007;106(2):269-274.

Blussé van Oud-Alblas HJ, Bösenberg AT, Tibboel T. Awareness in children: another two cases. Pediatric Anesthesia. 2008;18(7):654-657.

Davidson AJ, Huang GH, Czarnecki C. Awareness during anesthesia in children: a prospective cohort study. Anesthesia and Analgesia. 2005;100(3):653-661.

Ghoneim MM, Weiskopf RB. Awareness during anesthesia. Anesthesiology. 2000;92(2):597-604.

Ghoneim MM, Block RL. Learning and memory during general anesthesia: an update. Anesthesiology. 1997;87(2):387-410.

Orser BA, Mazer CD, Baker AJ. Awareness during anesthesia. CMAJ. 2008;178(2):185-188.

Grace R. The effect of variable-dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine-fentanyl anaesthesia. Anaesthesia. 2003;58(9):904-910.

Shiga T, Wajima Z, Inone T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103(2):429-37.

Lyons G, Macdonald R. Awareness during caesarean section. Anaesthesia. 1991;46(1):62-64.

Paech MJ, Scott KL, Clavisi O. A prospective study of awareness and recall associated with general anaesthesia for caesarean section. Int J Obstet Anesth. 2008;17(4):298-303.

Aitkenhead AR. Injuries associated with anaesthesia: A global perspective. Br J Anaesth. 2005;95(1):95-109.

Yeo SN, Lo WK. Bispectral index in assessment of adequacy of general anaesthesia for lower segment caesarean section. Anaesth Intensive Care. 2002;30(1):36-40.

Goldman L, Shah MV, Hebden MW. Memory of cardiac anaesthesia: Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation. Anaesthesia. 1987;42(6):596-603.

Yun W, Yun Y, Yong-hai S. Investigation an analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China. Chin Med J. 2005;118(14):1190-1194.

Phillips AA, McLean RF, Devitt JH. Recall of intraoperative events after general anaesthesia and cardiopulmonary bypass. Can J Anaesth. 1993;40(10):922-926.

Ranta S, Jussila J, Hynynen M. Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist. Acta Anaesthesiol Scand. 1996;40(5):554-560.

Dowd NP, Cheng DC, Karski JM. Intraoperative awareness in fast-track cardiac anesthesia. Anesthesiology. 1998;61(5):1068-1073.

Heier T, Steen PA. Awareness in anaesthesia: incidence, consequences and prevention. Acta Anaesthesiol Scand. 1996;40:1073-1086.

Ghoneim MM. Incidence and risk factors for awareness during anesthesia. Best Pract Res Clin Anaesthesiol. 2007;21:327-343.

Bogetz MS, Katz JA. Recall of surgery for major trauma. Anesthesiology. 1984;61(1):6-9.

Bergman IJ, Kluger MT, Short TG. Awareness during general anaesthesia: a review of 81 cases from the anaesthetic incident monitoring study. Anaesthesia. 2002;57(6):549-556.

Cruvinel MG, Castro CHV, Costa JRR. O uso do analisador de anestésicos inalatórios como método de detecção de falha no aparelho de anestesia e prevenção de consciência do per-operatório: Relato de caso. Rev Bras Anestesiol. 2003;53(5):640-645.

Errando CL, Sigl JC, Robles M. Awareness with recall during general anesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth. 2008;101(2):178-185.

Kotsovolis G, Komninos G. Awareness during anesthesia: how sure can we be that the patient is sleeping indeed?. Hippokratia. 2009;13(2):83-89.

Myles PS. Prevention of awareness during anaesthesia. Best Practice & Research Clinical Anaesthesiology. 2007;21(3):345-355.

Sandin RH, Enlund G, Samuelsson P. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707-711.

Nunes RR, Cavalcante SL, Lobo RF. Memórias explícita e implícita em anestesias com bloqueio neuromuscular e BIS. São Paulo Med J. 2007;125(^sSuppl):129.

Nunes RR, Sigl JC, Cavalcante SL. Influência do bloqueio neuromuscular despolarizante no BIS. São Paulo Med J. 2007;125(^sSuppl):125.

Nunes RR, Cavalcante SL. Influência do bloqueio neuromuscular despolarizante nas entropias. São Paulo Med J. 2007;125(^sSuppl):126.

Nunes RR, Cavalcante SL, Lobo RF. Influência do bloqueio neuromuscular no índice de estado cerebral. São Paulo Med J. 2007;125(^sSuppl):132.

Vieweg WV, Julius DA, Fernandez A. Post-traumatic stress disorder: clinical festures, pathophysiology and treatment. Am J Med. 2006;119:383-390.

Moulds ML, Nixon RD. In vivo flooding for anxiety disorders: Proposing its utility in the treatment posttraumatic stress disorder. J Anxiety Disord. 2006;20(4):498-509.

Nakell L. Adult post-traumatic stress disorder: screening and treating in primary care. Prim Care. 2007;34(3):593-610.

Leslie K, Chan MT, Myles PS. Posttraumatic stress disorder in aware patients from the B-aware trial. Anesth Analg. 2010;110(3):823-828.

Blacher RS. Awareness during anesthesia. Anesthesiology. 1984;61:1-2.

Fatores de risco para o despertar intraoperatório

Risk factor for intraoperative awareness

Rogean Rodrigues Nunes; Victor Camarão Porto; Vivianne Trevia Miranda; Nayanna Quezado de Andrade; Lara Moreira Mendes Carneiro

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol