Recall of intraoperative events after general anaesthesia and cardiopulmonary bypass

  • Andrew A. Phillips
  • Richard E. McLean
  • J. Hugh Devitt
  • Ellen M. Harrington
Reports of Investigation

Abstract

We wished to identify patients able to recall intraoperative events after general anaesthesia involving cardiopulmonary bypass (CPB). A balanced anaesthetic technique consisting of benzodiazepines, low dose fentanyl (15.9 ± 8.5 μg· kg− 1) and a volatile agent was employed. Perioperative recall was sought utilizing a structured interview on the fourth or fifth postoperative day. During 20 mo 837 patients underwent CPB. Seven hundred patients (84%) were able to respond to a structured postoperative interview. A detailed chart review was performed in patients with recall and in 60 randomly selected patients without recall. Eight patients (1.14%) reported recall of intraoperative events. We were unable to identify any differences between the two groups with respect to narcotic, benzodiazepine dosage or usage of inhalational agents. The incidence of recall in patients undergoing cardiac surgery was less in our group than previously reported. It is, however, higher than the 0.2% incidence recently reported in patients undergoing non-cardiac surgery. This is probably due to patient characteristics and intraoperative factors which make it difficult to avoid periods of relatively light anaesthesia during cardiac surgery.

Key words

anaesthesia: cardiac, cardiopulmonary bypass anaesthetics intravenous: fentanyl, diazepam anaesthetics volatile: halothane complications: awareness, recall 

Résumé

L’objectif de ce travail est d’identifier les patients capables de se rappeler des événements survenus pendant la chirurgie sous circulation extracorporelle (CEC). L’anesthésie consiste en des benzodiazépines, du fentanyl à faibles doses (15,9 ± 8,5 μg· kg− 1), et un agent volatile. On recherche la mémoire évocative périopératoire lors d’une interview au quatrième ou cinquième jour postopératoire. Sur une période de 20 mois, 837 patients ont subi une CEC. De ceux-ci, 700 (84%) sont capables de répondre à une interview postopératoire. Une révision du dossier d’anesthésie est effectuée chez les patients avec mémoire évocative et chez 60 patients sans mémoire évocative. Huit patients (1,14%) se rappellent certains événements périopératoires. Il n’y a pas de différence entre les deux groupes au regard de la posologie opiacée, des benzodiazépines ou de la concentration anesthésique. L’incidence de la mémoire évocative chez nos patients de chirurgie cardiaque est moindre que celle d’études antérieures. Elle est toutefois plus élevée que l’incidence de 0,2% récemment rapportée chez des patients de chirurgie autre que cardiaque. Selon toute probabilité, cette différence est due aux caractéristiques des malades et à des facteurs peropératoires qui ne permettent pas d’éviter pendant la chirurgie cardiaque des périodes d’anesthésie légère.

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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • Andrew A. Phillips
    • 1
  • Richard E. McLean
    • 1
  • J. Hugh Devitt
    • 1
  • Ellen M. Harrington
    • 1
  1. 1.Department of Anaesthesia, Sunnybrook Health Science CentreUniversity of TorontoToronto

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