New Technology No Better at Spotting 'Anesthesia Awareness'

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According to an accompanying editorial, more than 21 million patients in North America receive general anesthesia each year, and as many as one or two in every 1,000 may experience some awareness during a procedure. Awareness is more common in patients who have received neuromuscular-blocking drugs, making it impossible for them to communicate their distress.

One patient, undergoing surgery to remove her right eye, heard the surgeon speak to the resident. When she realized she was awake, she tried frantically to blink her eyes and move her head, to no avail. "I was screaming at the top of my lungs, but no noise was coming out," she recalled.

The phenomenon can lead to long-term psychological consequences, even post-traumatic stress disorder.

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The FDA-approved bispectral index system leads a growing market in devices promising to reduce anesthesia awareness. It is used in about 60 percent of all operating rooms in the United States yet, according to the study authors, evidence on its utility is scant.

"It works by recording information from an EEG on electrical activity in our brain," explained Avidan. "The type of electrical activity that our brain has is different when it's awake or asleep. This monitors electrical activity from the frontal area of the brain and analyzes the wave form."

For this study, 2,000 patients undergoing general (inhaled) anesthesia were randomly assigned to BIS-guided anesthesia or to conventional anesthesia. They were then assessed for anesthesia awareness at 0 to 24 hours after the procedure, 24 to 72 hours after, and 30 days after.

Two patients experienced definite anesthesia awareness in each group, an overall incidence of 0.21 percent. Five more patients (four in the BIS group and one in the control group) had possible awareness.

The device may be of benefit to patients receiving intravenous anesthesia, which is used in a minority of surgical procedures and which is considered to be a risk factor for anesthesia awareness, the authors stated.

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