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Anesth Analg 2006;102:967
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000190856.16254.A4

LETTER TO THE EDITOR

TIVA, Awareness, and the Brice Interview

Mats Enlund, MD, PhD

Department of Anesthesia and Intensive Care; Central Hospital, Västerås, Sweden, mats.enlund{at}ltv.se

To the Editor:

Drs. Eger and Sonner (1) recently raised the question: is recall more likely during IV versus inhaled anesthesia? There is no proper answer, but some findings indicate that the answer is no, as using the most (only) used diagnostic instrument for awareness detection, the structured interview ad modum Dr. Brice (2). First, in a study involving 1000 patients given total intravenous anesthesia, two patients were found to experience awareness (a broader perspective than recall), as diagnosed by the standard interview by Brice (2–3). This incidence was of the same magnitude as in modern studies involving patients given inhaled anesthesia (4). Second, in this large sample awareness study, there was a small number of patients, 284, given total intravenous anesthesia, and the incidence of awareness was zero in this small group (4). Third, in a follow-up of 5216 patients given total intravenous anesthesia and routinely interviewed according to the technique of Brice et al. (2) when leaving the recovery room, none experienced awareness (5). The interview was conducted only once as a routine. However, the interview was repeated after 5–7 days, again without signs of awareness in 19 patients who were briefly in light anesthesia, were uncomfortable at awakening, or reported nightmares postoperatively. This might indicate that the diagnostic potential of the interview technique is not optimal.

[The author occasionally gives lectures sponsored by AstraZeneca, GlaxoSmithKline, or Fresenius Kabi.]

References

  1. Eger EII, Sonner JM. How likely is awareness during anesthesia? Anesth Analg 2005;100:1544.[Free Full Text]
  2. Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970;42:535–42.[Abstract/Free Full Text]
  3. Nordstrom O, Englstrom AM, Persson S, Sandin R. Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade. Acta Anaesthesiol Scand 1997;41:978–84.[ISI][Medline]
  4. Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective study. Lancet 2000;355:707–11.[ISI][Medline]
  5. Enlund M, Hassan HG. Intraoperative awareness: detected by the structured Brice interview? Acta Anaesthesiol Scand 2002;46:343–4.[ISI][Medline]



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C. L. Errando, J. C. Sigl, M. Robles, E. Calabuig, J. Garcia, F. Arocas, R. Higueras, E. del Rosario, D. Lopez, C. M. Peiro, et al.
Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients
Br. J. Anaesth., August 1, 2008; 101(2): 178 - 185.
[Abstract] [Full Text] [PDF]

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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press