Does Brain Monitoring Prevent Anesthesia Awareness?

June 1, 2008

Studies suggest that one or two people in every thousand who undergo general anesthesia experience awareness during the procedure, maybe more in children. The Joint Commission, which inspects hospitals in the US, has made awareness during general anesthesia a “sentinel event.” (If you’re a hospital, a practitioner, or a patient, you definitely want to avoid these). The movie “Awake” and various TV programs have dramatized the issue of awareness.

The victims of awareness tell us the experience can be excruciating. Fortunately, most individuals do not experience physical pain but there is the possibility of later developing debilitating post-traumatic stress disorder. (A study of seven children confirmed to have had awareness found none of them had PTSD or any other troubling psychological problems a year later. This does not establish that PTSD does not occur in children who have had awareness but does suggest that long term problems, at least in children, are far from inevitable).

Can awareness be prevented with brain monitoring technology? An important new NEJM study looks at this.

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Does anesthesia “fry” the elderly brain?

December 30, 2007

One of the most common fears of people undergoing anesthesia and surgery is that anesthesia will cause harm, even permanent damage, to the brain. The traditional view is that anesthetic agents are rapidly metabolized (broken down) and/or excreted from the body, their effects are readily reversed, and anesthesia is therefore unlikely in the long run to cause neurologic injury.

We know that anesthetic agents affect many aspects of brain physiology, altering blood supply to the brain, metabolism, neurotransmitters, cerebrospinal fluid production, and more. These effects are being investigated in the laboratory and through the use of special imaging techniques. The picture that emerges is as complex as the brain itself, and is sometimes surprising. For instance, certain anesthetic agents seem to protect, not injure, the brain – at least in animal experiments.

Your Brain on Drugs

More than 50 years ago, it was reported that some older people have brain problems after surgery, and recent research challenges the belief that a well-conducted anesthetic and complication-free surgical procedure is totally neurologically benign.

The term postoperative cognitive dysfunction (POCD) has been coined to describe the mental changes, (in the areas of thinking, attention and memory) that do occur in some patients after anesthesia and surgery.

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