Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo....
Transcript of Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo....
![Page 1: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/1.jpg)
Dr Noël EmmanuelCHU TIVOLI
![Page 2: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/2.jpg)
![Page 3: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/3.jpg)
![Page 4: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/4.jpg)
![Page 5: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/5.jpg)
Anesthesia
Anesthesia
Amnesia
Muscle relaxation
Loss of reflexesAnalgesia
Unconsciousness
![Page 6: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/6.jpg)
Memory
• Explicit memory: conscious recollection of events and facts
• Age of 3
• Implicit memory: memory wich cannot beconsciously recalled but will result in changedbehaviour or performance
• Implict memory << explicit memory
![Page 7: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/7.jpg)
Awareness
• Explicit recall of an event occurring duringanesthesia
• Auditory or tactile experiences,pain,…• Distressing
• Post-traumatic stress disorder• Awareness <3 yr ??
![Page 8: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/8.jpg)
Consciousness
• Cortex/thalamus
• Age of consciousness: early
![Page 9: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/9.jpg)
Incidence
• Spontaneous reporting• 5th National Audit Project
• Direct questioning• Modified Brice questionnaire• Children are more suggestible
• Isolated Forearm Technique
![Page 10: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/10.jpg)
Spontaneous reporting
NAP5. BJA 2014
![Page 11: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/11.jpg)
![Page 12: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/12.jpg)
![Page 13: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/13.jpg)
Direct questioning
Sury M. Pediatric Anesthesia 2016;26(5):468-74
![Page 14: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/14.jpg)
Isolated Forearm Technique
![Page 15: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/15.jpg)
Isolated Forearm Technique
• Gold standard ?
• Dysanesthesia hypothesis ?• Binary interpretation
Pandit.Conscious Cogn. 2014; 2014; 27: 194-212
Pandit. BJA 2015; 115: 32-45
![Page 16: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/16.jpg)
Incidence
• Adults: 0,1-0,2%
• Children: 0,74%• UK: ± 3430/Yr (NHS: 463400/Yr)
Sury M. Pediatric Anesthesia 2016;26(5):468-74
![Page 17: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/17.jpg)
Characteristics
• Tactile experiences: 79%
• Auditory experiences: 55%
• Scared: 24%
• Pain: 24%
Sury M. Pediatric Anesthesia 2016;26(5):468-74
![Page 18: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/18.jpg)
![Page 19: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/19.jpg)
Dreaming
• 11%: No association with premedication, agents, type of surgery
• 19%: Liverpool technique
McKie et al. Anesthesia and IC 1973;1:407-414
Hobbs et al. Anaesthesia 1988; 43:560-562
![Page 20: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/20.jpg)
• Prospective cohort study• 864• Aged 5-12 Yr
• 10,4%
Anaesthesia 2005; 60: 854-861
![Page 21: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/21.jpg)
Risk factors in adults
• Inadvertent light anesthesia: mishap or misjudgement
• Unintentional light anesthesia: where signs of light anesthesia are masked (NMBA)
• Intentional light anesthesia: trauma, c-section
![Page 22: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/22.jpg)
Risk factors in children
• Use of tracheal tube• N2O
• Multiple airway manipulations• No associations with NMBA
• Endoscopic procedures
Davidson et al. Anaesthesia 2011;66:446-454
Lopez et al. Anaesthesia 2007; 62: 778-789
Malviya et al. A&A 2009; 109: 619-624
![Page 23: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/23.jpg)
Risk factors in children
• Pharmacodynamics of anesthesia ?
![Page 24: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/24.jpg)
Target of anesthesia
![Page 25: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/25.jpg)
Monitoring
• ECG• Saturation• NIBP• Temperature• Diuresis
• Do we monitor the brain?
![Page 26: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/26.jpg)
Monitoring the depth of anesthesia
• Raw EEG• BIS• Spectral entropy• Narcotrend Index• A-Line arx Index• Cerebral State Monitor
![Page 27: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/27.jpg)
Raw EEG
• Frequencies• Amplitude• Coherence• Order
• Frontal monitoring: waves that we classicallysee during GA is well representated in the frontal cortex
![Page 28: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/28.jpg)
Conventional waveform nomenclature
• Gamma: 30-100 Hz• Beta: 12-30 Hz
• High beta: >20• Low beta: 12-20
• Alpha: 8-12 Hz• Theta: 4-8 Hz• Delta: 0-4 Hz
• Slow delta: <1Hz
![Page 29: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/29.jpg)
Purdon et al. Anesthesiology 2015; 123: 937-960
![Page 30: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/30.jpg)
Patterns of EEG during GA
• Coherant alpha, delta
• High amplitude, slow oscillations (0,1-1HZ)
• Propofol ≈ sevoflurane
![Page 31: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/31.jpg)
![Page 32: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/32.jpg)
Purdon et al. Anesthesiology 2015; 123: 937-960
![Page 33: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/33.jpg)
Purdon et al. Anesthesiology 2015; 123: 937-960
![Page 34: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/34.jpg)
Purdon et al. Anesthesiology 2015; 123: 937-960
![Page 35: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/35.jpg)
Characteristics of EEG in children
• Total EEG power increase• Increase from infancy• Peak at 5-8 yr
• No alpha waves and slow waves <1yr• No alpha oscillation coherence < 1yr• Epileptiform EEG patterns and sevoflurane
![Page 36: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/36.jpg)
Akeju et al. Br J Anaesth. 2015; 115: 66-76
![Page 37: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/37.jpg)
Akeju et al. Br J Anaesth. 2015; 115: 66-76
![Page 38: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/38.jpg)
Akeju et al. Br J Anaesth. 2015; 115: 66-76
![Page 39: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/39.jpg)
Raw EEG and awareness
• Children: No study
• Adults: • Prospective cohort study: IFT• Multicenter• Frontal alpha-delta EEG• Connected consciousness can occur
Gaskell BJA 2017; 119: 664-673
![Page 40: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/40.jpg)
Processed EEG
• Limitations of the processed EEG• High power• Epileptiform pattern• Alpha coherence• Age-related EEG patterns (adults patterns)• Drug-dependant• Delay up to 1 min.
![Page 41: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/41.jpg)
Processed EEG
• BIS• Spectral entropy• Narcotrend Index• A-Line ARX Index• Cerebral State Monitor• PSI
![Page 42: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/42.jpg)
BIS
• Gold standard• Mathematical algorithm: score 0-100
• Adults EEG signal• Frequency of EEG signal• Synchronization of waveforms• Burst suppression %
• Range: 40-60• Validated for propofol and volatile agents
![Page 43: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/43.jpg)
BIS
• Awareness: No study
• Low to fair correlation: >1yr• Low accuracy• limitations
• Performance as ageSciusco et al.Pediatric anesthesia 2017; 27: 399-408
Malviya et al. A&A 2006; 102: 389-394McDermott A&A 2003; 97: 30-41
![Page 44: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/44.jpg)
Spectral entropy
• Degree of disorder EEG• Independant of absolute frequency or
amplitude• 100-0
– Response entropy: high frequency range(EMG)• RE ≥ SE
– State entropy: low frequency range• More stable
![Page 45: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/45.jpg)
Spectral entropy
• Awareness: No study
• Correlation: > 1yr• Age dependency
Klockars. Anethesiology 2012; 116: 340-351
Davidson et al. Anaesth Intensive care 2004; 32: 485-493
![Page 46: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/46.jpg)
Narcotrend index
• Pattern recognition EEG• Spectral, entropy
• Stage A (awake) to F (burst suppression , silent)• E: anesthesia• 14 stages
• Score: 100-0• Correlation
Weber et al.pediatric Anesthesia 2005; 15: 378-385
![Page 47: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/47.jpg)
• A-line ARX:• Derived AEP/2• Mid-latency AEP and passive EEG
• Cerebral State Monitor:• Alpha and beta power• Burst suppression
![Page 48: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/48.jpg)
• BIS >< AAI-1,6• Poor predictor of sevo. Concentration
• CSI and A-Line-arx in children• 20 P.• Diagnostic procedures• Good correlation CSI, AAI and UMSS scores
Ironfield PA 2007; 17: 452-459
Disma PA 2007; 17: 445-451
![Page 49: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/49.jpg)
Which one is the best?
![Page 50: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/50.jpg)
Consequences Adults
• Bored indifference PTSD
• 1/3: significant psychological symptoms
• Delayed
Osterman et al.,General Hospital Pscychiatry, 1998
Lennmarken et al.,A A Scandinavica, 2002
![Page 51: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/51.jpg)
Consequences in children
• Awareness and dreaming during anaesthesia• No child disturbances• 2 disturbing dreams
• Intraoperative awareness in children: myth or reality ?
• < 50% (5) realized ‘’aware’’• 1 negative thoughts• Later follow up: little evidence
Mckie et al Anaesth Intensive care, 1973
Iselin-chaves et al Current Opinion Anesthesiology, 2006
![Page 52: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/52.jpg)
Awareness during anesthesia in children
• Prospective cohort study: 864• Interview: Day 1, 3, 30• True awareness: 7 (0,8%)• No child upset by the memories• 1 child: phobia unrelated to awareness
Davidson et al. A&A 2005; 100: 653-661
![Page 53: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/53.jpg)
Consequences in children
• Few psychological problems
• No PTSD
![Page 54: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/54.jpg)
Prevention
• Aware!!• Detection high risk population?• Check of anesthesia equipement and drugs• Age adapted doses of hypnotic agents• Monitoring
– Old children: ok– Young children ?
![Page 55: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/55.jpg)
![Page 56: Dr Noël Emmanuel - bapanaesth.be€¦ · • BIS >< AAI-1,6 • Poor predictor of sevo. Concentration • CSI and A-Line-arx in children • 20 P. • Diagnostic procedures](https://reader034.fdocuments.us/reader034/viewer/2022050314/5f770b29ea857a3a6b103dd8/html5/thumbnails/56.jpg)
Conclusion
• Awareness can occur in children• Not same population as adults• No substantial degree of distress (limited)• Monitoring adapted to age• Causes: unclear (genetics?)