A Survey and Chart Review to Determine if Patients Exposed to General Anesthesia Significant Numbers of Times Would Increase the Risk for Intraoperative Awareness With Explicit Recall.
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 1,000
- 试验地点
- 1
- 主要终点
- Intraoperative Awareness with Explicit Recall for patients who underwent more than 20 general anesthesia events
研究概览
简要总结
This study will detect whether prior exposure to general anesthesia multiple times is associated with an increased incidence of awareness with explicit recall (AWR). This is especially important because patients who need to undergo multiple events of general anesthesia are medically some of the most vulnerable populations. The study hypothesizes that patients with significant exposure to general anesthesia have a higher incidence of AWR. This study may help clinicians and patients to better understand how to manage anesthesia care so that the safety and comfort of patients can be improved.
详细描述
Each year, tens of millions of Americans undergo general anesthesia. One of the biggest fears patients have regarding general anesthesia is experiencing intraoperative awareness. That means that the patients "wake" during surgery and become aware of their environment. Prior studies have shown that intraoperative awareness with explicit recall (AWR) occurs in 0.1%-0.2% of patients undergoing general anesthesia. Patients have reported different forms of AWR, including feeling the sensation of pain, difficulty breathing, or recalling conversations. AWR can leave a lasting negative effect on patients. In one study, 56.3% of patients who experienced AWR met the diagnostic criteria for PTSD with functional impairment. Another study found that PTSD was experienced by as many as 70% of patients who had AWR.5 These patients fear undergoing further medical treatment requiring anesthesia and suffer quality of life issues related to their episode(s) of AWR. The goal of this study is to determine whether there is a particular group of patients, those that have been anesthetized many times, at high risk for AWR and then to design protocols to prevent this from happening.
Rationale for Conducting this Research
While the incidence of intraoperative awareness with explicit recall (AWR) is 0.1%-0.2% in general population undergoing general anesthesia, higher incidence has been reported in the populations with special risk factors, such as obstetric, cardiac and trauma surgeries. Patients with a history of awareness are at increased risk of intraoperative awareness. However, it is not certain whether this association is related to the number of anesthesia exposure or the development of resistance to anesthetics in these patients. Prior studies have demonstrated that the incidence of AWR in females is threefold higher than in males and that AWR is higher in patients with difficult airways and in patients with drug addiction. In addition, patients with an ASA Status of III-V had a greater than 2.4 odd of AWR than patients with an ASA Status of I-II. Most recently, we took care of two young adult patients who had more than 20 surgeries requiring general anesthesia since their childhood and reported multiple incidents of AWR. One of patients had a new episode of AWR during a regular surgery a few months ago despite extra measures were taken by her anesthesiologists. In addition, we found animals that were anesthetized multiple times showed change in their sensitivity to general anesthetics. To date, there has not been a study that has looked at whether patients who have undergone general anesthesia a significant number of times (n>20) have a higher incidence of AWR.
Primary Objective
To determine whether patients who have undergone general anesthesia significant number of times have a significantly higher incidence of intraoperative awareness with explicit recall (AWR) as compared to the general population.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 7 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients who have been exposed to general anesthesia greater than 20 times or who have been exposed to general anesthesia 5 or fewer times between January 1, 1985 and June 15, 2017
- •Patients/their Guardians who consent to participate in the study.
- •Patients for whom a determination of AWR status can be made by anesthesiologists based on a standardized criteria.
- •Must be at least 7 years of age or older.
排除标准
- •Healthy volunteers,
- •Patients who cannot recall whether or not they have experienced intraoperative awareness with explicit recall
研究组 & 干预措施
Patients who have undergone exposer to General Anesthesia
Patients who have undergone general anesthesia at the University of Chicago Medical Center more than 20 times or patients who have general anesthesia 5 or fewer times in the past.
结局指标
主要结局
Intraoperative Awareness with Explicit Recall for patients who underwent more than 20 general anesthesia events
时间窗: Until study completion; up to 1 year.
The Number of incidences of intraoperative awareness with explicit recall with patients undergoing general anesthesia greater than 20 times using the 5-question modified Brice questionnaire
次要结局
- Intraoperative Awareness with Explicit Recall for patients who underwent less than 5 general surgeries involving general anesthesia(Until study completion; up to 1 year.)