Awareness, Anesthesia, Recall Phenomenon, Inhalation; Gas
Conditions
Keywords
TIVA, Isoflurane, old age
Brief summary
Awareness during general anesthesia - that has an incidence between 0.1% and 0.9% of cases and may be more in elderly - remains a concern for anesthesiologists. Awareness experiences range from isolated auditory perceptions to reports of a patient being fully awake, immobilized, and in pain. The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia.
Detailed description
Objective: To compare inhalational induction versus intravenous induction regarding awareness during laryngoscopy and intubation in elderly patients undergoing day case elective surgery.
Interventions
DRUGSevoflurane
IFT response, hemodynamics and BIS value were recorded during intubation period. Then the data acquisition was stopped and the isolated forearm cuff deflated. IFT values were noted by two independent observers
DRUGTIVA
IFT response, hemodynamics and BIS value were recorded during intubation period. Then the data acquisition was stopped and the isolated forearm cuff deflated. IFT values were noted by two independent observers
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Randomization was performed using a computer-generated random number table in opaque sealed envelopes with 1:1 allocation ratio by an anesthesiologist not directly involved in the trial or patient care.
Intervention model description
Interventions: Patients were randomized into either Group A (who received inhalational induction) and Group B (who received total intravenous induction followed by maintenance infusion). Main outcome measure: IFT response was recorded at laryngoscopy and intubation to identify awareness at this stressful timepoint.
Eligibility
Sex/Gender
ALL
Age
60 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* 50 American society of anesthesiologists- Physical status (ASA-PS) I and II patients, * aged 60 to 80 years, * 70-80 kg, * both sexes, * with intact hearing, * undergoing elective day case surgery were included in the study.
Exclusion criteria
1. Uncooperative patients, 2. Language barrier problems, 3. Psychological disorders, 4. Suspected difficult intubation, 5. History of awareness under anesthesia, 6. History of substance abuse, 7. The inability to have tourniquet on arm for the IFT (e.g., lymphedema or operative site) 8. Neuromuscular disorders. 9. Advanced renal, hepatic, cardiac, respiratory or neurological dysfunction 10. If rapid sequence induction was indicated (not suitable for inhalation induction).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| IFT response was recorded at laryngoscopy and intubation | 10 minutes | Score is from zero to 5 Increasing score means increasing risk of awareness especially if \>3 The primary outcome was IFT response was recorded at laryngoscopy and intubation to identify awareness at this stressful timepoint. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bispectral index monitor (BIS) | 40 minutes | Value from 100 to zero. 100 means fully awake We aim to be with in 40-60 intraoperatively to decrease risk of awareness BIS values were recorded at the following timings: * Baseline * After induction and muscle relaxation, * During laryngoscopy, * After successful intubation * After 20 minutes from skin incision * After 40 minutes from skin incision |
| Modified Brice questionnaire | 24 hours | 2 hours and 24 hours after the end of anesthesia, patients were interviewed regarding the experience of dreaming or recall (of the induction period) |
Countries
Egypt
Outcome results
None listed