Intraoperative awareness: detected by the structured Brice interview?
BACKGROUND
Awareness is a rare complication in general anesthesia, but its consequences are stressful. Efforts must be undertaken to prevent, diagnose, and, if occurring, treat it. The incidence of awareness is higher following anesthesia involving the use of muscle relaxants. As a part of a quality assurance program at our short-stay surgery all patients exposed to general anesthesia are routinely subjected to a Brice interview, which aims to evaluate our standard anesthetic technique regarding awareness.


METHODS
The Brice interview was used prospectively in 5216 patients given a propofol/opioid anesthetic for day-case or short-stay surgery. Neuromuscular blocks were used only for surgical needs, not routinely. All patients were interviewed on discharge from the recovery room. A second interview, according to Brice, was undertaken by telephone 3-7 days later in the case of a notable intraoperative event, or otherwise after postoperative patient complaints. All patients were also interviewed by telephone 1-2 days postoperatively.


RESULTS
None of the patient interviews indicated awareness. This was also the case in five non-relaxed patients who had an incident of light anesthesia with eye opening and gross motor response without forewarning. Neuromuscular blockade was used in 7% of patients.


CONCLUSIONS
We were unable to detect intraoperative awareness. The anesthetic regimen, including minimal use of muscle relaxants, might be beneficial for awareness prevention. Alternatively, the diagnostic power, the timing of the Brice interview, or the number of interviews performed may be questioned.
Enlund
M
M
Department of Anesthesia and Intensive Care, Uppsala University Hospital, Sweden. mats.enlund@ltvastmanland.se
Hassan
H G
HG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001279:Atracurium; D001364:Awareness / Q000187:drug effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000523:psychology; D008568:Memory; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D003473:Neuromuscular Nondepolarizing Agents; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D011184:Postoperative Period; D015742:Propofol; D012015:Reference Standards; D012121:Respiration, Artificial; D012307:Risk Factors
D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D015742:Propofol