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Michael S. Avidan - One of the best experts on this subject based on the ideXlab platform.

  • Intraoperative Awareness With Recall: A Descriptive, Survey-Based, Cohort Study.
    Anesthesia and analgesia, 2019
    Co-Authors: Anna Maria Bombardieri, Shagun Mathur, Andrea Soares, Anshuman Sharma, Arbi Ben Abdallah, Troy S. Wildes, Michael S. Avidan
    Abstract:

    Background Unintended Intraoperative Awareness with recall (AWR) is a potential complication of general anesthesia. Patients typically report recollections of (1) hearing sounds or conversations, (2) being unable to breathe or move, (3), feeling pain, and/or (4) experiencing emotional distress. The purpose of the current study was to identify and further characterize AWR experiences identified through postoperative surveys of a large unselected adult surgical cohort. Methods This is a substudy of a prospective registry study, which surveys patients on their health and well-being after surgery. Responses to 4 questions focusing on AWR were analyzed. Patients who reported AWR with pain, paralysis, and/or distress were contacted by telephone to obtain more information about their AWR experience. The interview results for patients who received general anesthesia were sent to 3 anesthesiologists, who adjudicated the reported AWR episodes. Results Of 48,151 surveys sent, 17,875 patient responses were received. Of these respondents, 622 reported a specific memory from the period between going to sleep and waking up from perceived general anesthesia and 282 of these reported related pain, paralysis, and/or distress. An attempt was made to contact these 282 patients, and 149 participated in a telephone survey. Among the 149 participants, 87 endorsed their prior report of AWR. However, only 22 of these patients had received general anesthesia, while 51 received only sedation and 14 received regional anesthesia. Three anesthesiologists independently adjudicated the survey results of the 22 general anesthesia cases and assigned 6 as definite AWR, 8 as possible AWR, and 8 as not AWR episodes. Of the 65 patients who confirmed their report of AWR after regional or sedation anesthesia, 37 (31 with sedation and 6 with regional anesthesia) had not expected to be conscious during surgery. Conclusions The complication of AWR continues to occur during intended general anesthesia. Many reports of AWR episodes occur in patients receiving sedation or regional anesthesia and relate to incorrect expectations regarding anesthetic techniques and conscious experiences, representing a potential target for intervention.

  • Assessment of Intraoperative Awareness with explicit recall: a comparison of 2 methods.
    Anesthesia and analgesia, 2013
    Co-Authors: George A. Mashour, Christopher R. Turner, Amy Shanks, Kevin K. Tremper, Christopher D. Kent, Paul Picton, Satya Krishna Ramachandran, Michael S. Avidan
    Abstract:

    BACKGROUND:Superiority of the modified Brice interview over quality assurance techniques in detecting Intraoperative Awareness with explicit recall has not been demonstrated definitively.METHODS:We studied a single patient cohort to compare the detection of definite Awareness using a single modified

  • Prevention of Intraoperative Awareness with explicit recall: making sense of the evidence.
    Anesthesiology, 2013
    Co-Authors: Michael S. Avidan, George A. Mashour
    Abstract:

    Prevention of Intraoperative Awareness with Explicit Recall: Making Sense of the Evidence Michael Avidan;George Mashour; Anesthesiology

  • Volitional delay of self-reported outcomes: Insights from a case of Intraoperative Awareness with explicit recall
    Anesthesia and analgesia, 2013
    Co-Authors: Alexander Villafranca, George A. Mashour, Michael S. Avidan, David B Glick, Benjamin G. Arenson, Eric Jacobsohn
    Abstract:

    Intraoperative Awareness with explicit recall (AWR) is a self-reported outcome of interest in clinical practice, quality assurance initiatives, and clinical trials. Combining structured postoperative interviews with a preoperative description of AWR is assumed to ensure prompt patient disclosure. We

  • prevention of Intraoperative Awareness in a high risk surgical population
    The New England Journal of Medicine, 2011
    Co-Authors: Michael S. Avidan, Eric Jacobsohn, David B Glick, Beth A Burnside, Lini Zhang, Alex Villafranca, Leah Karl, Saima Kamal, Brian A Torres, Alex S Evers
    Abstract:

    A total of 7 of 2861 patients (0.24%) in the BIS group, as compared with 2 of 2852 (0.07%) in the ETAC group, who were interviewed postoperatively had definite Intraoperative Awareness (a difference of 0.17 percentage points; 95% confidence interval [CI], −0.03 to 0.38; P = 0.98). Thus, the superiority of the BIS protocol was not demonstrated. A total of 19 cases of definite or possible Intraoperative Awareness (0.66%) occurred in the BIS group, as compared with 8 (0.28%) in the ETAC group (a difference of 0.38 percentage points; 95% CI, 0.03 to 0.74; P = 0.99), with the superiority of the BIS protocol again not demonstrated. There was no difference between the groups with respect to the amount of anesthesia administered or the rate of major postoperative adverse outcomes. Conclusions The superiority of the BIS protocol was not established; contrary to expectations, fewer patients in the ETAC group than in the BIS group experienced Awareness. (Funded by the Foundation for Anesthesia Education and Research and others; BAG-RECALL ClinicalTrials.gov number, NCT00682825.)

George A. Mashour - One of the best experts on this subject based on the ideXlab platform.

Amy Shanks - One of the best experts on this subject based on the ideXlab platform.

  • Psychological sequelae of surgery in a prospective cohort of patients from three Intraoperative Awareness prevention trials
    Anesthesia and analgesia, 2015
    Co-Authors: Elizabeth L. Whitlock, Amy Shanks, Beth A Burnside, Thomas L. Rodebaugh, Afton L. Hassett, Ellen Kolarik, Janet Houghtby, Hannah M. West, Erik A. Shumaker, Alex Villafranca
    Abstract:

    BACKGROUND:Elective surgery can have long-term psychological sequelae, especially for patients who experience Intraoperative Awareness. However, risk factors, other than Awareness, for symptoms of posttraumatic stress disorder (PTSD) after surgery are poorly defined, and practical screening methods

  • Increased Risk of Intraoperative Awareness in Patients with a History of Awareness
    Anesthesiology, 2013
    Co-Authors: Amrita Aranake, Amy Shanks, Eric Jacobsohn, David B Glick, Alex Villafranca, Stephen Gradwohl, Arbi Ben-abdallah, Nan Lin, Daniel L. Helsten, Alex S Evers
    Abstract:

    Background Patients with a history of Intraoperative Awareness with explicit recall (AWR) are hypothesized to be at higher risk for AWR than the general surgical population. In this study, the authors assessed whether patients with a history of AWR (1) are actually at higher risk for AWR; (2) receive different anesthetic management; and (3) are relatively resistant to the hypnotic actions of volatile anesthetics. Methods Patients with a history of AWR and matched controls from three randomized clinical trials investigating prevention of AWR were compared for relative risk of AWR. Anesthetic management was compared with the use of the Hotelling's T statistic. A linear mixed model, including previously identified covariates, assessed the effects of a history of AWR on the relationship between end-tidal anesthetic concentration and bispectral index. Results The incidence of AWR was 1.7% (4 of 241) in patients with a history of AWR and 0.3% (4 of 1,205) in control patients (relative risk = 5.0; 95% CI, 1.3-19.9). Anesthetic management did not differ between cohorts, but there was a significant effect of a history of AWR on the end-tidal anesthetic concentration versus bispectral index relationship. Conclusions Surgical patients with a history of AWR are five times more likely to experience AWR than similar patients without a history of AWR. Further consideration should be given to modifying perioperative care and postoperative evaluation of patients with a history of AWR.

  • Assessment of Intraoperative Awareness with explicit recall: a comparison of 2 methods.
    Anesthesia and analgesia, 2013
    Co-Authors: George A. Mashour, Christopher R. Turner, Amy Shanks, Kevin K. Tremper, Christopher D. Kent, Paul Picton, Satya Krishna Ramachandran, Michael S. Avidan
    Abstract:

    BACKGROUND:Superiority of the modified Brice interview over quality assurance techniques in detecting Intraoperative Awareness with explicit recall has not been demonstrated definitively.METHODS:We studied a single patient cohort to compare the detection of definite Awareness using a single modified

  • Prevention of Intraoperative Awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial.
    Anesthesiology, 2012
    Co-Authors: George A. Mashour, Christopher R. Turner, Amy Shanks, Kevin K. Tremper, Paul Picton, Satya Krishna Ramachandran, Sachin Kheterpal, Christa M. Schueller, Michelle Morris, John C. Vandervest
    Abstract:

    Background Intraoperative Awareness with explicit recall occurs in approximately 0.15% of all surgical cases. Efficacy trials based on the Bispectral Index™ (BIS) monitor and anesthetic concentrations have focused on high-risk patients, but there are no effectiveness data applicable to an unselected surgical population.

  • A novel electronic algorithm for detecting potentially insufficient anesthesia: implications for the prevention of Intraoperative Awareness
    Journal of Clinical Monitoring and Computing, 2009
    Co-Authors: George A. Mashour, John C. Vandervest, Amy Shanks, Roy K. Esaki, Sachin Kheterpal
    Abstract:

    Objective A recent clinical trial compared a minimum alveolar concentration (MAC)-based protocol to an electroencephalography (EEG)-based protocol for the prevention of Intraoperative Awareness. One limitation of this study design is that MAC-based protocols are not sensitive to the use of intravenous agents, while EEG-based protocols are. Our objective was to develop a MAC alert that incorporates intravenous agents. Methods We developed an electronic algorithm and alerting system that calculates a total age-adjusted MAC value based on inhalational agents, but also incorporates intravenous agents. We retrospectively applied the algorithm to adult general anesthesia cases over a 1 year period to assess the frequency of alert triggers, using thresholds of 

E Kochs - One of the best experts on this subject based on the ideXlab platform.

  • rough set based classification of eeg signals to detect Intraoperative Awareness comparison of fuzzy and crisp discretization of real value attributes
    Lecture Notes in Computer Science, 2004
    Co-Authors: Michael Ningler, Gudrun Stockmanns, Gerhard Schneider, O Dressler, E Kochs
    Abstract:

    Automated classification of calculated EEG parameters has been shown to be a promising method for detection of Intraoperative Awareness. In the present study, rough set-based methods were employed to generate classification rules. For these methods, discrete attributes are required. We compared a crisp and a fuzzy discretization of the real parameter values. Fuzzy discretization transforms one real attribute value to several discrete values. By combining the different (discrete) values of all attributes, several sub-objects were produced from a single original object. Rule generation from a training set of objects and classification of a test set provided good classification rates of approximately 90% for both crisp and fuzzy discretization. Fuzzy discretization resulted in a simpler and smaller rule set than crisp discretization. Therefore, the simplicity of the resulting classifier justifies the higher computational effort caused by fuzzy discretization.

  • Rough Sets and Current Trends in Computing - Rough Set-Based Classification of EEG-Signals to Detect Intraoperative Awareness: Comparison of Fuzzy and Crisp Discretization of Real Value Attributes
    Rough Sets and Current Trends in Computing, 2004
    Co-Authors: Michael Ningler, Gudrun Stockmanns, Gerhard Schneider, O Dressler, E Kochs
    Abstract:

    Automated classification of calculated EEG parameters has been shown to be a promising method for detection of Intraoperative Awareness. In the present study, rough set-based methods were employed to generate classification rules. For these methods, discrete attributes are required. We compared a crisp and a fuzzy discretization of the real parameter values. Fuzzy discretization transforms one real attribute value to several discrete values. By combining the different (discrete) values of all attributes, several sub-objects were produced from a single original object. Rule generation from a training set of objects and classification of a test set provided good classification rates of approximately 90% for both crisp and fuzzy discretization. Fuzzy discretization resulted in a simpler and smaller rule set than crisp discretization. Therefore, the simplicity of the resulting classifier justifies the higher computational effort caused by fuzzy discretization.

Kevin K. Tremper - One of the best experts on this subject based on the ideXlab platform.

  • Assessment of Intraoperative Awareness with explicit recall: a comparison of 2 methods.
    Anesthesia and analgesia, 2013
    Co-Authors: George A. Mashour, Christopher R. Turner, Amy Shanks, Kevin K. Tremper, Christopher D. Kent, Paul Picton, Satya Krishna Ramachandran, Michael S. Avidan
    Abstract:

    BACKGROUND:Superiority of the modified Brice interview over quality assurance techniques in detecting Intraoperative Awareness with explicit recall has not been demonstrated definitively.METHODS:We studied a single patient cohort to compare the detection of definite Awareness using a single modified

  • Prevention of Intraoperative Awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial.
    Anesthesiology, 2012
    Co-Authors: George A. Mashour, Christopher R. Turner, Amy Shanks, Kevin K. Tremper, Paul Picton, Satya Krishna Ramachandran, Sachin Kheterpal, Christa M. Schueller, Michelle Morris, John C. Vandervest
    Abstract:

    Background Intraoperative Awareness with explicit recall occurs in approximately 0.15% of all surgical cases. Efficacy trials based on the Bispectral Index™ (BIS) monitor and anesthetic concentrations have focused on high-risk patients, but there are no effectiveness data applicable to an unselected surgical population.

  • protocol for the michigan Awareness control study a prospective randomized controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of Intraoperative Awareness
    BMC Anesthesiology, 2009
    Co-Authors: George A. Mashour, Kevin K. Tremper, Michael S. Avidan
    Abstract:

    Background The incidence of Intraoperative Awareness with explicit recall is 1-2/1000 cases in the United States. The Bispectral Index monitor is an electroencephalographic method of assessing anesthetic depth that has been shown in one prospective study to reduce the incidence of Awareness in the high-risk population. In the B-Aware trial, the number needed to treat in order to prevent one case of Awareness in the high-risk population was 138. Since the number needed to treat and the associated cost of treatment would be much higher in the general population, the efficacy of the Bispectral Index monitor in preventing Awareness in all anesthetized patients needs to be clearly established. This is especially true given the findings of the B-Unaware trial, which demonstrated no significant difference between protocols based on the Bispectral Index monitor or minimum alveolar concentration for the reduction of Awareness in high risk patients.

  • A Novel Classification Instrument for Intraoperative Awareness Events
    Anesthesia and analgesia, 2009
    Co-Authors: George A. Mashour, Kevin K. Tremper, David B Glick, Roy K. Esaki, Michael O'connor, Michael S. Avidan
    Abstract:

    BACKGROUND:Intraoperative Awareness with explicit recall occurs in approximately 1–2 cases per 1000. Given the rarity of the event, a better understanding of Awareness and its sequelae will likely require the compilation of data from numerous studies. As such, a standard description and expression o

  • A retrospective study of Intraoperative Awareness with methodological implications.
    Anesthesia and analgesia, 2009
    Co-Authors: George A. Mashour, Luke Y.-j. Wang, Christopher R. Turner, John C. Vandervest, Amy Shanks, Kevin K. Tremper
    Abstract:

    BACKGROUND: Awareness during general anesthesia is a problem receiving increased attention from physicians and patients. Large multicentered studies have established an accepted incidence of Awareness during general anesthesia as approximately 1–2 per 1000 cases or 0.15%. More recent retrospective data, however, suggest that the actual incidence may be as low as 0.0068%. METHODS: To assess the incidence of Awareness at our institution, we conducted a review of adult patients undergoing surgical procedures over a 3-year period. Information on Awareness came from entries of “Intraoperative Awareness” captured during our standard evaluations on postoperative day one in our perioperative information system. Patients were not questioned specifically about Awareness. RESULTS: We reviewed 116,478 charts; 65,061 patients received general anesthesia and 51,417 received other types of anesthesia. Of the patients receiving general anesthesia, 44,006 had complete postoperative documentation. The reported incidence of undesired Intraoperative Awareness in this population was 10/44,006 (1/4401 or 0.023%). Of the patients who received other anesthetic modalities, 22,885 had complete postoperative documentation. Undesired Intraoperative Awareness was reported in 7/22,885 patients who did not receive general anesthesia (1/3269 or 0.03%). The reported incidence of Intraoperative Awareness was not statistically different between the two groups (P = 0.54). Relative risk of Intraoperative Awareness during a general anesthetic compared with a nongeneral anesthetic was 0.74, with 95% confidence interval [0.28, 2.0]. CONCLUSION: Using a retrospective methodology, reports of Intraoperative Awareness are not statistically different in patients who received general anesthesia compared with those who did not. These results suggest that, despite success with other rare perioperative events, the resolution of retrospective database analyses may be too low to study Intraoperative Awareness.