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Defining awakening from anesthesia in neonates: a consensus study.
MedLine Citation:
PMID:  21324046     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:  A descriptive tool for determining awakening in infants is desirable to test the value of depth of anesthesia monitors. Although scales and criteria have been developed for children and infants, none has been applied to the study of anesthetised neonates. We aimed to seek consensus in a group of experts on a definition of awakening at the end of anesthesia in neonates. Methods:  We used a modified Delphi technique with an iterative process of questionnaires and anonymised feedback. Communication was conducted by email. Thirty-one consultant pediatric anesthetists in the UK and Ireland took part. Consensus was defined a priori as 80% agreement. Results:  The 83% of respondents agreed that defining awakening is possible. Consensus was reached on six criteria and also that a combination of these criteria must be used. As crying and attempting to cry are similar, we propose that at least two of the following five behaviors are present to consider a neonate awake after anesthesia: (i) crying or attempting to cry, (ii) vigorous limb movements, (iii) gagging on a tracheal tube, (iv) eyes open, and (v) looking around. There was also consensus that three stimuli are appropriate to test rousability in neonates awakening from anesthesia: (i) removal of skin adhesive tape, (ii) stroking/tickling the skin or gentle shaking, and (iii) pharyngeal suction. Conclusions:  We propose a scale for determining awakening from anesthesia in neonates that may be used in future studies, particularly regarding electroencephalographic data and depth of anesthesia monitoring in neonates.
Authors:
Matthew D Bould; Michael R J Sury
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-17
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  -     ISSN:  1460-9592     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
 Department of Anesthesiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada  Portex Unit of Anaesthesia, University College London Institute of Child Health, London.
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