Perception and practices of depth of anesthesia monitoring and intraoperative awareness event rate among Jordanian anesthesiologists: a cross-sectional study.

BACKGROUND: Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there is a wide variation in the incidence of intraoperative awareness and in the practices and attitudes toward depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists' practice and attitudes toward DoA monitoring and estimate the event rate of intraoperative awareness among the participating anesthesiologists. METHODS: A descriptive cross-sectional survey of Jordanian anesthesiologists working in public, private, and university hospitals was utilized using a questionnaire developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests. RESULTS: A total of 107 anesthesiologists responded and completed the survey. About one-third of the respondents (34.6%; 95% CI 26.1-44.2) had never used a DoA monitor and only 6.5% (95% CI 3.1-13.2) reported using it as a "daily practice". The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5-83.5) believed that currently available DoA monitors are effective for DoA monitoring and only 4.7% (95%CI 1.9-10.8) reported it as being "invalid". Most respondents reported that the main purpose of using a DoA monitor was to prevent awareness (86.0%; 95%CI 77.9-91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9-72.2), and reduce recovery time (57%; 95%CI 47.4-66.1). The event rate of intraoperative awareness was estimated at 0.4% among participating anesthesiologists. Most Jordanian hospitals lacked policy intending to prevent intraoperative awareness. CONCLUSIONS: Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.

Effect of total intravenous vs volatile anesthetics on intraoperatively acquired electrically evoked compound action potential in children undergoing cochlear implant surgery: A randomized prospective study.

OBJECTIVE: The purpose of the present study was to compare the effects of inhalational anesthesia to those of total intravenous anesthesia on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in children undergoing cochlear implantation. STUDY DESIGN: Randomized prospective study. SETTING: Tertiary referral teaching hospital. PATIENTS: Forty children aged 6 months to 17years with bilateral severe-to-profound sensorineural hearing loss and undergoing cochlear implantation were enrolled in the study. INTERVENTION: Patients were randomly assigned (1:1 ratio) into 2 groups to receive inhalational or total intravenous anesthesia. MEASUREMENTS: The e-ECAP measurements were obtained with neural response telemetry software. MAIN RESULTS: All electrodes showed lower e-ECAP thresholds under propofol, and results were statistically significant for the apical electrodes (P<.05). There was no statistical difference in the impedances between the 2 groups. Propofol minimally affected the e-ECAP. In contrast, the impedance was not affected by anesthesia. CONCLUSION: Volatile anesthetics result in higher e-ECAP thresholds in children, suggesting that e-ECAP thresholds acquired during inhalational anesthesia overestimate auditory nerve stimulation levels, which may cause discomfort postoperatively and adversely affect the child's adaptation to the implant. We recommend the use of total intravenous anesthesia for the measurement of the e-ECAP thresholds during cochlear implant surgery.