Accidental awareness during anesthesia in children.

This educational review explores the current understanding of accidental awareness during general anesthesia (AAGA) in children. Estimates of incidence in children vary between 1 in 135 (determined by direct questioning) and 1 in 51,500 (determined from spontaneous reporting). The lessons from the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland show that the characteristics of spontaneous reports of AAGA are extremely variable and relate to the type of procedure and anesthetic technique rather than age group: approximately 50% of experiences were distressing; most lasted less than 5 min; neuromuscular blockade (NMB) combined with pain caused the most distress; most cases (approximately 70%) occur at induction or emergence. The value of depth of anesthesia monitoring in preventing AAGA is uncertain but is probably useful in patients having total intravenous anesthesia and NMB. Reports of AAGA by children should be received sympathetically and a generic protocol for managing distressed patients is presented.