30 de janeiro de 2013

Artigo recomendado: Prevention of Intraoperative Awareness with Explicit Recall - Making Sense of the Evidence

Michael S. Avidan, George A. Mashour

Anesthesiology 2013; 118:449-56, M. S. Avidan and G. A. Mashour

Unintended intraoperative awareness with subsequent explicit recall (AWR) is a major concern for patients undergoing general anesthesia and has persisted as a complication despite modern anesthetic techniques. In order to eliminate this complication, it would be helpful if anesthesia practitioners could determine reliably and accurately when patients were unaware. Although voluntary patient movement in response to commands reliably reflects awareness, the absence of such movement does not guarantee unawareness. Patients might have received paralytic agents or anesthetic agents that lead to unresponsiveness but not unconsciousness. There is ongoing debate whether the prevention of all intraoperative awareness episodes, even those without explicit recall, should be a therapeutic goal for anesthesiologists. In this clinical commentary, we are not addressing this controversy, but are restricting the discussion to the prevention of AWR.

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