Children are more likely to be awake during surgery than adults

May 9 2005

New groundbreaking Australian research has discovered that children are more likely to be awake during surgery than adults.

Research team leader Andrew Davidson says that when more than 850 children were questioned after being anaesthetised, researchers found 28 cases of suspected awareness.

Four independent adjudicators all agree that of those 850 children, seven, almost one per cent, had been awake during their surgery.

Dr Davidson, of the Royal Children's Hospital in Melbourne, said the incidence of adult awareness under anaesthetic was much lower - between 0.1 and 0.2 per cent.

The children, all selected randomly from among operating theatre patients at the hospital, remembered things such as the noise of an orthopaedic saw, one having an ear tube insertion remembered the doctor making a hole in the ear drum and then sucking out the fluid inside the ear. Another child having a needle injected in their hip remembered the feeling of the needle being poked around, Dr Davidson said.

He was very surprised by the number of children who were awake during anaesthesia as the assumption was that it does not happen in children and surmises that may be children just don't tell anyone because they are afraid.

When one child who was aware told her mother her mother told her not to be stupid as that didn't happen.

He said a few of the children remembered being in pain during their surgery, but it was not severe and did not seem to make the children nearly as anxious as would be expected.

The children were monitored for up to a month and their behaviour did not seem to have been affected.

Dr Davidson presented the findings to the annual scientific meeting of the Australian and New Zealand College of Anaesthetists in Auckland this weekend.

He said more studies needed to be done to gauge levels of anxiety better, one child who wasn't in this study, had been awake during a previous anaesthetic. When the child came back for another operation the mother said, 'You'll be asleep, you won't remember anything', the child retorted with ' well I wasn't asleep last time. Last time, they forgot to turn off my ears '. The child was hesitant about the second operation because she didn't believe she'd be asleep during the anaesthetic.

Dr Davidson said the study, carried out between 2002 and 2004, suggested anaesthetists might need to think about giving children more anaesthetic to prevent awareness and this has generated considerable concern among paediatric anaesthetists, because of the fear of litigation.

Davidson hopes new technologies will produce ways of preventing awareness, and says more studies are under way.

The research is published in the American Journal of Anaesthesia and Analgesia, and is one of the first large studies to look at children's awareness during anaesthetic.