• Angela C Lee, Amanda Townsend Redding, Imelda Tjia, Md Sohel Rana, and Eugenie Heitmiller.
• Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.
• Paediatr Anaesth. 2021 Jun 1; 31 (6): 676-685.

BackgroundAwareness under general anesthesia occurs rarely, but can result in emotional trauma. Although well-studied in adults, there is a paucity of data on unintentional awareness in children.AimsThis case series examines instances of self-reported awareness registered with Wake Up Safe, a patient safety organization that maintains a database of adverse events in pediatric anesthesia.MethodsCases of self-reported intraoperative awareness submitted to Wake Up Safe from January 1, 2010 to May 31, 2020 were reviewed for circumstances, causative factors, and level of harm.ResultsFourteen cases of self-reported intraoperative awareness out of 555 360 cases in patients aged 5-20 years were noted during the study period. Overall incidence of awareness was 2.52 (95% CI: 1.38-4.23) cases per 100 000 patients, or approximately 1:40 000. Self-reported intraoperative awareness was more frequently associated with cardiac and gastrointestinal endoscopic procedures. Incidence for cardiac procedures was 20.34 (95% CI: 8.18-41.90) cases per 100 000 patients. Incidence for gastrointestinal endoscopic procedures was 7.74 (95% CI: 1.60-22.62) cases per 100 000 patients. Most patients were assessed to have suffered harm.ConclusionsSelf-reported intraoperative awareness is a rare complication in pediatric patients that has implications for harm. Compared to awareness cases elicited by a questionnaire method, cases of self-reported awareness during general anesthesia may represent those that have a greater impact. A preoperative discussion of intraoperative awareness should be considered for procedures that carry a higher likelihood of awareness in order to mitigate harm.© 2021 John Wiley & Sons Ltd.

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