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Published in: Journal of Cardiothoracic Surgery 1/2016

Open Access 01-12-2016 | Research article

Is hyperlipidemia a potential protective factor against intraoperative awareness in cardiac surgery?

Authors: Qingshui Zheng, Qian Wang, Chaoqun Wu, Zhifa Wang, Hushan Ao

Published in: Journal of Cardiothoracic Surgery | Issue 1/2016

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Abstract

Background

Intraoperative awareness is a dreaded complication that leads to psychological sequelae such as posttraumatic stress disorder, especially in patients undergoing cardiac surgery. This study investigated the incidence of awareness among patients receiving cardiac surgery and sought to identify the risk factors contributing to intraoperative awareness.

Methods

Patients with informed consent undergoing cardiac surgery from June to September in 2012 were enrolled. At least one structured interview was performed postoperatively with the modified Brice Interview Questionnaire to identify intraoperative awareness as confirmed awareness, possible awareness, and no awareness. Confirmed awareness events reported by patients were classified into different categories with the Michigan Awareness Classification Instrument. The questionnaire results were combined with the patient medical records. A logistic regression model was used to analyze the risk factors that may have led to intraoperative awareness.

Results

An estimated 2136 patients were included, and 1874 patients completed at least one interview. 83 patients (4.4 %) were identified as possible or confirmed awareness, among which 46 (2.5 %) reported confirmed awareness. Patients who experienced confirmed awareness were mostly of Class 1 and 2, 15 and 24 patients respectively, which represented isolated auditory and tactile perceptions. And 11 patients reported feelings of distress intraoperatively. Hyperlipidemia was associated with intraoperative awareness (OR = 0.499, 95 % CI = 0.252–0.989, p = 0.043) and using chi-square test, however, no significance was found with logistic regression.

Conclusion

Patients undergoing cardiac surgery are at high risk for intraoperative awareness. Distress is a common feeling in patients with intraoperative awareness. Hyperlipidemia is a potential protective factor for intraoperative awareness in cardiac surgery.
Literature
1.
go back to reference Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-aware randomised controlled trial. Lancet. 2004;363:1757–63.CrossRefPubMed Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-aware randomised controlled trial. Lancet. 2004;363:1757–63.CrossRefPubMed
2.
go back to reference Xu L, Wu AS, Yue Y. The incidence of intra-operative awareness during general anesthesia in china: a multi-center observational study. Acta Anaesthesiol Scand. 2009;53:873–82.CrossRefPubMed Xu L, Wu AS, Yue Y. The incidence of intra-operative awareness during general anesthesia in china: a multi-center observational study. Acta Anaesthesiol Scand. 2009;53:873–82.CrossRefPubMed
3.
go back to reference Goldmann L, Shah MV, Hebden MW. Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation. Anaesthesia. 1987;42:596–603.CrossRefPubMed Goldmann L, Shah MV, Hebden MW. Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation. Anaesthesia. 1987;42:596–603.CrossRefPubMed
4.
go back to reference Wang Q, Wang Z, Hao Z, Ao H. The occurrence of intraoperative awareness in cardiac surgery Chinese. J Anesth. 2013;33:1407–8. Wang Q, Wang Z, Hao Z, Ao H. The occurrence of intraoperative awareness in cardiac surgery Chinese. J Anesth. 2013;33:1407–8.
5.
go back to reference Runeson BS, Rich CL. Diagnostic and statistical manual of mental disorders, 3rd ed. (DSM-III), adaptive functioning in young Swedish suicides. Ann Clin Psychiatry. 1994;6:181–3.CrossRefPubMed Runeson BS, Rich CL. Diagnostic and statistical manual of mental disorders, 3rd ed. (DSM-III), adaptive functioning in young Swedish suicides. Ann Clin Psychiatry. 1994;6:181–3.CrossRefPubMed
6.
go back to reference Leslie K, Chan MT, Myles PS, Forbes A, McCulloch TJ. Posttraumatic stress disorder in aware patients from the B-aware trial. Anesth Analg. 2010;110:823–8.CrossRefPubMed Leslie K, Chan MT, Myles PS, Forbes A, McCulloch TJ. Posttraumatic stress disorder in aware patients from the B-aware trial. Anesth Analg. 2010;110:823–8.CrossRefPubMed
7.
go back to reference Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970;42:535–42.CrossRefPubMed Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970;42:535–42.CrossRefPubMed
8.
go back to reference Mashour GA, Tremper KK, Avidan MS. Protocol for the "Michigan awareness control study": a prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness. BMC Anesthesiol. 2009;9:7.CrossRefPubMedPubMedCentral Mashour GA, Tremper KK, Avidan MS. Protocol for the "Michigan awareness control study": a prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness. BMC Anesthesiol. 2009;9:7.CrossRefPubMedPubMedCentral
9.
go back to reference Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6–10.CrossRefPubMed Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6–10.CrossRefPubMed
10.
go back to reference Akavipat P, Sookplung P, Premsamran P, Toomtong P, Kusumaphanyo C, Muansaiyart P. The Thai anesthesia incident monitoring study (Thai AIMS): an analysis of 21 awareness events. J Med Assoc Thai. 2009;92:335–41.PubMed Akavipat P, Sookplung P, Premsamran P, Toomtong P, Kusumaphanyo C, Muansaiyart P. The Thai anesthesia incident monitoring study (Thai AIMS): an analysis of 21 awareness events. J Med Assoc Thai. 2009;92:335–41.PubMed
11.
go back to reference Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter united states study. Anesth Analg. 2004;99:833–9. table of contents. Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter united states study. Anesth Analg. 2004;99:833–9. table of contents.
12.
go back to reference Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707–11.CrossRefPubMed Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707–11.CrossRefPubMed
13.
go back to reference Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg. 2009;108:527–35.CrossRefPubMed Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg. 2009;108:527–35.CrossRefPubMed
14.
go back to reference Tempe DK, Siddiquie RA. Awareness during cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13:214–9.CrossRefPubMed Tempe DK, Siddiquie RA. Awareness during cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13:214–9.CrossRefPubMed
15.
go back to reference Gordon PC, Morrell DF, Pamm JD. Total intravenous anesthesia using propofol and alfentanil for coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 1994;8:284–8.CrossRefPubMed Gordon PC, Morrell DF, Pamm JD. Total intravenous anesthesia using propofol and alfentanil for coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 1994;8:284–8.CrossRefPubMed
16.
go back to reference Maunuksela EL. Hemodynamic response to different anesthetics during open-heart surgery. Acta Anaesthesiol Scand Suppl. 1977;65:1–71.CrossRefPubMed Maunuksela EL. Hemodynamic response to different anesthetics during open-heart surgery. Acta Anaesthesiol Scand Suppl. 1977;65:1–71.CrossRefPubMed
17.
go back to reference Wang Y, Yue Y, Sun YH, Wu AS, Wu QW, Zhang YQ, Feng CS. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, china. Chin Med J (Engl). 2005;118:1190–4. Wang Y, Yue Y, Sun YH, Wu AS, Wu QW, Zhang YQ, Feng CS. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, china. Chin Med J (Engl). 2005;118:1190–4.
18.
go back to reference Errando CL, Perez-Caballero P, Gelb AW, Sigl JC. Methodology, human factors, and incidence of intraoperative awareness. Acta Anaesthesiol Scand. 2010;54:781–3.CrossRefPubMed Errando CL, Perez-Caballero P, Gelb AW, Sigl JC. Methodology, human factors, and incidence of intraoperative awareness. Acta Anaesthesiol Scand. 2010;54:781–3.CrossRefPubMed
19.
go back to reference Kain K, Catto AJ, Grant PJ. Impaired fibrinolysis and increased fibrinogen levels in south Asian subjects. Atherosclerosis. 2001;156:457–61.CrossRefPubMed Kain K, Catto AJ, Grant PJ. Impaired fibrinolysis and increased fibrinogen levels in south Asian subjects. Atherosclerosis. 2001;156:457–61.CrossRefPubMed
20.
go back to reference Forouhi NG, Rumley A, Lowe GD, McKeigue P, Sattar N. Specific elevation in plasma tissue plasminogen activator antigen concentrations in south Asians relative to Europeans. Blood Coagul Fibrinolysis. 2003;14:755–60.CrossRefPubMed Forouhi NG, Rumley A, Lowe GD, McKeigue P, Sattar N. Specific elevation in plasma tissue plasminogen activator antigen concentrations in south Asians relative to Europeans. Blood Coagul Fibrinolysis. 2003;14:755–60.CrossRefPubMed
21.
go back to reference Yu HY, Liu CH, Chen YS, Wang SS, Chu SH, Lin FY. Relationship of international normalized ratio to bleeding and thromboembolism rates in Taiwanese patients receiving vitamin K antagonist after mechanical valve replacement. J Formos Med Assoc. 2005;104:236–43.PubMed Yu HY, Liu CH, Chen YS, Wang SS, Chu SH, Lin FY. Relationship of international normalized ratio to bleeding and thromboembolism rates in Taiwanese patients receiving vitamin K antagonist after mechanical valve replacement. J Formos Med Assoc. 2005;104:236–43.PubMed
22.
go back to reference McEvoy MD, Reeves ST, Reves JG, Spinale FG. Aprotinin in cardiac surgery: a review of conventional and novel mechanisms of action. Anesth Analg. 2007;105:949–62.CrossRefPubMed McEvoy MD, Reeves ST, Reves JG, Spinale FG. Aprotinin in cardiac surgery: a review of conventional and novel mechanisms of action. Anesth Analg. 2007;105:949–62.CrossRefPubMed
23.
go back to reference Mi WD, Sakai T, Takahashi S, Matsuki A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth. 1998;45:19–22.CrossRefPubMed Mi WD, Sakai T, Takahashi S, Matsuki A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth. 1998;45:19–22.CrossRefPubMed
24.
go back to reference Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O'Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA, Group B-RR. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011;365:591–600. Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O'Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA, Group B-RR. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011;365:591–600.
25.
go back to reference Zheng H, Zou H, Liu X, Chu J, Zhou Y, Loh HH, Law PY. Cholesterol level influences opioid signaling in cell models and analgesia in mice and humans. J Lipid Res. 2012;53:1153–62. Zheng H, Zou H, Liu X, Chu J, Zhou Y, Loh HH, Law PY. Cholesterol level influences opioid signaling in cell models and analgesia in mice and humans. J Lipid Res. 2012;53:1153–62.
Metadata
Title
Is hyperlipidemia a potential protective factor against intraoperative awareness in cardiac surgery?
Authors
Qingshui Zheng
Qian Wang
Chaoqun Wu
Zhifa Wang
Hushan Ao
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2016
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-016-0454-7

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