Awareness during pediatric anesthesia - what is the position of European pediatric anesthesiologists?

Background: The incidence of awareness in the pediatric population is reported as high as 1 : 125. An online survey was conducted about the current perception and practice of members of the British and French pediatric anesthesia societies regarding awareness during general anesthesia. Methods: Following the approval of the executive committees of the British and French pediatric anesthesia societies, members with a valid email contact address were invited to participate in a web-based survey. Perceived risk factors, use of awareness monitors, pre- and postoperative discussions of awareness as well as personal experience were enquired. Results: A total of 302 (51%) responded to the email survey. More than 60% indicated that awareness is a problem in pediatric anesthesia with the majority estimating an incidence of 1 : 1000. Almost half (49%) the respondents believe that awareness is age-dependent and 50% are not concerned below 1 month of age. More than 86% of respondents do not discuss the risk of awareness with the parents or actively look for awareness despite 27% reporting at least one episode in their practice. Intra-operative monitoring almost exclusively consists of clinical signs and endtidal anesthetic concentrations. Bispectral index (BIS) monitoring is routinely used by approximately 10% of the surveyed members. Conclusions: This survey demonstrates that European pediatric anesthesiologists perceive awareness as a major problem. However, none seems to address the issue openly or looks for its presence routinely. The vast majority of pediatric anesthesiologists rely almost exclusively on clinical monitoring and endtidal anesthetic concentrations for its detection.