Monitoring consciousness in the pediatric patient: not just a small adult

Intraoperative awareness, defined as postoperative memory for intraoperative events, is believed to occur about 0.2% of the time in a general adult surgical population. A recent large-scale prospective study from a single institution revealed a strikingly high incidence (0.8%) of intraoperative awareness in children aged 5–12 years although the sequelae of awareness during surgery in children were reported to be relatively minor. This contrasts with awareness in adult patients, for whom this complication often causes psychological trauma, thus having medico-legal implications. Various monitors to detect intraoperative awareness have been used with varying success in adults. To date, however, no monitor has been shown to be effective in detecting intraoperative awareness during surgery in pediatric patients. Further research is required to clarify the rates of intraoperative awareness in the pediatric population as well as the need for monitoring this event during the clinical practice of pediatric anesthesiology.