Perception and practices of depth of anesthesia monitoring and intraoperative awareness event rate among Jordanian anesthesiologists: a cross-sectional study

Abstract Background Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there ‎is a wide variation in the incidence intraoperative awareness and in the practices and attitudes of depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists’ practice and attitudes toward DoA monitoring and their estimation of the incidence of ‎intraoperative awareness. Methods A descriptive cross-sectional survey of the Jordanian anesthesiologists working in public, private, and university hospitals was utilized using questionnaire ‎developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests.‎ Results A total of 107 physicians participated and completed the survey. About one-third of the participant (34.6%; 95% CI 26.1–44.2) had never used a DoA monitor and only 6.5% (96% CI ) reported using it as a “daily practice”. The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5–83.5) believed that currently available DoA monitors are effective for DoA monitoring, and only 4.7% (95%CI ‎1.9–10.8‎) reported it as being “invalid”. Most participants reported that the main purpose of using the DoA monitor was to prevent awareness (86.0%; 95%CI 77.9–91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9–72.2), and reduce recovery time (57%; 95%CI 47.4–66.1). The event rate of intraoperative awareness was estimated at 0.4% among participated anesthesiologists. Most of participants’ hospitals lacked policy intended to prevent intraoperative awareness. Conclusions Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.