Psychological Effect of Explicit Recall After Sedation (PEERS)

Demographic and perioperative variables will be summarized. Descriptive statistics will be used to examine the incidence of awareness under sedation. We will further report the incidence of awareness with or without psychological sequalae, as well as the immediate and delayed awareness. We will also summarize the recall experience, initial emotional responses toward the event of awareness, as well as the patient satisfaction. The psychological consequences will be defined and graded using the PHQ-9 (patient health questionnaire-9) and PCL-S (PTSD Checklist Stressor - S) questionnaires. The severity of harm using modified National Patient Safety Agency (NPSA) will also be described. For the primary analysis, to assess the risk of explicit recall experience towards the development of PTSD and depression, we performed univariable logistic regression to assess whether explicit recall will be associated with either co-primary outcome. This will be followed by an assessment of individual element of recall experiences, such as auditory recall, feeling pressure, feeling pain and paralysis, etc. Multivariable logistic regression analysis will also performed to adjust for potential confounders For the secondary analysis, we will further perform logistic regression analysis to assess the potential risk factors for explicit recall. The potential risk factors to fit into the models include: i) patient factors: obesity, obstructive sleep apnoea or any cardiopulmonary diseases that lead to sedation failure, history of psychiatric disease, ii) anestheteic factors such as the choice of sedatives, iii) patient expectation (assessed by NAP5 method), iv) duration and experiences of explicit recall (e.g. auditory, tactile or pain). Additionally, we will assess patient expectations and communication between the patients and healthcare providers. To assess the impact of surgery on the development of psychiatric symptoms, we will evaluate changes in the severity of depressive symptoms before and after surgery. We will also estimate the mental healthcare burden by determining the number of new psychiatric consultations potentially required. P values \<0.05 were accepted as statistically significant.