ORCID
- J. Andrade: 0000-0002-6626-7192
Abstract
SummaryGeneral anaesthesia for obstetric surgery has distinct characteristics, which may contribute towardsa higher risk of accidental awareness during general anaesthesia. The primary aim of this study wasto investigate the incidence, experience and psychological implications of unintended consciousawareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in Englandwere recruited. Patients received three repetitions of standardised questioning over 30 days, withresponses indicating memories during general anaesthesia verified using interviews and recordinterrogation. A total of 12 patients had certain/probable or possible awareness; an incidence of 1 in256 (95%CI 1 in 149 – 1 in 500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 1 in 122 –1 in 417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%)patients; paralysis by five (41.7%), paralysis with pain by two (16.7%) reported. Accidentalawareness occurred during induction and emergence in nine (75%) patients. Factors associated withAAGA were high BMI (25-30 kg.m-2), low BMI (<18.5 kg.m-2), out-of-hours surgery and use ofketamine or thiopental for induction. Standardised psychological impact scores at 30 days weresignificantly higher in awareness patients (median (IQR [range]): 15 (2.75 – 52 [2 – 56]) than inpatients without awareness: 3 (1 – 9 [0 – 64]; p = 0.010). Four patients had a provisional diagnosis ofpost-traumatic stress disorder. We conclude that direct postoperative questioning reveals high ratesof accidental awareness during general anaesthesia for obstetric surgery, which has implications foranaesthetic practice, consent and follow-up.
DOI Link
Publication Date
2021-06-01
Publication Title
Anaesthesia
Volume
76
Issue
6
ISSN
0003-2409
Acceptance Date
2020-12-10
Deposit Date
2020-12-19
Embargo Period
2021-01-19
Funding
This work was supported by an Obstetric Anaesthetists' Association research grant.
Keywords
accidental awareness during general anaesthesia, anaesthesia, obstetric, post-traumatic stress disorder, recall
First Page
759
Last Page
776
Recommended Citation
Odor, P., Bampoe, S., Lucas, D., Andrade, J., Moonesinghe, S., & Pandit, J. (2021) 'Incidence of accidental awareness during general anaesthesia in obstetrics: a multi-centre, prospective cohort study', Anaesthesia, 76(6), pp. 759-776. Available at: 10.1111/anae.15385
