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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study
Anaesthesia, Volume 76, No. 6, Year 2021
Notification
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Description
General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149–500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122–417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25–30 kg.m-2); low BMI (<18.5 kg.m-2); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7–52.0 [2–56]) than in patients without awareness 3 (1–9 [0–64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up. © 2021 Association of Anaesthetists
Authors & Co-Authors
Lucas, Dominique Nuala
United Kingdom, Harrow
Northwick Park Hospital
Moonesinghe, Suneetha Ramani
United Kingdom, London
University College London
Andrade, Jackie
United Kingdom, Plymouth
University of Plymouth
Pandit, Jaideep J.
United Kingdom, Oxford
University of Oxford Medical Sciences Division
United Kingdom, Oxford
University of Oxford
Adamson, Christine C.D.
Unknown Affiliation
Adeyeye, Ademola A.
Unknown Affiliation
Baird, Yolanda
Unknown Affiliation
Baldwin, Matthew R.
Unknown Affiliation
Blagova, Tatyana
Unknown Affiliation
Bowen, Mary P.
Unknown Affiliation
Carvalho, José Carlos Almeida
Unknown Affiliation
Feneley, Andrew
Unknown Affiliation
Funnell, Sarah
Unknown Affiliation
Hammond, Sarah Jane
Unknown Affiliation
Henry, Orion
Unknown Affiliation
Higgins, Nicola
Unknown Affiliation
Hussein, Zanariah
Unknown Affiliation
James, Michael Frank M.
Unknown Affiliation
Kaye, Richard Mugula
Unknown Affiliation
Mackenzie, Matthew J.
Unknown Affiliation
McCarthy, Robert J.
Unknown Affiliation
McCready, Sharon
Unknown Affiliation
Mohamed, Mona Ali
Unknown Affiliation
Mupudzi, McDonald
Unknown Affiliation
Nolan, Terry M.
Unknown Affiliation
Osagie, Olabisi O.
Unknown Affiliation
Palani, P. Bahavan
Unknown Affiliation
Pandey, Roshan
Unknown Affiliation
Patel, Harsh P.
Unknown Affiliation
Prenter, Andrew
Unknown Affiliation
Pritchard, Naomi
Unknown Affiliation
Ramage, Stephen
Unknown Affiliation
Roberts, Fiona R.
Unknown Affiliation
Russell, Robin
Unknown Affiliation
Slade, Susan Carolyn
Unknown Affiliation
Sultan, Pervez
Unknown Affiliation
Suppiah, Puvan I.
Unknown Affiliation
El-Boghdadly, Kariem
Unknown Affiliation
Kemp, Harriet I.
Unknown Affiliation
Lo, Q.
Unknown Affiliation
Morkane, Clare M.
Unknown Affiliation
Statistics
Citations: 19
Authors: 41
Affiliations: 6
Identifiers
Doi:
10.1111/anae.15385
ISSN:
00032409
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative