Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study

Summary 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 conscio...

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Published in:	Anaesthesia Vol. 76; no. 6; pp. 759 - 776
Main Authors:	Odor, P. M., Amarasekara, L., Anandakrishnan, S., Babio‐Galan, M., Banks, S., Barnes, L., Birch, S., Birts, W., Blightman, O., Brown, H., Bykar, H., Calvert, C., Chen, P., Chowdhury, P., Crooks, J., Crowther, E., Curtis, A., Dannatt, P., Duckham, E., Dunn, L., Eapen, S., Eason, S., El‐Amin, O., Everett, M., Fulton, L., Funnell, S., Hancock, H., Harris, G., Herbert, L., Higgins, N., Hilton, J., Hindmoor, C., Tiller, A., Jackson, M., Kainth, R., Kelliot, S., Kelly, J., Kessack, L., Khaku, M., Khan, S., Lane, K., Latif, H., Laycock, H., Light, K., Lowe, J., Machavarapu, K., Mackenzie, M., Magee, D., Manso, K., Masters, J., McAllister, T., McDougall, S., McMonagle, M., McNamara, H., McRae, L., Mohamed, M., Morgan, E., Moser, C., Mount, M., Nicholson, A., Oliver, K., Onslow, J., Orr, T., Osagie, O., Owston, H., Patel, J., Patel, R., Prenter, A., Rajput, Z., Ranatunga, K., Routley, C., Salberg, A., Sellick, J., Senbeto, S., Sharafudeen, S., Sharieff, I., Sibug, S., Sinha, A., Smith, E., Smith, L., Smyth, C., Spence, E., Stafford, H., Straughan, B., Swarbrick, C., Theron, S., Thomas, M., Topham, C., Venkaya, J., Veronica, I., Vincent, R., Waters, G., Winslow, L., Man Wong, J., Wu, J., Young, E., Zeinali, D., Grover, V., Hopkins, P., Martin, D.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-06-2021
Subjects:	accidental awareness during general anaesthesia Adult anaesthesia Anesthesia Anesthesia, General - adverse effects Anesthesia, General - methods Anesthesia, General - statistics & numerical data Anesthesia, Obstetrical - adverse effects Anesthesia, Obstetrical - methods Anesthesia, Obstetrical - statistics & numerical data Cesarean Section - methods Cesarean Section - statistics & numerical data Cohort analysis Cohort Studies England Female General anesthesia Humans Incidence Interrogation Intraoperative Awareness - epidemiology Ketamine obstetric Obstetrics Pain Paralysis Patients Post traumatic stress disorder Prospective Studies Psychology Questions recall Surgery Thiopental England general accidental awareness during general anaesthesia post-traumatic stress disorder obstetric recall anaesthesia
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Summary:	Summary 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-2409 1365-2044
DOI:	10.1111/anae.15385