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

Pan-London Peri-operative Audit and Research Network (PLAN), for the DREAMY Investigators Group

doi:10.1111/anae.15385

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

Pan-London Peri-operative Audit and Research Network (PLAN), for the DREAMY Investigators Group

Neonatology (Pediatrics)

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	759-776
Number of pages	18
Journal	Anaesthesia
Volume	76
Issue number	6
DOIs	https://doi.org/10.1111/anae.15385
State	Published - Jun 2021

Bibliographical note

Funding Information:
Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims ( ClinicalTrials.gov : NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri‐operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co‐ordination and patient follow‐up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the . RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared. International Journal of Obstetric Anesthesia

Funding Information:
Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims (ClinicalTrials.gov: NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri-operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co-ordination and patient follow-up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the International Journal of Obstetric Anesthesia. RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared.

Publisher Copyright:
© 2021 Association of Anaesthetists

Keywords

accidental awareness during general anaesthesia
anaesthesia
general
obstetric
post-traumatic stress disorder
recall
Prospective Studies
Anesthesia, Obstetrical/adverse effects
Intraoperative Awareness/epidemiology
Humans
England
Cesarean Section/methods
Incidence
Anesthesia, General/adverse effects
Adult
Female
Cohort Studies

PubMed: MeSH publication types

Multicenter Study
Journal Article

Publisher link

10.1111/anae.15385

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

abstract = "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. ",

keywords = "accidental awareness during general anaesthesia, anaesthesia, general, obstetric, post-traumatic stress disorder, recall, Prospective Studies, Anesthesia, Obstetrical/adverse effects, Intraoperative Awareness/epidemiology, Humans, England, Cesarean Section/methods, Incidence, Anesthesia, General/adverse effects, Adult, Female, Cohort Studies",

author = "{Pan-London Peri-operative Audit and Research Network (PLAN), for the DREAMY Investigators Group} and Odor, {P. M.} and S. Bampoe and Lucas, {D. N.} and Moonesinghe, {S. R.} and J. Andrade and Pandit, {J. J.} and A. A'Court and D. Abdel-Gadir and A. Abdu and C. Abisogun and Z. Aboud and J. Abrams and A. Ackerman and C. Adamson and R. Addison and A. Adeyeye and R. Adler and M. Aduse-Poku and S. Adyanthaya and N. Ahmad and D. Ahmed and A. Ahmed and B. Akindele and O. Akindele and S. Akrimi and S. Al-Rawi and Y. Ali and J. Allam and A. Allana and K. Allen and O. Allen and N. Amaradasa and L. Amarasekara and F. Amoakwa-adu and P. Anandageetha and S. Anandakrishnan and R. Anandanadesan and M. Anderson and S. Apps and A. Aquilina and G. Arbane and A. Arch and S. Armstrong and R. Arya and G. Ashiru and K. Ashpole and C. Atkinson and F. Atkinson and E. Auer and K. Roberts",

note = "Funding Information: Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims ( ClinicalTrials.gov : NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri‐operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co‐ordination and patient follow‐up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the . RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared. International Journal of Obstetric Anesthesia Funding Information: Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims (ClinicalTrials.gov: NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri-operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co-ordination and patient follow-up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the International Journal of Obstetric Anesthesia. RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared. Publisher Copyright: {\textcopyright} 2021 Association of Anaesthetists",

year = "2021",

month = jun,

doi = "10.1111/anae.15385",

language = "English (US)",

volume = "76",

pages = "759--776",

journal = "Anaesthesia",

issn = "0003-2409",

publisher = "Wiley-Blackwell",

number = "6",

}

TY - JOUR

T1 - Incidence of accidental awareness during general anaesthesia in obstetrics

T2 - a multicentre, prospective cohort study

AU - Pan-London Peri-operative Audit and Research Network (PLAN), for the DREAMY Investigators Group

AU - Odor, P. M.

AU - Bampoe, S.

AU - Lucas, D. N.

AU - Moonesinghe, S. R.

AU - Andrade, J.

AU - Pandit, J. J.

AU - A'Court, A.

AU - Abdel-Gadir, D.

AU - Abdu, A.

AU - Abisogun, C.

AU - Aboud, Z.

AU - Abrams, J.

AU - Ackerman, A.

AU - Adamson, C.

AU - Addison, R.

AU - Adeyeye, A.

AU - Adler, R.

AU - Aduse-Poku, M.

AU - Adyanthaya, S.

AU - Ahmad, N.

AU - Ahmed, D.

AU - Ahmed, A.

AU - Akindele, B.

AU - Akindele, O.

AU - Akrimi, S.

AU - Al-Rawi, S.

AU - Ali, Y.

AU - Allam, J.

AU - Allana, A.

AU - Allen, K.

AU - Allen, O.

AU - Amaradasa, N.

AU - Amarasekara, L.

AU - Amoakwa-adu, F.

AU - Anandageetha, P.

AU - Anandakrishnan, S.

AU - Anandanadesan, R.

AU - Anderson, M.

AU - Apps, S.

AU - Aquilina, A.

AU - Arbane, G.

AU - Arch, A.

AU - Armstrong, S.

AU - Arya, R.

AU - Ashiru, G.

AU - Ashpole, K.

AU - Atkinson, C.

AU - Atkinson, F.

AU - Auer, E.

AU - Roberts, K.

N1 - Funding Information: Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims ( ClinicalTrials.gov : NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri‐operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co‐ordination and patient follow‐up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the . RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared. International Journal of Obstetric Anesthesia Funding Information: Research Ethics Committee and Health Research Authority approvals were granted alongside prospective registration of the trial aims (ClinicalTrials.gov: NCT03100396). We wish to thank the allied trainee research networks that supported this study: South East Anaesthetics Research Chain (SEARCH); Oxford Critical Care and Anaesthetics Research Enterprise (OxCCARE); Southcoast Peri-operative Audit and Research Collaboration (SPARC); South Yorkshire Hospitals Audit and Research Collaboration (SHARC); and Midlands East Research by Critical Care and Anaesthetic Trainees (MERCAT). We also wish to thank K. Fox for her assistance with study co-ordination and patient follow-up. JP was the clinical lead for the 5th National Audit Project, is an elected Council member of the Royal College of Anaesthetists (RCOA) and Chair of the Safe Anaesthesia Liaison Group. DL chairs the OAA Education subcommittee and is a senior editor for the International Journal of Obstetric Anesthesia. RM holds senior and advisory positions in the Health Services Research Centre (RCOA) and NHS England. The views expressed are individual and not representative of those organisations. This work was supported by an Obstetric Anaesthetists' Association research grant. No other competing interests declared. Publisher Copyright: © 2021 Association of Anaesthetists

PY - 2021/6

Y1 - 2021/6

N2 - 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.

AB - 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.

KW - accidental awareness during general anaesthesia

KW - anaesthesia

KW - general

KW - obstetric

KW - post-traumatic stress disorder

KW - recall

KW - Prospective Studies

KW - Anesthesia, Obstetrical/adverse effects

KW - Intraoperative Awareness/epidemiology

KW - Humans

KW - England

KW - Cesarean Section/methods

KW - Incidence

KW - Anesthesia, General/adverse effects

KW - Adult

KW - Female

KW - Cohort Studies

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DO - 10.1111/anae.15385

M3 - Article

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AN - SCOPUS:85099229520

SN - 0003-2409

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JO - Anaesthesia

JF - Anaesthesia

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ER -

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

Abstract

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Keywords

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