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

Research output: Contribution to journalArticlepeer-review

1 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 languageEnglish (US)
Pages (from-to)759-776
Number of pages18
JournalAnaesthesia
Volume76
Issue number6
DOIs
StatePublished - 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

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