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Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study.
Odor, P M; Bampoe, S; Lucas, D N; Moonesinghe, S R; Andrade, J; Pandit, J J.
Afiliação
  • Odor PM; Centre for Anaesthesia and Peri-operative Medicine, University College London Hospital, London, UK.
  • Bampoe S; Centre for Anaesthesia and Peri-operative Medicine, University College London Hospital, London, UK.
  • Lucas DN; Department of Anaesthesia, Northwick Park Hospital, London, UK.
  • Moonesinghe SR; Centre for Peri-operative Medicine, Research Department for Targeted Intervention, University College London, London, UK.
  • Andrade J; School of Psychology, University of Plymouth, Plymouth, UK.
  • Pandit JJ; Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK.
Anaesthesia ; 76(6): 759-776, 2021 06.
Article em En | MEDLINE | ID: mdl-33434945
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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cesárea / Consciência no Peroperatório / Anestesia Geral / Anestesia Obstétrica Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans País/Região como assunto: Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cesárea / Consciência no Peroperatório / Anestesia Geral / Anestesia Obstétrica Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans País/Região como assunto: Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article