@article{e3c430bceb87462d873e086296c6396a,
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, anaesthesia, general, obstetric, post-traumatic stress disorder, recall",
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 B. Avery and M. Babio-Galan and H. Bader and G. Badham and S. Bagchi and S. Bailey and Y. Baird and C. Balaka and M. Baldwin and P. Balfour and S. Bali and S. Banks and P. Barclay and L. Barnes and T. Barnes and N. Barot and S. Barrett and V. Barrett and K. Barrett and L. Bates and K. Batte and B. Baytug and M. Behravesh and S. Bell and R. Benloch and R. Bentley and J. Berg and C. Berwick and R. Berwick and R. Bhadange and S. Bhattacharyya and E. Bielskute and S. Birch and S. Bird and R. Bird and W. Birts and B. Black and T. Blagova and H. Blake and O. Blightman and S. Blunden and R. Bolton and C. Borkett-Jones and J. Boselli and M. Bowen and R. Bowen and J. Bowyer and H. Boyle and Z. Brar and J. Bray and S. Brayshaw and C. Bressington and A. Brewer and N. Brice and L. Bridge and J. Briscoe and S. Brocklesby and H. Brown and S. Brown and D. Brunnen and K. Burijintichenna and S. Burnard and A. Burtt and V. Buswell and H. Bykar and M. Cairney and C. Calvert and L. Camarasa and N. Campbell and F. Campbell-Jones and J. Cantliffe and W. Carrol and J. Carvalho and C. Cashell and S. Cassie and K. Cassim and M. Chandler and R. Chapman and R. Charles and P. Chen and D. Cheyne and K. Chima and F. Chin and R. Chirvasuta and {Shao Chong}, M. and S. Choudhury and P. Chowdhury and T. Christmas and S. Chughwani and S. Ciechanowicz and E. Clarey and R. Coe and J. Cohen and N. Coker and K. Collins and L. Collis and J. Comar and M. Conroy and K. Constantin and J. Corfe and E. Coulborn and V. Cowie and R. Crone and J. Cronin and J. Crooks and N. Crowther and E. Crowther and C. Cruz and A. Curtis and S. Curtis and S. Curtis and A. Dabrowicz and N. Daines and V. Dalal and P. Dannatt and D. Das and J. Dash and K. Davidson and S. Davies and Y. Davis and J. Dawson and J. Dean and C. Dean and J. Denman and N. Desai and P. Dewan and S. Dimont and C. Donovan and M. Doraiswami and K. Doughty and J. Douglass and M. Dower and S. Downing and W. Duberry and E. Duckham and L. Dudgeon and S. Dukes and L. Dunn and V. Duraiswamy and A. O'Dwyer and K. Dyer and S. Eapen and M. Earl and S. Eason and K. Edwards and Z. Edwards and O. Egole and J. Ekpa and O. El-Amin and K. El-Boghdadly and D. Monks",
note = "Publisher Copyright: {\textcopyright} 2021 Association of Anaesthetists",
year = "2021",
month = jun,
doi = "10.1111/anae.15385",
language = "English",
volume = "76",
pages = "759--776",
journal = "Anaesthesia",
issn = "0003-2409",
number = "6",
}