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Awareness during anaesthesia raised during Caesarean section

Wednesday January 13th 2021

The rate of 'accidental awareness' under general anaesthetic is much higher than expected during Caesarean section, according to a new analysis.

The study was led by Dr Peter Odor, of University College Hospital, London, UK. His team studied 3,115 women having general anaesthesia for obstetric procedures including caesarean, at 72 NHS hospitals in England.

They found that one in 256 patients experienced awareness, with 58% reporting distress, 42% feeling paralysed, and 17% feeling paralysed and in pain. The women also felt tugging, stitching, dissociation and being unable to breathe.

This rate is much higher than the one in 19,000 previously reported in a 2014 national audit into accidental awareness, the researchers say.

Women who experienced awareness during surgery were far more likely to meet criteria for post-traumatic stress disorder when measured after 30 days. A third of the women in this study met the criteria, the researchers report in yesterday's (12 January) Anaesthesia.

Dr Odor said: "We identified a complex range of risk factors for awareness, including drug types and variations in practice. Although the incidence of awareness during caesarean section is much higher than that in the general surgical population, it is important to emphasise that general anaesthesia remains safe and around half the patients that experienced awareness did not find it distressing."

Co-author Dr Jaideep Pandit added: "The issue of consent is especially important, as the incidence we find is similar to that for other complications which we would normally warn patients about."

The authors also highlight a link with the drugs thiopentone and ketamine and risk of awareness. "Our data suggests that, compared with propofol, the risk of awareness is increased four-fold when thiopentone is used for induction of anaesthesia and 26-fold when ketamine is used," they report.

Odor, P. M. et al. Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study. Anaesthesia 12 January 2021; doi: 10.1111/anae.15385

[abstract]

Tags: Childbirth and Pregnancy | Pharmaceuticals | UK News | Women's Health & Gynaecology

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