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Accidental perception in obstetric surgery “may be more common”

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A new study concludes that accidental perceptions of women undergoing obstetric surgery may be more frequent than previously thought.

A 2014 national audit on accident awareness revealed 1 in 19,000 patients General anesthesia Reported an accidental perception to medical staff.

The latest research published in the journal anesthesiaSuggests that it could be 1 in 256 women undergoing obstetric surgery.

We also found that the psychological impact on obstetric surgery patients experiencing consciousness was significantly higher than in unconscious patients.

Before Fiveth National audit project (NAP5) used voluntary reporting to healthcare professionals to provide some reassurance that accidental perceptions are rare. However, we also admit that for Caesarean section patients, that number can be as low as 1 in 670.

Investigate memory perception

To further investigate, the research team reviewed the experience of 3115 patients who underwent general anesthesia for obstetric surgery at 72 hospitals in the United Kingdom between May 2017 and August 2018.

Patients completed three standardized questionnaires over a 30-day period, and answers showing memory during general anesthesia were then validated using detailed interviews and a survey of the status of each consciousness episode.

They found 12 reports of accidental recognition. Of them:

Other sensations included pulling, sewing, dissociation sensations, and inability to breathe.

For long-term psychological harm, often Post-traumatic stress disorder, The researcher discovered.



Dr. Peter Odor

Dr. Peter Odor, Project Leader and Consultant Anesthesiologist at the University College Hospital in London, said: Medscape News UK: “In this study, we conducted a process aimed at eliminating all the various complications that may occur in memory, especially after asking the patient directly about their memory, especially at that time. , I dig deeper into what those memories are. You are stressed and undergoing surgery in an unfamiliar environment. “

Accidental awareness occurred during the induction and appearance of general anesthesia in 75% of patients who reported awareness.

Ketamine and thiopental

Factors associated with accidental recognition during general anesthesia are:

  • 25-30 overweight body mass index (BMI), and underweight BMI less than 18.5

  • Overtime surgery

  • Use of Ketamine Or thiopental for induction

The overexpression of the drug thiopental to induce anesthesia in conscious cases was impressive, the researchers said.

“Our data is Propofol, In the case of thiopental, the risk of consciousness increases fourfold [thiopental] Used for induction of anesthesia, they said that using ketamine increased 26-fold.

“One of our recommendations is to consider the transition to greater standardization with general anesthesia in obstetrics,” said Dr. Odor.

“We have provided many answers, but the question remains as to why awareness is more common in pregnant women. The next step is to apply the lessons learned from this study to future risk reduction. It’s useful. “

The author also considers various other possible explanations for the findings. They include birth-related hormonal changes that may “affect memory, recall, or even sensitivity to general anesthesia” during “a period of increased attention to surrounding events.” Was included.

“Urgent” need for new guidance

Jackie, a professor of psychology at the University of Plymouth, co-authored the study, commenting on the finding that conscious patients had significantly higher psychological impact scores at 30 days compared to unconscious patients.・ Andrade commented as follows. An explanation of what happened and quality support after an episode of accidental awareness during general anesthesia can help reduce its psychological impact. “

Dr. Tim Meek and a consultant anesthesiologist at the Association of Anesthesiologists at James Cook University Hospital in Middlesbrough said:

Incidence of Accidental Cognition During General Anesthesia in Obstetrics: Multicenter Prospective Cohort Study, Odor P et al., Anesthesia. https://doi.org/10.1111/anae.15385

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