A prospective study of awareness and recall associated with general anaesthesia for caesarean section

Paech, Michael J.; Scott, K. L.; Clavisi, Ornella; Chua, Sebastian; McDonnell, N.

doi:10.1016/j.ijoa.2008.01.016

Cited by 97 publications

(49 citation statements)

References 25 publications

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“…Over several decades, the incidence appears to have consistently reported to be approximately 1-2:1000 general anaesthetics [7][8][9][10][11][12]. It has been reported to be higher in obstetric (1:384 [13]), cardiac (1:43 [14]), and paediatric (1:135 [15]) anaesthesia. However, some studies do report a much lower incidence (1:14 560 [16]), but these have been criticised for using a modified Brice interview within 48 h of anaesthesia and not repeating it [17].…”

Section: Introductionmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out‐of‐hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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Section: Introductionmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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“…Rejyonal anestezi, sezaryen operasyonu için genel anesteziye kıyasla anne mortalitesini azaltması, (1)(2)(3) genel anesteziyle beraber gözlenebilecek zor entübasyon, aspirasyon, (4)(5)(6) intraoperatif farkındalık riskinden kaçınılmasını sağlaması, (7) uterus atonisi ve buna bağlı kan kaybını azaltması (8) nedeniyle tercih edilecek anestezi tekniği olarak kabul edilmektedir. Hatta bazı yazarlar bir kontrendikasyon olmadığı sürece elektif sezaryen operasyonları için genel anestezinin "kabul edilemez" olduğunu savunmaktadır.…”

Section: Introductionunclassified

The effect of anesthetic technique on operating room time in elective cesarean section: spinal or general?

Sungur¹,

Havas²,

Karadeniz³

et al. 2012

J Turk Anaesth Int Care

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ÖZETAmaç: Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok uygulama süresinin eğitim hastanesinde ameliyat odası kullanım süresini uzattığına dair yaygın kanının sorgulanması hedeflenmiştir.Gereç ve Yöntem: Elektif sezaryen operasyonu planlanan ASA I-II 120 gebe, spinal ve genel anestezi olarak 2 grupta ça-lışmaya alınmıştır. Her iki anestezi tekniği de eğitmen gözetiminde benzer deneyimdeki tıpta uzmanlık öğrencileri tarafından uygulanmıştır. Hastaların demografik verileri, gebelik özellikleri, t hazır (ameliyat odasına giriş-ameliyat için hazır olma süresi), t insizyon (giriş-cerrahi insizyon), t histerotomi (cerrahi insizyon-histerotomi), t histerotomi-doğum (histerotomi-göbek kordonuna klemp konulması), t derlenme (cerrahi bitiş-uyanma odasına giriş süresi), t operasyon (cerrahi başlangıç-bitiş), t ameliyat odası (ameliyat odası giriş-çıkış) süreleri, operasyon sırasında kullanılan sıvı ve efedrin miktarı kaydedilmiş. Ayrıca yenidoğanların demografik verileri, Apgar skorları ve umbilikal ven kan gazı verileri değerlendirilmiştir.Bulgular: Gebelerin demografik verileri ve gebelik özellikleri benzer bulunmuştur. Spinal anestezi grubunda t hazır , t insizyon , t histerotomi ve t histerotomi-doğum süresi, genel anestezi grubunda ise t derlenme süresi anlamlı derecede uzun olarak saptanmıştır. Ameliyat odası kullanım süreleri spinal ve genel anestezi grubunda benzer bulunmuştur (72.9±16.7 ve 70.2±12.9 dk.). Spinal anestezi alan gebelerde sıvı tüketimi ve efedrin gereksinimi daha fazla olmuştur. Yenidoğanların demografik verileri, PCO 2 değerleri arasında fark saptanmamıştır. Genel anestezi grubunda spinale oranla yenidoğanların PO 2 değerleri daha yüksek (36.7±14.2 ve 28.1±7.8 mmHg; p<0.001), pH değerleri ise daha düşük (7.32±0.04 ve 7.34±0.06; p=0.049) olmuştur, ancak bu deği-şiklikler Apgar skorlarına yansımamıştır.Sonuç: Cerrahi kanının aksine, eğitim hastanesinde spinal anestezi uygulaması ameliyat odası kullanım süresini arttırma-maktadır.Anahtar kelimeler: Obstetrik anestezi, sezaryen, genel anestezi, spinal anestezi, ameliyat odası SUMMARY The Effect of Anesthetic Technique on Operating Room Usage Time in Elective Cesarean Section: Spinal or General?Objective: This prospective observational study aimed to investigate the surgical claim that spinal anesthesia in elective cesarean section in educational setting increases operating room time.Material and Methods: ASA I-II 120 elective cesarean section parturients were grouped into spinal and general anesthesia groups. Both techniques were performed by residents under consultant supervision. Demographic characteristics of parturients, different time intervals as abbreviated with t ready (entry of the patient into operating room-readiness for surgery), t incision (entry of the patient-skin incision), t hysterotomy (skin incision-hysterotomy), t hysterotomy-delivery (hysterotomy-cord clamping), t emergence (end of the operation-entry to the postoperative care unit), t operation (start-end of surgery), t operating r...

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“…This apparent over-representation of obstetrics reflects what is already known about obstetric general anaesthesia: that it is a high-risk area for anaesthetic awareness [9,10]. In this regard, perhaps the prominence of obstetrics in the NAP5 report represents a convergence of risk factors identified throughout the report; throw difficult intubation into the mix (all the obstetric cases concerned awareness at induction or soon after, and nine involved a difficult airway) and you have your 'perfect storm' of the obese parturient (10 of the 14 cases were obese) presenting to a non-consultant anaesthetist as an emergency, out of hours (the NAP5 activity surveys found that almost two thirds of all anaesthetic activity between 00:01 and 08:00 was obstetric related [11,12]), requiring a rapid sequence induction (traditionally done with thiopental [13], a drug with which trainees may have little experience [14] -and that is highlighted in the NAP5 report as being given in an inappropriately low dose for the size of the parturient in seven cases).…”

Section: Awareness and Obstetric Anaesthesia: A Perfect Stormmentioning

confidence: 97%

Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports

Lucas

Yentis

2015

Anaesthesia

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A prospective study of awareness and recall associated with general anaesthesia for caesarean section

Cited by 97 publications

References 25 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The effect of anesthetic technique on operating room time in elective cesarean section: spinal or general?

Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports

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