Accidental sensation occurs when a patient is temporarily conscious during a general anesthetic and when he remembers things that happened during surgery, perhaps feeling pain or inability to move. However, sensation usually occurs during the movement at the beginning or end of a general anesthetic (i.e. before and after surgery), as the patient goes to sleep or wakes up. Although accidental sensation during general anesthesia is rare, and experiences usually last only a few seconds or minutes, the problem remains an important concern for both patients and anesthetists.
New study published in Anesthesia (journal of the Society of Anesthetists), showing that 1 in 256 women undergoing pregnancy-related surgery, including a caesarean section, had a sensation under general anesthesia – a much larger figure higher than previously reported. A national accident awareness survey (NAP5) in 2014 showed that about 1 in 19,000 patients receiving general anesthesia inadvertently reported unconsciousness to medical staff. Although this event varied for different types of surgery and patient subgroups, the frequency of reports was encouraging.
This new research was led by the suggestion from NAP5 that women with cesarean section, or other surgery at childbirth, may have a higher sensitivity. The researchers examined more than 3,000 women with general anesthesia for obstetric procedures in 72 NHS hospitals in England and found 12 reports of infertility: seven (58%) patients were afflicted and five (42%) ‘feeling of paralysis (inability to move, which may have occurred due to the common use of drugs to relax muscles during general anesthesia for pregnant women). Two women (17%) felt paralyzed with pain. Other feelings included thatching, stitching, feelings of separation and inability to breathe. Prolonged psychological harm often included features of post-traumatic stress disorder.
Dr Peter Odor, Project Director and Consultant Anesthetist at University College Hospital in London, explained: “This research focuses on patients across. We identified a complex range of risk factors for consciousness, including types of drugs and changes in use.While the frequency of sensation during caesarean section is much higher than that in the general surgery population, it is important to emphasize that general anesthesia is still safe and about half of the patients did not. patients who have experienced unconsciousness Although we have provided many responses, there are still questions about exactly why consciousness is more common in pregnant women; our next steps are apply the lessons learned from this study to help reduce risk in the future. “
Co-author Dr Jaideep Pandit, Professor of Anesthesia at Oxford University Hospitals NHS Foundation Trust, UK, and former lead author of the NAP5 study, said: “This project builds on previous research findings. particularly important, as the event we are experiencing is similar to the other complications we would normally warn patients of. ”
Dr Nuala Lucas, co-author and Consultant Anesthetist Obstetric Consultant at Northwick Park Hospital, London, UK, said: “This is the largest ever study of this problem in women and has managed to increase our understanding of the condition. We found an association with certain anesthetic drugs (thiopentone) and muscle tissue. Factors such as out-of-hours (late-night) emergency work were also associated with sensitivity. “Co-author Jackie said Andrade, Professor of Psychology at the University of Plymouth: “Post – traumatic stress disorder usually develops when an event is perceived as life – threatening and uncontrollable. providing an explanation of what happened and high-quality post-program support accidental awareness during general anesthesia can help reduce its psychological impact. “
Dr Chris Elton, President of the Society of Obstetric Anesthetists and based at Leicester Royal Infirmary, UK, says: “This research sheds light on this important issue for women undergoing general anesthesia for department. cesareans and anesthetists who administer it Pregnant women with general anesthesia deserve high-quality information for the consent process and the highest levels of anesthesia.This work encourages further research and highlight the real need for evidence-based guidelines in this area – the Society of Obstetric Anesthetists in conjunction with the Society of Anesthetists has already begun work on this, general anesthesia is rarely performed in obstetrics , and this problem is very rare. Women with concerns about this issue should contact their obstetric center for information and support. “
Dr Tim Meek from the Association of Consultant Anesthetists and Anesthetists at James Cook University Hospital in Middlesbrough, UK, said: “This research highlights an area where evidence-based guidance is desperately needed to help anesthetists achieve the best safe for pregnant women We have a long history of working with the Society of Obstetric Anesthetists to implement internationally respected guidelines and look forward to completing the new work seo. “
Notes to editors
This study took place from May 2017 to August 2018, and analyzed 3115 admissions for patients undergoing general anesthesia for obstetric surgery in 72 hospitals in England. Patients responded to three routine questionnaires over 30 days, with responses reflecting memories during general anesthesia subsequently confirmed using in-depth interviews and analyzes of the location of each sensory event.
Accident awareness at the beginning (entry) and end (manifestation) of general anesthesia occurred in nine (75%) of the 12 patients who reported awareness. Factors associated with accident sensitivity during general anesthesia were high body fat index (BMI) (25-30 kg / m2); low (underweight) BMI (
In terms of out-of-hours surgery, 10 out of 12 conscious patients (83%) underwent surgery during the night movement (20: 00-07: 59H), a much higher proportion compared to the an unconscious group in which only 1373 (44%) patients underwent overnight surgery.
An analysis of symptom records suggesting post-traumatic stress disorder (PTSD) at 30 days post-surgery found that women with consciousness were significantly more likely to meet criteria for PTSD than women who had surgery obstetric under general anesthesia, but without sensation. Overall, four of the twelve women with consciousness (33%) reported PTSD. All women with consciousness were followed up for a year after surgery and received support, rehabilitation and psychological services according to best practice recommendations.
Too much overproduction of the drug thiopentone to promote anesthesia in the sensory cases is ongoing, the authors say. “Our data suggest that, compared with propofol, the risk of sensitivity is quadrupled when thiopentone is used for anesthesia induction and 26-fold when ketamine is used. It has been suggested recently brief, based on brain records, propofol intake maintains deeper anesthesia than thiopental in pregnant women, so there may be a pharmacological basis for our observations.However, it now appears that there was specific justification for the use of thiopentone or ketamine as entry agents in obstetrics, rather than considering these agents as basic options. “
The authors also consider a number of other possible explanations for the conclusions. “In addition to use issues, other factors may be contributing to issues of consciousness in obstetrics. Childbirth is a time with more attention to surrounding events, so that short periods of awareness are increased in recurrence. call, as are other details of the birth experience., “they explain. “Another potential is that the hormonal changes associated with pregnancy affect memory, recall or even sensitivity to general anesthesia and increase the likelihood of consciousness.”
The results of this project are expected to lead to changes in the use of individual anesthetists, their hospital training and support systems nationally and internationally.
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