What is the clinical evidence from this study?

Study design: Observational. Population: Cesarean section under general anesthesia (n=1161). Intervention: General anesthesia. Primary outcome: Incidence of definite accidental awareness under general anesthesia (AAGA).

April 4, 2023Open Access

Accidental Awareness Under General Anesthesia During Cesarean Section: An Observational Study

Q: What does this research mean for the field?

General anesthesia during Cesarean section results in a 0.43% incidence of definite accidental awareness, primarily occurring during anesthesia emergence. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

General anesthesia during Cesarean section resulted in a 0.43% incidence of definite accidental awareness, primarily occurring during anesthesia emergence.

Study Design

Type

Observational (n=1,161)

Multicenter

Yes

Structured PICO

What is the incidence of accidental awareness under general anesthesia during Cesarean section in the Republic of Srpska?

Population

1,161 patients who underwent Cesarean section (427 elective, 734 emergency) in five medical centers in the Republic of Srpska (Bosnia and Herzegovina)

Intervention

General anesthesia for Cesarean section

Outcome

Incidence of accidental awareness under general anesthesia (measured postoperatively using the modified Brice questionnaire)patient reported

Accidental awareness under general anesthesia during Cesarean section has a significant incidence (1.03%) in the Republic of Srpska, highlighting the need for new protocols.

Limitations

Recall bias and possible misinterpretation of patients' memories
Potential influence of the researcher on the choice of answers during direct interviews
Risk of patients misunderstanding self-administered questionnaires
Incomplete patient enrollment in certain hospitals due to lack of researchers
Lack of a 30-day postoperative follow-up interview
Observational design without strictly controlled anesthesia management protocols

Abstract

Background A Caesarean section (CS) if performed under general anesthesia (GA) is a procedure with an increased risk of accidental awareness. This study aimed to examine the incidence of accidental awareness under GA in hospitals in the Republic of Srpska (Bosnia and Herzegovina) where GA for CS is performed in a significantly higher percentage compared to spinal anesthesia. Methodology In the period from 2016 to 2018, a multicenter, prospective, observational study was conducted in five medical centers in the Republic of Srpska (Bosnia and Herzegovina). The study included 1,161 patients who underwent CS. A total of 427 (36.7%) patients had elective and 734 (63.3%) had emergency CSs. The patients were surveyed postoperatively using the modified Brice questionnaire. Results Of the 1,161 patients included in the study, 12 (1.03%) reported memory in the period between induction and emergence of anesthesia. Five (0.43%) of them reported definite and seven (0.6%) possible and unlikely awareness. Significant psychological trauma due to pain was reported by two patients. Dreams during anesthesia were reported by 42 patients (3.61%) and five of them stated that the dreams were unpleasant. Conclusions Accidental awareness under GA during CS has a significant incidence in medical centers in the Republic of Srpska (Bosnia and Herzegovina). According to our findings, creating new protocols for GA when performing CS is necessary.

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