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Intraoperative awareness during general anesthesia for cesarean delivery
1Department of Anaesthesia, York Hospital, York, UK. kayrobins14@hotmail.com
Anesthesia and Analgesia
|August 20, 2009
Summary
Intraoperative awareness during cesarean delivery is rare but can cause PTSD. Monitoring anesthesia depth with Bispectral Index (BIS) scores below 60 and using volatile anesthetics or nitrous oxide can prevent awareness.
Area of Science:
- Anesthesiology
- Obstetric Anesthesia
Background:
- Intraoperative awareness, recalling events during general anesthesia, is a rare but serious complication.
- It can lead to posttraumatic stress disorder (PTSD) and is challenging to monitor due to unreliable clinical signs.
Purpose of the Study:
- To review strategies for preventing intraoperative awareness during cesarean delivery.
- To highlight the importance of monitoring anesthesia depth and appropriate anesthetic agent selection.
Main Methods:
- Review of current anesthetic practices and monitoring techniques for cesarean delivery.
- Discussion of the role of Bispectral Index (BIS) monitoring, volatile anesthetics, and nitrous oxide.
Main Results:
- The incidence of awareness during cesarean delivery has decreased to approximately 0.26% with modern anesthetic protocols.
- Bispectral Index (BIS) monitoring aiming for scores <60 is recommended.
- Targeting 0.7 minimum alveolar anesthetic concentration (MAC) of volatile anesthetics and using nitrous oxide can reduce awareness risk.
Conclusions:
- Deeper anesthesia levels effectively reduce awareness incidence.
- Current evidence does not indicate increased risks of tocolysis or fetal morbidity with deeper anesthesia.
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