Detecting awareness during general anaesthetic caesarean section. An evaluation of two methods

Seventy-four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p less than 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. All patients were monitored for awareness using the isolated forearm technique and lower oesophageal contractility. Provoked lower oesophageal contractility was the most effective of the different indices. A value greater than 35 mmHg on at least one occasion had a false negative rate of 33%, a false positive rate of 28% and a predictive value of 25%. A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the 'aware' patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.