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

Area of Science:

• Anesthesiology
• Obstetrics
• Surgical Safety

Background:

• General anesthesia (GA) for Cesarean sections (CS) carries an elevated risk of accidental awareness.
• Hospitals in the Republic of Srpska utilize GA for CS more frequently than spinal anesthesia.
• Understanding the incidence of awareness is crucial for patient safety in this region.

Purpose of the Study:

• To determine the incidence of accidental awareness during general anesthesia for Cesarean sections.
• To investigate the occurrence of definite, possible, and unlikely awareness.
• To assess patient experiences, including psychological trauma and dreams, following anesthesia.

Main Methods:

• A multicenter, prospective, observational study conducted from 2016 to 2018.
• Inclusion of 1,161 patients undergoing Cesarean sections across five medical centers.
• Postoperative patient surveys utilizing the modified Brice questionnaire.

Main Results:

• A total of 1.03% of patients reported some form of memory during anesthesia.
• Definite awareness was reported by 0.43% and possible/unlikely awareness by 0.6% of patients.
• Two patients experienced significant psychological trauma, and 3.61% reported dreams, with some being unpleasant.

Conclusions:

• Accidental awareness during GA for CS occurs with significant frequency in the Republic of Srpska.
• The findings highlight the need for revised general anesthesia protocols for Cesarean sections.
• Implementing updated protocols can improve patient safety and reduce the incidence of awareness.