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Awareness under Anaesthesia: A review of patients following General Anaesthesia at a Tertiary Hospital in Nigeria
Abstract
Background: Awareness and recall of surgical events under general anaesthesia is an uncommon adverse effect that may result in psychological distress for the patient. This prospective review of cases was performed to evaluate the incidence of awareness and recall during general anaesthesia in a surgical population at the University College Hospital, Ibadan.
Patients and Methods: A prospective audit was conducted over a period of 10 months using open ended questionnaire administered within 24 – 36 hours postoperatively to patients who had surgical procedures under general anaesthesia. The anaesthetic record of each patient that had awareness and recall was reviewed to search for data that might explain the awareness episode.
Results: A total of 1,185 patients were visited in the postoperative period. Nine hundred and fifty-five patients (80.6%) had general anaesthesia while 230 patients (19.4%) had other forms of anaesthesia (regional anaesthesia or conscious sedation). Of the 955 patients (479 males and 476 females) that had general anaesthesia, 7 (5 females and 2 males) patients reported occurrence of awareness during the operation with recall of intra-operative events, the incidence of awareness was 0.7%. Identified risk factors in patients who reported awareness include lack of amnesic premedication, light general anaesthesia as a result of sub-optimal doses of hypnotic agents and failure to administer supplemental doses of analgesic intra-operatively.
Conclusion: The incidence of awareness with recall in this prospective review was 0.7%, light anaesthesia being the major predisposing factor. Use of amnesic premedicants, monitoring of end tidal volatile agent concentration and intraoperative supplementation of analgesia may reduce the occurrence of awareness under general anaesthesia.
Patients and Methods: A prospective audit was conducted over a period of 10 months using open ended questionnaire administered within 24 – 36 hours postoperatively to patients who had surgical procedures under general anaesthesia. The anaesthetic record of each patient that had awareness and recall was reviewed to search for data that might explain the awareness episode.
Results: A total of 1,185 patients were visited in the postoperative period. Nine hundred and fifty-five patients (80.6%) had general anaesthesia while 230 patients (19.4%) had other forms of anaesthesia (regional anaesthesia or conscious sedation). Of the 955 patients (479 males and 476 females) that had general anaesthesia, 7 (5 females and 2 males) patients reported occurrence of awareness during the operation with recall of intra-operative events, the incidence of awareness was 0.7%. Identified risk factors in patients who reported awareness include lack of amnesic premedication, light general anaesthesia as a result of sub-optimal doses of hypnotic agents and failure to administer supplemental doses of analgesic intra-operatively.
Conclusion: The incidence of awareness with recall in this prospective review was 0.7%, light anaesthesia being the major predisposing factor. Use of amnesic premedicants, monitoring of end tidal volatile agent concentration and intraoperative supplementation of analgesia may reduce the occurrence of awareness under general anaesthesia.
