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Intraoperative awareness during general anesthesia for cesarean delivery.
Anesth Analg. 2009 Sep; 109(3):886-90.A&A

Abstract

Intraoperative awareness is defined as the spontaneous recall of an event occurring during general anesthesia. A move away from rigid anesthetic protocols, which were designed to limit drug transmission across the placenta, has reduced the incidence of awareness during cesarean delivery to approximately 0.26%. Nevertheless, it remains an undesirable complication with potential for the development of posttraumatic stress disorder. Assessing depth of anesthesia remains a challenge for the anesthesia provider as clinical signs are unreliable and there is no sensitive and specific monitor. Bispectral Index monitoring with the goal of scores <60 has been recommended to prevent awareness. Induction drugs vary in their ability to produce amnesia and the period of hypnotic effect is affected by the rate at which they are redistributed. After initiation of anesthesia, volatile anesthetics should be administered to a target of 0.7 minimum alveolar anesthetic concentration, which has been shown to consistently achieve mean Bispectral Index scores <60. Because of its rapid uptake, nitrous oxide remains an important adjunct to reduce the risk of awareness during emergency cesarean delivery. In the absence of fetal compromise, there is no rationale for an inspired oxygen concentration above 0.33. Deeper levels of anesthesia reduce the incidence of awareness; current evidence does not suggest an increased risk of tocolysis or fetal morbidity.

Authors+Show Affiliations

Department of Anaesthesia, York Hospital, York, UK. kayrobins14@hotmail.comNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19690262

Citation

Robins, Kay, and Gordon Lyons. "Intraoperative Awareness During General Anesthesia for Cesarean Delivery." Anesthesia and Analgesia, vol. 109, no. 3, 2009, pp. 886-90.
Robins K, Lyons G. Intraoperative awareness during general anesthesia for cesarean delivery. Anesth Analg. 2009;109(3):886-90.
Robins, K., & Lyons, G. (2009). Intraoperative awareness during general anesthesia for cesarean delivery. Anesthesia and Analgesia, 109(3), 886-90. https://doi.org/10.1213/ane.0b013e3181af83c1
Robins K, Lyons G. Intraoperative Awareness During General Anesthesia for Cesarean Delivery. Anesth Analg. 2009;109(3):886-90. PubMed PMID: 19690262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative awareness during general anesthesia for cesarean delivery. AU - Robins,Kay, AU - Lyons,Gordon, PY - 2009/8/20/entrez PY - 2009/8/20/pubmed PY - 2009/9/10/medline SP - 886 EP - 90 JF - Anesthesia and analgesia JO - Anesth Analg VL - 109 IS - 3 N2 - Intraoperative awareness is defined as the spontaneous recall of an event occurring during general anesthesia. A move away from rigid anesthetic protocols, which were designed to limit drug transmission across the placenta, has reduced the incidence of awareness during cesarean delivery to approximately 0.26%. Nevertheless, it remains an undesirable complication with potential for the development of posttraumatic stress disorder. Assessing depth of anesthesia remains a challenge for the anesthesia provider as clinical signs are unreliable and there is no sensitive and specific monitor. Bispectral Index monitoring with the goal of scores <60 has been recommended to prevent awareness. Induction drugs vary in their ability to produce amnesia and the period of hypnotic effect is affected by the rate at which they are redistributed. After initiation of anesthesia, volatile anesthetics should be administered to a target of 0.7 minimum alveolar anesthetic concentration, which has been shown to consistently achieve mean Bispectral Index scores <60. Because of its rapid uptake, nitrous oxide remains an important adjunct to reduce the risk of awareness during emergency cesarean delivery. In the absence of fetal compromise, there is no rationale for an inspired oxygen concentration above 0.33. Deeper levels of anesthesia reduce the incidence of awareness; current evidence does not suggest an increased risk of tocolysis or fetal morbidity. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19690262/Intraoperative_awareness_during_general_anesthesia_for_cesarean_delivery_ L2 - https://doi.org/10.1213/ane.0b013e3181af83c1 DB - PRIME DP - Unbound Medicine ER -