Awareness during general anesthesia for cesarean section: A prospective observational cohort study

Objective: The incidence of intra-operative awareness with explicit recall in the western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1-2% of patients at high risk for this complication. There is paucity of literature of awareness in the Indian population undergoing cesarean section (CS), therefore we wanted to study the incidence of awareness in this high-risk group in Indian population. Methodology: We have prospectively evaluated the incidence and characteristics of awareness during general anesthesia (GA) in pregnant patients undergoing cesarean section in a tertiary care hospital. Structured interviews were conducted in the post- anesthesia care unit, at 4 hours post extubation, at 24 hours and on postoperative day 3. The perceived quality of the awareness episode, intraoperative dreaming, and sequelae were investigated. The anesthetic records were reviewed to search for data that might explain the awareness episode. Results: The study included 350 patients. Calculated incidence of intraoperative awareness was 1.4% (5 out of 350 patients). Out of which 1.1% patients (i.e. 4 out of 350) were considered to have 'definite awareness' and 0.3% patient (one patient) was categorized as 'possible awareness'. Conclusions: Incidence of awareness during general anesthesia was found 1.4%. In spite of not using benzodiazepine, opioids and volatile anesthetics before baby delivery in sizeable number of patients, it is a reassuring to know that incidence of awareness is lesser than assumed (3%).