AWARENESS UNDER GENERAL ANAESTHESIA: INCIDENCE, RISK FACTORS AND CAUSES IN NIGERIAN PATIENTS

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AWARENESS UNDER GENERAL ANAESTHESIA: INCIDENCE, RISK FACTORS AND CAUSES IN NIGERIAN PATIENTS

ABSTRACT

BACKGROUND: Awareness under general anaesthesia is an anaesthetic

complication that receives little or no attention from surgical care providers in the

West African sub-region. This is evidenced by the few literature reports on the

subject. This study sought to establish the occurrence of awareness, its incidence,

causes and risk factors as well as recall of intraoperative events in our surgical

patient population.

METHOD: Patients who had elective and emergency surgical procedures done

under general anaesthesia and were capable of responding intelligently to

questions were interviewed after full recovery from anaesthesia, 6-72 hours

postoperatively. Anaesthetists were unaware of the purpose of the study, thus

their normal anaesthetic techniques appropriate for the surgery were not altered.

Data on patient demographics, premedication, anaesthetic technique, surgical risk

classification and intra-operative complications were collected from the

anaesthetic chart. Postoperatively, eligible patients were interviewed to determine

the occurrence of awareness with recall.

RESULTS: Analysis of data collected showed that 1.07% of the patients

experienced awareness under general anaesthesia as they recalled statements

made by staff during surgery. Awareness was significantly associated with

intraoperative complications such as hypotension, difficult intubation resulting in

hypoxia, severe haemorrhage and hypoxia from any cause. (P <0.0001). Other

risk factors were nonuse of anxiolytics/ amnestic agents as premedication, use of

relaxant technique, Obstetric emergencies done under general anaesthesia, and

emergency surgery performed after normal working hours. Surprisingly, 96.7%

of the respondents were satisfied with the anaesthesia received, including some

of those who probably had some awareness.

CONCLUSIONS: Awareness does occur among our surgical patients. The

incidence of 1.07% in this study is higher than that reported in studies in the

developed world. Inappropriately light anaesthesia, late presentations of patients

with complications, emergency nature of surgery may account for this difference.

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