This Article Full Text Full Text (PDF) CME: Take the course for this article: Course on Intraoperative Awareness during General Anesthesia for Cesarean Delivery Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Robins, K. Articles by Lyons, G. PubMed PubMed Citation Articles by Robins, K. Articles by Lyons, G. Related Collections Obstetrics Complications Patient Safety

---

OBSTETRIC ANESTHESIOLOGY

Intraoperative Awareness During General Anesthesia for Cesarean Delivery

Kay Robins, FRCA^*, and Gordon Lyons, FRCA, MD

From the *Department of Anaesthesia, York Hospital, York; and Department of Obstetric Anaesthesia, St. James’ University Hospital, Leeds, UK.

Address correspondence and reprint requests to Kay Robins, FRCA, Department of Anaesthesia, York Hospital, York YO61 1PS, UK. Address e-mail to kayrobins14{at}hotmail.com.

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.