General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.
The first survey on career prospects in cardiology in England and Wales was started in 1979 and published in 1981.1 The purpose was twofold: to obtain accurate information on the appropriate ratio between the number of consultant posts and senior registrars in training and to identify districts which might be poorly endowed with expertise and facilities in the specialty. In both respects the survey identified serious deficiencies. Recognition of the problems has already influenced attitudes both within the profession and among those, responsible for its administration.A decision was made by the cardiology committee of the Royal College of Physicians and by the council of the British Cardiac Society that the situation should be monitored biennially at least until adequate provision for cardiology becomes more generally available. A second survey has therefore been conducted of both staffing and facilities available in the health districts of England and Wales relating to 1 July 1982. We report a summary of our findings together with additional information made available to us by colleagues in Scotland and Northern Ireland. Methods of inquiryA cardiologist in each health region of England and Wales was sent a list of districts in his locality and asked to suggest a physician in each who might be willing to complete a questionnaire. Some districts are large with hospitals which operate autonomously; in such cases two contacts were approached.The questionnaire was substantial and comprised 19 sections relating to consultant staff, senior registrars, technical staff, referral patterns, facilities, and equipment. Cardiovascular physicians (cardiologists) Accepted for publication 15 September 1983 were defined as physicians who have both a special interest and an appropriate training in the specialty, though these criteria were not specified further. We made a distinction between those who spend virtually all of their professional time in cardiology and those with a major commitment to the specialty (occupying more than 40% of their time) but with additional responsibilities in general medicine.As in our previous survey, about half our questionnaires were returned promptly. When necessary, second and third reminders were sent and finally telephone contact was made until all information had been received for each health district. The level of cooperation was generally excellent.The complete data were stored in a main frame computer (Vax III) to facilitate analysis and subsequent comparisons. They were then assembled for each region and submitted under confidential cover to our original regional advisors for scrutiny as a guard against inadvertent errors. Disagreements between regional advisors and our district contacts were resolved by further inquiries. We believe that the data we have collected are as complete and as accurate as can reasonably be expected without the availability of first hand local knowledge.
Objective To assess the potential benefits of using extended trained ambulance personnel (paramedics) as primary responders for domiciliary obstetric and gynaecological emergencies. Design An observational study of performance and analysis of operational data in a newly established service. Setting A mixed urban and rural population served by South Glamorgan Health Authority. Main outcome measures Work load, response times, management and transfer of patients, efficiency of communications and appropriateness of training. Results There was an initial increase in requests above that when a hospital‐based service operated. Targets for response times were met. The mean response time for providing appropriate skilled help was halved compared with the previous arrangements and a safe and efficient service was provided. Prompt transport and advance notice and preparation for reception in the delivery unit contributed to optimal management. Medical staff depletion in the delivery unit was minimised. Conclusion An Emergency Domiciliary Obstetric Service based on primary response by specially trained ambulance service paramedics can beneficially replace traditional hospital‐based Obstetric Flying Squads.
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