Awareness under Anaesthesia: A review of patients following General Anaesthesia at a Tertiary Hospital in Nigeria

Background: Awareness and recall of surgical events under general anaesthesia is an uncommon adverse effect that may result in psychological distress for the patient. This prospective review of cases was performed to evaluate the incidence of awareness and recall during general anaesthesia in a surgical population at the University College Hospital, Ibadan.Patients and Methods: A prospective audit was conducted over a period of 10 months using open ended questionnaire administered within 24 – 36 hours postoperatively to patients who had surgical procedures under general anaesthesia. The anaesthetic record of each patient that had awareness and recall was reviewed to search for data that might explain the awareness episode.Results: A total of 1,185 patients were visited in the postoperative period. Nine hundred and fifty-five patients (80.6%) had general anaesthesia while 230 patients (19.4%) had other forms of anaesthesia (regional anaesthesia or conscious sedation). Of the 955 patients (479 males and 476 females) that had general anaesthesia, 7 (5 females and 2 males) patients reported occurrence of awareness during the operation with recall of intra-operative events, the incidence of awareness was 0.7%. Identified risk factors in patients who reported awareness include lack of amnesic premedication, light general anaesthesia as a result of sub-optimal doses of hypnotic agents and failure to administer supplemental doses of analgesic intra-operatively.Conclusion: The incidence of awareness with recall in this prospective review was 0.7%, light anaesthesia being the major predisposing factor. Use of amnesic premedicants, monitoring of end tidal volatile agent concentration and intraoperative supplementation of analgesia may reduce the occurrence of awareness under general anaesthesia

Anesthetic and surgical predictors of treatment outcome in re-do craniotomy

Introduction: Craniotomy is a neurosurgical operation done to remove brain tumor, repair vascular lesion, and relieve intracranial pressure. Complications can arise which may necessitate re-do craniotomy. The study is planned to find out the relationship between variables such as age, American Society of Anaesthesiologist (ASA), Glasgow coma score (GCS), frequency of re-do craniotomy, and surgical outcome of re-do craniotomy. Materials and Methods: This is a retrospective study of all the patients who had re-do craniotomy over a 4-year period. The data that were collected included age, sex, ASA classification, indication for re-do craniotomy, GCS, frequency of re-do craniotomy, postoperative complications, and outcome. Results: Twenty-five patients had indication for re-do craniotomy within the study period. Forty percent were male and 60% were female, and their mean age was 38.56 ± 17.38 years. The indications for re-do craniotomy were removal of residual tumor, evacuation of clot, and cerebrospinal fluid leakage. Seventy-six percent had good outcome, while 24% had poor outcome. Outcome was good for patients who had re-do craniotomy done once, while poor outcome was for patients with second and third craniotomies. Ninety percent of patients with ASA 2 had good outcome, while 9.1% had poor outcome; but 64.3% had good outcome with ASA 3, while 37.7% had poor outcome with a P-value of 0.18. Seventy-five percent had poor outcome in patients with GCS of less than 9, while 25% had good outcome; but 14.3% had poor outcome in patients with GCS above 9, while 85.7% had good outcome with a P-value of 0.031. Conclusions: Increasing frequency of re-do craniotomy and lower GCS were major factors affecting outcome in re-do craniotomy in our center. The outcome of these patients is valuable in the management of other patients with re-do craniotomy in future