DREAMY
Direct REporting of Awareness in MaternitY patients (DREAMY): A multi-centre observational study of accidental awareness under general anaesthesia in obstetric surgery patients
See the DREAMY Twitter feed for the most recent updates and progress with study analysis and reporting: @DREAMYresearch
Protocol paper:
https://pubmed.ncbi.nlm.nih.gov/32139144/
First results paper (GA characteristics and airway complications for obstetric surgery):
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15250
Second results paper (incidence of AAGA, risk factors and psychological implications in obstetric surgery):
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15385
Background
In 2014 the RCoA/AAGBI 5th National Audit Project (NAP 5) highlighted important variation in risk of spontaneously reported accidental awareness during general anaesthesia (AAGA) associated with type of surgery and nature of the anaesthetic. Obstetric anaesthesia was over-represented in reported cases of AAGA - accounting for 0.8% of all general anaesthetics in the NAP 5 activity survey but almost 10% of AAGA reports. This translated into an incidence of awareness of approximately one in every 670 general anaesthetics. The unavoidable challenges of obstetric general anaesthesia practice - including the use of rapid sequence induction, neuromuscular blockade and short duration between anaesthetic induction and start of surgery - are all likely to contribute to the high risk of AAGA in obstetric surgery.
The primary aim of the DREAMY study is to establish the incidence of AAGA using a Brice questionnaire following obstetric general anaesthesia in the UK. The secondary aims are to investigate the experience and psychological implications of Brice positive AAGA episodes in obstetric patients. This will include 12 month outcome reporting, using structured follow up and the Post-Traumatic Stress Disorder Checklist (PCL-5), alongside case review of the surgical, anaesthetic and patient factors that make obstetric patients more likely to report AAGA than the non-obstetric population.
Study design
DREAMY is a prospective, multi-centre observational cohort study using a mixed methods approach to provide quantitative and qualitative data on AAGA in obstetric patients. Patients recruited to the study will be screened for AAGA using the standardised Brice questionnaire on three occasions over 30 days; termed a "Thrice Brice" methodology. The Brice questionnaire is a standard screening tool for AAGA and comprises five simple questions.
English-speaking women, aged >18 years and undergoing obstetric surgery (e.g. LSCS, EUA, MROP) with GA will be eligible to participate. Written consent will be taken from all participants. All potential cases of AAGA identified using Brice questionnaires will receive structured interviews to delineate the awareness memories, context and effects; alongside assessment for post- traumatic stress disorder (PTSD) symptoms until 12 months (using the PCL-5 checklist). Additionally the study will report data on the characteristics of obstetric GAs and provide follow up to an initial cohort of non-AAGA patients to establish baseline PTSD incidence.
We hope that the results and process of involvement in the DREAMY study will help raise understanding of AAGA, provide vital descriptors of risk to inform consent discussions and improve clinical care for patients at high risk of a feared anaesthetic complication.
We thank the OAA/NIAA for facilitating this research with a project grant
https://www.niaa.org.uk/OAALarge-Project-Grant-2016-R1
The project is being conducted with a steering group involving PLAN, NAP 5 leads and the OAA. We are conducting the research in close partnership with neighbouring anaesthetic trainee networks:
OxCCARE (Oxford Critical Care & Anaesthetics Research Enterprise) https://oxccare.wordpress.com
SEARCH (South East Anaesthetic Research Chain) http://www.searchkss.co.uk
SPARC (Southcoast Perioperative Audit & Research Collaboration) http://wessex-sparc.com
Study Documents:
DREAMY PIS 1.1.pdf (662 KB)
Study Training Documents:
Set Up Guide for DREAMY.pdf (1.60 MB)
DREAMY Training Slides.pdf (3.64 MB)
DREAMY REDCap User Guide.pdf (2.88 MB)
DREAMY Departmental poster.pdf (1.50 MB)
Please contact DREAMYresearch@gmail.com for access to the Study Document Pack and Investigator Site File Pack
Access the DREAMY data server: https://dreamy.sgul.ac.uk
Access the NAP5 awareness support pathway: http://nap5.org.uk/NAP5-Anaesthetia-Awareness-Pathway#pt
Further info email: DREAMYresearch@gmail.com or see Twitter on @DREAMYresearch
DREAMY Participating Hospital Sites
http://www.uk-plan.net/DREAMYsites
Previous events
DREAMY Training Meeting - 4th May 2017
DREAMY Investigators' Preliminary Results Meeting - 21st November 2018
DREAMY Chief Investigator
Peter Odor, St. George's University Hospital
DREAMY Steering Group
PLAN Committee
Sam Bampoe, University College London Hospital
Nuala Lucas, Northwick Park Hospital / Obstetric Anaesthetists Association
Prof. Jaideep Pandit, Oxford University / NAP5 Lead
Prof. Jackie Andrade, School of Psychology, Plymouth University / NAP5 Psychology Lead
Ramani Moonesinghe, University College London Hospital, NIAA HSRC
Maurizio Cecconi, St. George's University Hospital
