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Anesthesia Awareness: When the Mind Is Not Suppressed

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Suppressing the Mind

Part of the book series: Contemporary Clinical Neuroscience ((CCNE))

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Abstract

In approximately 1–2 general anesthetics/1000, adequate hypnosis and amnesia are not achieved, leading to intraoperative awareness and subsequent explicit recall. “Anesthesia awareness,” as it is sometimes called, is one of the most feared complications of surgery by both patients and physicians alike. A significant proportion of these patients develops long-term psychological sequelae, including posttraumatic stress disorder. In this chapter I discuss the incidence, risk factors, prevention, and postoperative consequences of anesthesia awareness.

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References

  • Alkire, M. T., A. G. Hudetz, and G. Tononi. 2008. Consciousness and anesthesia. Science 322(5903):876–880.

    Article  CAS  PubMed  Google Scholar 

  • Avidan, M. S., L. Zhang, B. A. Burnside, K. J. Finkel, A. C. Searleman, J. A. Selvidge, L. Saager, M. S. Turner, S. Rao, M. Bottros, C. Hantler, E. Jacobsohn, and A. S. Evers. 2008. Anesthesia awareness and the bispectral index. New Engl J Med 358(11):1097–1108.

    Article  CAS  PubMed  Google Scholar 

  • Bigelow, HJ. 1846. Insensibility during surgical operations produced by inhalation. Boston Med Surg J 35:309–317.

    Google Scholar 

  • Bowdle, T. A. 2006. Depth of anesthesia monitoring. Anesthesiol Clin 24(4):793–822.

    Article  CAS  PubMed  Google Scholar 

  • Brice, D. D., R. R. Hetherington, and J. E. Utting. 1970. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 42(6):535–542.

    Article  CAS  PubMed  Google Scholar 

  • Bruhn, J., P. S. Myles, R. Sneyd, and M. M. R. F. Struys. 2006. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next? Br J Anaesth 97(1):85–94.

    Article  CAS  PubMed  Google Scholar 

  • Campagna, J. A., K. W. Miller, and S. A. Forman. 2003. Mechanisms of actions of inhaled anesthetics. New Engl J Med 348(21):2110–2124.

    Article  CAS  PubMed  Google Scholar 

  • Cheng, V. Y., L. J. Martin, E. M. Elliott, J. H. Kim, H. T. J. Mount, F. A. Taverna, J. C. Roder, J. F. Macdonald, A. Bhambri, N. Collinson, K. A. Wafford, and B. A. Orser. 2006. Alpha5GABAA receptors mediate the amnestic but not sedative-hypnotic effects of the general anesthetic etomidate. J Neurosci 26(14):3713–3720.

    CAS  Google Scholar 

  • Dahaba, A. A. 2005. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg 101(3):765–773.

    Article  PubMed  Google Scholar 

  • Davidson, A. J., G. H. Huang, C. Czarnecki, M. A. Gibson, S. A. Stewart, K. Jamsen, and R. Stargatt. 2005. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 100(3):653–661.

    Article  PubMed  Google Scholar 

  • Davidson, A. J., S. J. Sheppard, A. L. Engwerda, A. Wong, L. Phelan, C. M. Ironfield, and R. Stargatt. 2008. Detecting awareness in children by using an auditory intervention. Anesthesiology 109(4):619–624.

    Article  PubMed  Google Scholar 

  • Eger, E. I., II, L. J. Saidman, and B. Brandstater. 1965. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology 26(6):756–763.

    Article  PubMed  Google Scholar 

  • Ekman, A., M. L. Lindholm, C. Lennmarken, and R. Sandin. 2004. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 48(1):20–26.

    Article  CAS  PubMed  Google Scholar 

  • Errando, C. L., J. C. Sigl, M. Robles, E. Calabuig, J. García, F. Arocas, R. Higueras, E. Del Rosario, D. López, C. M. Peiró, J. L. Soriano, S. Chaves, F. Gil, and R. García-Aguado. 2008. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth 101(2):178–185.

    Article  CAS  PubMed  Google Scholar 

  • Fitzgerald, B. M., and J. Elder. 2008. Will a 1-page informational handout decrease patients’ most common fears of anesthesia and surgery? J Surg Educ 65(5):359–363.

    Article  PubMed  Google Scholar 

  • Gibbs, F. A., L. E. Gibbs, and W. G. Lennox. 1937. Effect on the electroencephalogram of certain drugs which influence nervous activity. Arch Intern Med 60:154–166.

    Google Scholar 

  • Grace, R. F. 2003. The effect of variable-dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine-fentanyl anaesthesia. Anaesthesia 58(9):904–910.

    Article  CAS  PubMed  Google Scholar 

  • Guedel, A. 1937. Inhalation anaesthesia: a fundamental guide. New York, NY: Macmillan.

    Google Scholar 

  • Healy, B. 2008. Under anesthesia, yet aware. US News World Rep 144(9):68.

    PubMed  Google Scholar 

  • Hutchinson, R. 1961. Awareness during surgery. A study of its incidence. Br J Anaesth 33:463–469.

    Article  CAS  PubMed  Google Scholar 

  • JCAHO. 2004. Preventing and managing the impact of anesthesia awareness. Joint Comm Persp 24(12):10–11.

    Google Scholar 

  • Kent, C. D., and K. B. Domino. 2007. Awareness: practice, standards, and the law. Best Pract Res Clin Anaesthesiol 21(3):369–383.

    Article  PubMed  Google Scholar 

  • Kerssens, C., J. Klein, and B. Bonke. 2003. Awareness: monitoring versus remembering what happened. Anesthesiology 99(3):570–575.

    Article  PubMed  Google Scholar 

  • Lee, U., G. A. Mashour, S. Kim, G.J. Noh, and B.M. Choi. 2009. Propofol Induction Reduces the capacity for neural information integration: implications for the mechanism of consciousness and general anesthesia. Conscious Cogn 18(1):56–64.

    Google Scholar 

  • Leslie, K., and H. Skrzypek. 2007. Dreaming during anaesthesia in adult patients. Best Pract Res Clin Anaesthesiol 21(3):403–414.

    Article  PubMed  Google Scholar 

  • Leslie, K., P. S. Myles, A. Forbes, M. T. V. Chan, S. K. Swallow, and T. G. Short. 2005. Dreaming during anaesthesia in patients at high risk of awareness. Anaesthesia 60(3):239–244.

    Article  CAS  PubMed  Google Scholar 

  • Leslie, K., H. Skrzypek, M. J. Paech, I. Kurowski, and T. Whybrow. 2007. Dreaming during anesthesia and anesthetic depth in elective surgery patients: a prospective cohort study. Anesthesiology 106(1):33–42.

    Article  PubMed  Google Scholar 

  • Liem, E. B., C.-M. Lin, M.-I. Suleman, A. G. Doufas, R. G. Gregg, J. M. Veauthier, G. Loyd, and D. I. Sessler. 2004. Anesthetic requirement is increased in redheads. Anesthesiology 101(2):279–283.

    Article  CAS  PubMed  Google Scholar 

  • Lu, J., L. E. Nelson, N. Franks, M. Maze, N. L. Chamberlin, and C. B. Saper. 2008. Role of endogenous sleep-wake and analgesic systems in anesthesia. J Comp Neurol 508(4):648–662.

    Article  PubMed  Google Scholar 

  • Mashour, G. A. 2004. Consciousness unbound: toward a paradigm of general anesthesia. Anesthesiology 100(2):428–433.

    Article  PubMed  Google Scholar 

  • Mashour, G. A. 2006. Monitoring consciousness: EEG-based measures of anesthetic depth. Semin Anesthesia Perioper Med Pain 25:205–210.Mashour, G. A., 2009. Post-traumatic stress disorder after intraoperative awareness and high-risk surgery. Anesth Analg, In press.

    Article  Google Scholar 

  • Mashour, G. A., and E. LaRock. 2008. Inverse zombies, anesthesia awareness, and the hard problem of unconsciousness. Conscious Cogn 17(4):1163–1168.

    Article  Google Scholar 

  • Mashour, G. A., Y. Jiang, and J. Osterman. 2006. Perioperative treatment of patients with a history of intraoperative awareness and post-traumatic stress disorder. Anesthesiology 104(4):893–894.

    Article  PubMed  Google Scholar 

  • Mashour, G. A., L. Y. J. Wang, R. K. Esaki, and N. N. Naughton. 2008. Operating room desensitization as a novel treatment for post-traumatic stress disorder after intraoperative awareness. Anesthesiology 109(5):927–929.

    Article  PubMed  Google Scholar 

  • Mashour, G. A., L. Y. J. Wang, C. R. Turner, A. Shanks, J. Vandervest, and K. K. Tremper. 2009. A retrospective study of intraoperative awareness with methodological implications. Anesth Analg 108(2):521–526.

    Article  PubMed  Google Scholar 

  • Moerman, N., B. Bonke, and J. Oosting. 1993. Awareness and recall during general anesthesia. Facts and feelings. Anesthesiology 79(3):454–464.

    Article  CAS  PubMed  Google Scholar 

  • Myles, P. S., K. Leslie, J. McNeil, A. Forbes, and M. T. Chan. 2004. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 363(9423):1757–1763.

    Article  CAS  PubMed  Google Scholar 

  • Myles, P. S., K. Leslie, and A. Forbes. 2008. Anesthesia awareness and the bispectral index. New Engl J Med 359(4):428–429.

    CAS  PubMed  Google Scholar 

  • Paech, M. J., K. L. Scott, O. Clavisi, S. Chua, and N. McDonnell. 2008. A prospective study of awareness and recall associated with general anaesthesia for caesarean section. Intl J Obstetric Anesth 17(4):298–303.

    Article  CAS  Google Scholar 

  • Pollard, R. J., J. P. Coyle, R. L. Gilbert, and J. E. Beck. 2007. Intraoperative awareness in a regional medical system: a review of 3 years’ data. Anesthesiology 106(2):269–274.

    Article  PubMed  Google Scholar 

  • Rampil, I. J. 1998. A primer for EEG signal processing in anesthesia. Anesthesiology 89(4):980–1002.

    Article  CAS  PubMed  Google Scholar 

  • Sakai, T., H. Singh, W. D. Mi, T. Kudo, and A. Matsuki. 1999. The effect of ketamine on clinical endpoints of hypnosis and EEG variables during propofol infusion. Acta Anaesthesiol Scand 43(2):212–216.

    Article  CAS  PubMed  Google Scholar 

  • Samuelsson, P., L. Brudin, and R. H. Sandin. 2007. Late psychological symptoms after awareness among consecutively included surgical patients. Anesthesiology 106 (1):26–32.

    Article  PubMed  Google Scholar 

  • Samuelsson, P., L. Brudin, and R. H. Sandin. 2008a. BIS does not predict dreams reported after anaesthesia. Acta Anaesthesiol Scand 52(6):810–814.

    Article  CAS  PubMed  Google Scholar 

  • Samuelsson, P., L. Brudin, and R. H. Sandin. 2008b. Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness. Acta Anaesthesiol Scand 52(6):805–809.

    Article  CAS  PubMed  Google Scholar 

  • Sandin, R. H., G. Enlund, P. Samuelsson, and C. Lennmarken. 2000. Awareness during anaesthesia: a prospective case study. Lancet 355(9205):707–711.

    Article  CAS  PubMed  Google Scholar 

  • Scheller, B., G. Schneider, M. Daunderer, E. F. Kochs, and B. Zwissler. 2005. High-frequency components of auditory evoked potentials are detected in responsive but not in unconscious patients. Anesthesiology 103(5):944–950.

    Article  PubMed  Google Scholar 

  • Schneider, G., R. Hollweck, M. Ningler, G. Stockmanns, and E. F. Kochs. 2005. Detection of consciousness by electroencephalogram and auditory evoked potentials. Anesthesiology 103(5):934–943.

    Article  PubMed  Google Scholar 

  • Sebel, P. S., T. Andrew Bowdle, M. M. Ghoneim, I. J. Rampil, R. E. Padilla, T. J. Gan, and K. B. Domino. 2004. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 99(3):833–839.

    Article  PubMed  Google Scholar 

  • Sebel, P. S., T. Andrew Bowdle, I. J. Rampil, R. E. Padilla, T. J. Gan, M. M. Ghoneim, and K. B. Domino. 2007. Don’t ask, don’t tell. Anesthesiology 107(4):672.

    Article  PubMed  Google Scholar 

  • Shafer, A., P. F. White, J. Schüttler, and M. H. Rosenthal. 1983. Use of a fentanyl infusion in the intensive care unit: tolerance to its anesthetic effects? Anesthesiology 59(3):245–248.

    CAS  PubMed  Google Scholar 

  • Snow, J.D. 1847. On the inhalation of the vapour of ether in surgical operations. London: John Churchill.

    Google Scholar 

  • Strickland, R. A., and J. F. Butterworth. 2007. Sexual dreaming during anesthesia: early case histories (1849–1888) of the phenomenon. Anesthesiology 106(6):1232–1236.

    Article  PubMed  Google Scholar 

  • Tammisto, T, and S. Takki. 1973. Nitrous oxide-oxygen-relaxant anaesthesia in alcoholics: a retrospective study. Acta Anaesthesiol Scand Supplementum 53:68–75.

    CAS  Google Scholar 

  • Tammisto, T., and I. Tigerstedt. 1977. The need for fentanyl supplementation of N2O-O2 relaxant anaesthesia in chronic alcoholics. Acta Anaesthesiol Scand 21(3):216–221.

    Article  CAS  PubMed  Google Scholar 

  • Tononi, G. 2004. An information integration theory of consciousness. BMC Neurosci 5(1):42.

    Article  PubMed  Google Scholar 

  • Toscano, A., C. Pancaro, and V. A. Peduto. 2007. Scopolamine prevents dreams during general anesthesia. Anesthesiology 106(5):952–955.

    Article  CAS  PubMed  Google Scholar 

  • Voss, L., and J. Sleigh. 2007. Monitoring consciousness: the current status of EEG-based depth of anaesthesia monitors. Best Pract Res Clin Anaesthesiol 21(3):313–325.

    Article  PubMed  Google Scholar 

  • Winterbottom, E. H. 1950. Insufficient anaesthesia. Br Med J 1(4647):247.

    Article  CAS  PubMed  Google Scholar 

  • Xing, Y., J. M. Sonner, E. I. Eger, M. Cascio, and D. I. Sessler. 2004. Mice with a melanocortin 1 receptor mutation have a slightly greater minimum alveolar concentration than control mice. Anesthesiology 101(2):544–546.

    Article  CAS  PubMed  Google Scholar 

  • Yamamura, T., M. Fukuda, H. Takeya, Y. Goto, and K. Furukawa. 1981. Fast oscillatory EEG activity induced by analgesic concentrations of nitrous oxide in man. Anesth Analg 60(5):283–288.

    Article  CAS  PubMed  Google Scholar 

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Conflicts

The author has no conflicts of interest to declare. Funding for the author’s research on awareness comes from the Foundation for Anesthesia Education & Research and the American Society of Anesthesiologists.

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Authors and Affiliations

  1. Departments of Anesthesiology and Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA

    George A. Mashour (Assistant Professor of Anesthesiology and Neurosurgery)

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  1. George A. Mashour
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Correspondence to George A. Mashour .

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Editors and Affiliations

  1. Dept. Anesthesiology, Medical College of Wisconsin, Watertown Plank Road 8701, Milwaukee, 53226, U.S.A.

    Anthony Hudetz

  2. Dept. Anesthesiology, University of Wisconsin-Madison, University Ave. 1300, Madison, 53706, U.S.A.

    Robert Pearce

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Mashour, G.A. (2009). Anesthesia Awareness: When the Mind Is Not Suppressed. In: Hudetz, A., Pearce, R. (eds) Suppressing the Mind. Contemporary Clinical Neuroscience. Humana Press. https://doi.org/10.1007/978-1-60761-462-3_8

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