Skip to main content
SpringerLink
Log in

The Challenge of Accidental Awareness During General Anesthesia

  • Protocol
  • First Online:
Book cover General Anesthesia Research

Part of the book series: Neuromethods ((NM,volume 150))

Abstract

Intraoperative unconsciousness and amnesia are main goals of general anesthesia. Although these objectives are achieved in the vast majority of cases, in very rare circumstances they are not “completely” obtained, or maintained, and in turn, accidental consciousness and subsequent memorization of sensorial information may occur during intended anesthesia. This failure of anesthesia is termed as general anesthesia awareness (or accidental awareness during general anesthesia, or simply awareness). While the incidence of this complication is rare, the clinical features and its potentially devastating psychological sequelae impose a thorough knowledge of the phenomenon.

During anesthesia, the patient may be occasionally cognizant responding to commands or may wake up. This intraoperative awakening, termed as “wakefulness,” must be not confused with the awareness. The discriminating element for a proper definition of awareness, indeed, is the concomitant presence of two elements that correspond to higher cognitive functions: consciousness and memory processing of the intraoperative experience.

Although not all wakefulness episodes complete the memory processing (encoding, storing through consolidation, and retrieval), consolidated unexpected experiences can be expressed as explicit-spontaneous, or induced, reports. The pathways of this declarative, or explicit, memory produce, in turn, the awareness with recall phenomenon. Alternatively, the intraoperative experience can be processed without requiring conscious memory content and expressed as inexplicable changes in behaviors, or performances, or through the mechanism of priming, in which exposure to one stimulus influences a response to a subsequent stimulus, without conscious guidance, or intention. The processing of information via nondeclarative, or implicit, memory system, leads to the other awareness subtype: the awareness without explicit recall.

Referring to the state of the art of research, the aim of this chapter is to dissect the multiple aspects of this anesthesia-induced complication. Although in recent years research has allowed us to understand many aspects of the phenomenon, its complete characterization still seems far away, and several controversies and dark sides remain. In particular, the chapter addresses topics related to definitions and classification, epidemiology, clinical features, risk factors, management, and strategies useful for prevention.

Finally, the interest in the subject is justified as it represents a fascinating matter of investigation which intersects study areas in the contexts of the “general anesthesia research” and neuroscience. Mechanisms of anesthesia, and impact of anesthetics on consciousness and memory, represent an attractive way for studying brain and mind through an “experimental model” (general anesthesia) that is carried out on several tens of millions of patients, every year.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Protocol
USD 49.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AAGA:

Accidental awareness during general anesthesia

AAWR:

Anesthesia awareness with recall

ASA:

American Society of Anesthesiologists

AWER:

Awareness without explicit recall

BDZs:

Benzodiazepines

CIIA:

Combination of intravenous and inhaled anesthesia

DoA:

Depth of anesthesia

ETAC:

End-tidal anesthetic concentration

GA:

General anesthesia

GAA:

General anesthesia awareness

GABAAR:

Gamma-aminobutyric acid A receptor

IA:

Intraoperative awakening

ICU:

Intensive care unit

IFT:

Isolated forearm technique

MAC:

Minimal alveolar concentration

NAP5:

Fifth National Audit Project from Great Britain

NMBAs:

Neuromuscular blocking agents

NMDA:

N-methyl-d-aspartate

NO:

Nitrous oxide

PTSD:

Posttraumatic stress disorder

TIVA:

Total intravenous anesthesia

References

  1. Kotsovolis G, Komninos G (2009) Awareness during anesthesia: how sure can we be that the patient is sleeping indeed? Hippokratia 13(2):83–89

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Winterbottom EH (1950) Insufficient anaesthesia. Br Med J 1(4647):247–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Meyer BC, Blacher RS (1961) A traumatic neurotic reaction induced by succinylcholine chloride. N Y State J Med 61:1255–1261

    CAS  PubMed  Google Scholar 

  4. American Psychiatric Association (ed) (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington, VA

    Google Scholar 

  5. Domino KB, Posner KL, Caplan RA, Cheney FW (1999) Awareness during anesthesia: a closed claims analysis. Anesthesiology 90(4):1053–1061

    Article  CAS  PubMed  Google Scholar 

  6. Cascella M (2014) What about memory, consciousness, recall, and awareness in Anesthesia? Iran J Med Sci 39(3):311–312

    PubMed  PubMed Central  Google Scholar 

  7. Mashour GA (2004) The cognitive binding problem: from Kant to quantum neurodynamics. Neuro Quantology 1:29–38

    Google Scholar 

  8. Edelman GM (1987) Neural Darwinism. The theory of neuronal group selection. Basic Book, New York

    Google Scholar 

  9. Baars B (1988) A cognitive theory of consciousness. Cambridge University Press, New York

    Google Scholar 

  10. Crick F, Koch C (1990) Towards a neurobiological theory of consciousness. Semin Neurosci 2:263–275

    Google Scholar 

  11. Thagard P, Stewart TC (2014) Two theories of consciousness: semantic pointer competition vs. information integration. Conscious Cogn 30:73–90

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  13. Graziano MSA, Kastner S (2011) Human consciousness and its relationship to social neuroscience: a novel hypothesis. Cogn Neurosci 2:98–113

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rauss K, Pourtois G (2013) What is bottom-up and what is top-down in predictive coding? Front Psychol 4:276

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cascella M, Schiavone V, Muzio MR, Cuomo A (2016) Consciousness fluctuation during general anesthesia: a theoretical approach to anesthesia awareness and memory modulation. Curr Med Res Opin 32(8):1351–1359

    Article  CAS  PubMed  Google Scholar 

  16. Mashour GA, Orser BA, Avidan MS (2011) Intraoperative awareness: from neurobiology to clinical practice. Anesthesiology 114(5):1218–1233

    Article  PubMed  Google Scholar 

  17. Cascella M, Bifulco F, Viscardi D, Tracey MC, Carbone D, Cuomo A (2016) Limitation in monitoring depth of anesthesia: a case report. J Anesth 30(2):345–348

    Article  PubMed  Google Scholar 

  18. Linassi F, Zanatta P, Tellaroli P, Ori C, Carron M (2018) Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens. Br J Anaesth 121(1):198–209

    Article  CAS  PubMed  Google Scholar 

  19. Pandit JJ (2014) Acceptably aware during general anaesthesia: 'dysanesthesia'--the uncoupling of perception from sensory inputs. Conscious Cogn 27:194–212

    Article  PubMed  Google Scholar 

  20. Chung HS (2014) Awareness and recall during general anesthesia. Korean J Anesthesiol 66:339–345

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ullman MT (2004) Contributions of memory circuits to language: the declarative/procedural model. Cognition 92:231–270

    Article  PubMed  Google Scholar 

  22. Rauch SL, Shin LM, Phelps EA (2006) Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research--past, present, and future. Biol Psychiatry 60(4):376–382

    Article  PubMed  Google Scholar 

  23. Veselis RA, Reinsel RA, Feshchenko VA, Johnson R Jr (2004) Information loss over time defines the memory defect of propofol: a comparative response with thiopental and dexmedetomidine. Anesthesiology 101(4):831–841

    Article  CAS  PubMed  Google Scholar 

  24. Dutton RC, Smith WD, Smith NT (1995) Brief wakeful response to command indicates wakefulness with suppression of memory formation during surgical anesthesia. J Clin Monit 11(1):41–46

    Article  CAS  PubMed  Google Scholar 

  25. Dutton RC, Smith WD, Smith NT (1995) Wakeful response to command indicates memory potential during emergence from general anesthesia. J Clin Monit 11(1):35–40

    Article  CAS  PubMed  Google Scholar 

  26. Takamiya S, Yuki S, Hirokawa J, Manabe H, Sakurai Y (2019) Dynamics of memory engrams. Neurosci Res. pii: S0168-0102(19)30089-6. https://doi.org/10.1016/j.neures.2019.03.005

  27. Newell BR, Shanks DR (2014) Unconscious influences on decision making: a critical review. Behav Brain Sci 37(1):1–19

    Article  PubMed  Google Scholar 

  28. Veselis RA (2015) Memory formation during anaesthesia: plausibility of a neurophysiological basis. Br J Anaesth 115(Suppl 1):i13–i19

    Article  PubMed  PubMed Central  Google Scholar 

  29. Labossière DI, Leboe-McGowan JP (2018) Specific and non-specific match effects in negative priming. cta Psychol (Amst) 182:138–153

    Article  Google Scholar 

  30. Hagood EW, Gruenewald TL (2018) Positive versus negative priming of older adults' generative value: do negative messages impair memory? Aging Ment Health 22:257–260

    Article  PubMed  Google Scholar 

  31. Sanders RD, Raz A, Banks MI, Boly M, Tononi G (2016) Is consciousness fragile? Br J Anaesth 116:1–3

    Article  CAS  PubMed  Google Scholar 

  32. Deeprose C, Andrade J (2006) Is priming during anesthesia unconscious? Conscious Cogn 15(1):1–23

    Article  PubMed  Google Scholar 

  33. Tunstall ME, Sheikh A (1983) Comparison of 1.5% enflurane with 1.25% isoflurane in oxygen for caesarean section: avoidance of awareness without nitrous oxide. Br J Anaesth 62:138–143

    Article  Google Scholar 

  34. King H, Ashley S, Brathwaite D et al (1993) Adequacy of general anesthesia for cesarean section. Anesth Analg 77:84–88

    Article  CAS  PubMed  Google Scholar 

  35. Sanders RD, Tononi G, Laureys S et al (2012) Unresponsiveness? Unconsciousness. Anesthesiology 116:946–959

    Article  PubMed  Google Scholar 

  36. Andrade J, Deeprose C (2007) Unconscious memory formation during anaesthesia. Best Pract Res Clin Anaesthesiol 21:385–401

    Article  PubMed  Google Scholar 

  37. Bailey AR, Jones JG (1997) Patients’ memories of events during general anaesthesia. Anaesthesia 52(5):460–476

    Article  CAS  PubMed  Google Scholar 

  38. Andrade J (1995) Learning during anaesthesia: a review. Br J Psychol 86:479–506

    Article  PubMed  Google Scholar 

  39. Jelicic M, De Roode A, Bovill JG, Bonke B (1992) Unconscious learning during anaesthesia. Anaesthesia 47(10):835–837

    Article  CAS  PubMed  Google Scholar 

  40. Rosendahl J, Koranyi S, Jacob D, Zech N, Hansen E (2016) Efficacy of therapeutic suggestions under general anesthesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 16(1):125. https://doi.org/10.1186/s12871-016-0292-0

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tulving E (2001) Episodic memory and common sense: how far apart? Philos Trans R Soc Lond Ser B Biol Sci 356(1413):1505–1515

    Article  CAS  Google Scholar 

  42. Veselis RA, Pryor KO, Reinsel RA, Li Y, Mehta M, Johnson R Jr (2009) Propofol and midazolam inhibit conscious memory processes very soon after encoding: an event-related potential study of familiarity and recollection in volunteers. Anesthesiology 110(2):295–312

    CAS  PubMed  Google Scholar 

  43. Habib R, Nyberg L (2008) Neural correlates of availability and accessibility in memory. Cereb Cortexl 18(7):1720–1726

    Article  Google Scholar 

  44. Pryor KO, Root JC, Mehta M, Stern E, Pan H et al (2015) Effect of propofol on the medial temporal lobe: a functional magnetic resonance imaging study in human subjects. Br J Anaesth 115:i104–i113

    Article  PubMed  PubMed Central  Google Scholar 

  45. Deeprose C, Andrade J, Varma S, Edwards N (2004) Unconscious learning during surgery with propofol anaesthesia. Br J Anaesth 92:171–177

    Article  CAS  PubMed  Google Scholar 

  46. Veselis RA, Reinsel RA, Feshchenko VA, Wroński M (1997) The comparative amnestic effects of midazolam, propofol, thiopental, and fentanyl at equisedative concentrations. Anesthesiology 87:749–764

    Article  CAS  PubMed  Google Scholar 

  47. Johns FR, Sandler NA, Buckley MJ, Herlich A (1998) Comparison of propofol and methohexital continuous infusion techniques for conscious sedation. J Oral Maxillofac Surg 56:1124–1127

    Article  CAS  PubMed  Google Scholar 

  48. Zarnowska ED, Rodgers FC, Oh I et al (2015) Etomidate blocks LTP and impairs learning but does not enhance tonic inhibition in mice carrying the N265M point mutation in the beta3 subunit of the GABA(A) receptor. Neuropharmacology 93:171–178

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Cheng VY, Martin LJ, Elliott EM, Kim JH, Mount HT et al (2006) Alpha5GABAA receptors mediate the amnestic but not sedative-hypnotic effects of the general anesthetic etomidate. J Neurosci 26:3713–3720

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Friederich P, Dybek A, Urban BW (2000) Stereospecific interaction of ketamine with nicotinic acetylcholine receptors in human sympathetic ganglion-like SH-SY5Y cells. Anesthesiology 93:818–824

    Article  CAS  PubMed  Google Scholar 

  51. Forman SA, Chin VA (2008) General Anesthetics and molecular mechanisms of unconsciousness. Int Anesthesiol Clin 46:43–53

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Nedaei SE, Pourmotabbed A, Mehrabi Nasab E, Touhidi A (2009) Ketamine induces anterograde and retrograde amnesia in rats. Physiol Pharmacol 12(4):328–335

    Google Scholar 

  53. Arrázola MS, Varela-Nallar L, Colombres M et al (2009) Calcium/calmodulin-dependent protein kinase type IV is a target gene of the wnt/beta-catenin signaling pathway. J Cell Physiol 221:658–667

    Article  PubMed  CAS  Google Scholar 

  54. Liu H, Xu GH, Wang K et al (2014) Involvement of GSK3β/β-catenin signaling in the impairment effect of ketamine on spatial memory consolidation in rats. Neurobiol Learn Mem 111:26–34

    Article  CAS  PubMed  Google Scholar 

  55. Chortkoff BS, Bennett HL, Eger EI 2nd (1993) Subanesthetic concentrations of isoflurane suppress learning as defined by the category-example task. Anesthesiology 79(1):16–22

    Article  CAS  PubMed  Google Scholar 

  56. Nishikawa K, MacIver MB (2001) Agent-selective effects of volatile anesthetics on GABAA receptor-mediated synaptic inhibition in hippocampal interneurons. Anesthesiology 94(2):340–347

    Article  CAS  PubMed  Google Scholar 

  57. Masquelier T, Hugues E, Deco G, Thorpe SJ (2009) Oscillations, phase-of-firing coding, and spike timing-dependent plasticity: an efficient learning scheme. J Neurosci 29(43):13484–13493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Perouansky M, Rau V, Ford T et al (2010) Slowing of the hippocampal θ rhythm correlates with anesthetic-induced amnesia. Anesthesiology 113:1299–1309

    Article  CAS  PubMed  Google Scholar 

  59. Jordan BD, Wright EL (2010) Xenon as an anesthetic agent. AANA J 78:387–392

    PubMed  Google Scholar 

  60. Haseneder R, Kratzer S, Kochs E et al (2008) Xenon reduces N-methylD-aspartate and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor-mediated synaptic transmission in the amygdala. Anesthesiology 109:998–1006

    Article  CAS  PubMed  Google Scholar 

  61. Lister RG (1985) The amnesic action of benzodiazepines in man. Neurosci Biobehav Rev 9:87–94

    Article  CAS  PubMed  Google Scholar 

  62. Lister RG, Weingartner H, Eckardt MJ, Linnoila M (1988) Clinical relevance of effects of benzodiazepines on learning and memory. PsychopharmacolSer 6:117–127

    CAS  Google Scholar 

  63. Mashour GA, Kent C, Picton P et al (2013) Assessment of intraoperative awareness with explicit recall: a comparison of 2 methods. Anesth Analg 116:889–891

    Article  PubMed  Google Scholar 

  64. Nordström O, Engström AM, Persson S, Sandin R (1997) Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade. Acta Anaesthesiol Scand 41(8):978–984

    Article  PubMed  Google Scholar 

  65. Pandit JJ, Andrade J, Bogod DG et al (2014) 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth 113(4):549–559

    Article  CAS  PubMed  Google Scholar 

  66. Bischoff P, Rundshagen I, Schneider G (2015) Undesired awareness phenomena during general anesthesia: evidence-based state of knowledge, current discussions and strategies for prevention and management. Anaesthesist 64(10):732–739

    Article  CAS  PubMed  Google Scholar 

  67. Tasbihgou SR, Vogels MF, Absalom AR (2018) Accidental awareness during general anaesthesia - a narrative review. Anaesthesia 73(1):112–122

    Article  CAS  PubMed  Google Scholar 

  68. Walker EM, Bell M, Cook TM, Grocott MP, Moonesinghe SR, SNAP-1 investigator group (2016) Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth 117:758–766

    Article  CAS  PubMed  Google Scholar 

  69. Sandin RH, Enlund G, Samuelsson P, Lennmarken C (2000) Awareness during anaesthesia: a prospective case study. Lancet 355:707–711

    Article  CAS  PubMed  Google Scholar 

  70. Sebel PS, Bowdle TA, Ghoneim MM et al (2004) The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 99:833–839

    Article  PubMed  Google Scholar 

  71. Mashour GA, Shanks A, Tremper KK et al (2012) Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology 117:717–725

    Article  PubMed  Google Scholar 

  72. Cascella M, Viscardi D, Schiavone V et al (2016) A 7-year retrospective multisource analysis on the incidence of Anesthesia awareness with recall in Cancer patients: a chance of collaboration between Anesthesiologists and psycho-oncologists for awareness detection. Medicine (Baltimore) 95(5):e2757. https://doi.org/10.1097/MD.0000000000002757

    Article  CAS  Google Scholar 

  73. Schneider G, Wagner K, Reeker W et al (2002) Bispectral index (BIS) may not predict awareness reaction to intubation in surgical patients. J Neurosurgical Anesthesiology 14:7–11

    Article  Google Scholar 

  74. Sanders RD, Gaskell A, Raz A et al (2017) Incidence of connected consciousness after tracheal intubation: a prospective, international, multicenter cohort study of the isolated forearm technique. Anesthesiology 126:214–222

    Article  PubMed  Google Scholar 

  75. Mashour GA, Avidan MS (2015) Intraoperative awareness: controversies and non-controversies. Br J Anaesth 115:Si20–SS26

    Article  Google Scholar 

  76. Davidson AJ, Smith KR, Blussé van Oud-Alblas HJ et al (2011) Awareness in children: a secondary analysis of five cohort studies. Anaesthesia 66:446

    Article  CAS  PubMed  Google Scholar 

  77. Davidson AJ, Huang GH, Czarnecki C et al (2005) Awareness during anesthesia in children: a prospective cohort study. Anesth Analg 100:653

    Article  PubMed  Google Scholar 

  78. Sury MR (2016) Accidental awareness during anesthesia in children. Paediatr Anaesth 26(5):468–474

    Article  PubMed  Google Scholar 

  79. Noël E, Van Der Linden P (2016) Le réveil peropératoire en anesthésie pédiatrique : revue de la literature. Rev Med Brux 37(6):476–482

    PubMed  Google Scholar 

  80. Mashour GA, Wang LY, Turner CR, Vandervest JC, Shanks A, Tremper KK (2009) A retrospective study of intraoperative awareness with methodological implications. Anesth Analg 108:521–536

    Article  PubMed  Google Scholar 

  81. Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB (2013) Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia awareness registry. Br J Anaesth 110:381–387

    Article  CAS  PubMed  Google Scholar 

  82. Jones JG (1994) Perception and memory during general anaesthesia. Br J Anaesth 73(1):31–37

    Article  CAS  PubMed  Google Scholar 

  83. Lennmarken C, Bildfors K, Enlund G, Samuelsson P, Sandin R (2002) Victims of awareness. Acta Anaesthesiol Scand 46(3):229–231

    Article  CAS  PubMed  Google Scholar 

  84. Kent CD, Posner KL, Mashour GA et al (2015) Patient perspectives on intraoperative awareness with explicit recall: report from a north American anaesthesia awareness registry. Br J Anaesth 115(Suppl 1):i114–i121

    Article  PubMed  Google Scholar 

  85. Cascella M (2016) Mechanisms underlying brain monitoring during anesthesia: limitations, possible improvements, and perspectives. Korean J Anesthesiol 69(2):113–120

    Article  PubMed  PubMed Central  Google Scholar 

  86. Cascella M (2015) Anesthesia awareness. Can midazolam attenuate or prevent memory consolidation on intraoperative awakening during general anesthesia without increasing the risk of postoperative delirium? Korean J Anesthesiol 68(2):200–202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Timić T, Joksimović S, Milić M, Divljaković J, Batinić B, Savić MM (2013) Midazolam impairs acquisition and retrieval, but not consolidation of reference memory in the Morris water maze. Behav Brain Res 241:198–205

    Article  PubMed  CAS  Google Scholar 

  88. Semba K, Adachi N, Arai T (2005) Facilitation of serotonergic activity and amnesia in rats caused by intravenous anesthetics. Anesthesiology 102(3):616–623

    Article  CAS  PubMed  Google Scholar 

  89. American Society of Anesthesiologists Task Force on Intraoperative Awareness (2006) Practice advisory for intraoperative awareness and brain function monitoring: a report by the american society of anesthesiologists task force on intraoperative awareness. Anesthesiology 104(4):847–864

    Article  Google Scholar 

  90. Cascella M, Fusco R, Caliendo D et al (2017) Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: a prospective cohort study of patients undergoing day case breast surgery. Oncotarget 8(45):79248–79256

    Article  PubMed  PubMed Central  Google Scholar 

  91. Gyulaházi J, Redl P, Karányi Z, Varga K, Fülesdi B (2016) Dreaming under anesthesia: is it a real possibility? Investigation of the effect of preoperative imagination on the quality of postoperative dream recalls. BMC Anesthesiol 16(1):53

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  92. Samuelsson P, Brudin L, Sandin RH (2008) Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness. Acta Anaesthesiol Scand 52:805–809

    Article  CAS  PubMed  Google Scholar 

  93. Stait ML, Leslie K, Bailey R (2008) Dreaming and recall during sedation for colonoscopy. Anaesth Intensive Care 36(5):685–690

    Article  CAS  PubMed  Google Scholar 

  94. Brice DD, Hetherington RR, Utting JE (1970) A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 42(6):535–542

    Article  CAS  PubMed  Google Scholar 

  95. Osterman JE, van der Kolk BA (1998) Awareness during anesthesia and posttraumatic stress disorder. Gen Hosp Psychiatry 20(5):274–281

    Article  CAS  PubMed  Google Scholar 

  96. Mashour GA, Esaki RK, Tremper KK, Glick DB, O’Connor M, Avidan MS (2010) A novel classification instrument for intraoperative awareness events. Anesth Analg 110:813–815

    Article  PubMed  Google Scholar 

  97. Wang M, Messina AG, Russell IF (2012) The topography of awareness: a classification of intra-operative cognitive states. Anaesthesia 67:1197–1201

    Article  CAS  PubMed  Google Scholar 

  98. Kuo PJ, Lee CL, Wang JH, Hsieh SY, Huang SC, Lam CF (2017) Inhalation of volatile anesthetics via a laryngeal mask is associated with lower incidence of intraoperative awareness in non-critically ill patients. PLoS One 12(10):e0186337

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  99. Ghoneim MM (2007) Incidence and risk factors for awareness during anaesthesia. Best Prac Res Clin Anaesthesiol 21:327–343

    Article  Google Scholar 

  100. Pollard RJ, Coyle JP, Gilbert RL, Beck JE (2007) Intraoperative awareness in a regional medical system. Anesthesiology 106:269–274

    Article  PubMed  Google Scholar 

  101. Wennervirta J, Ranta SO, Hynynen M (2002) Awareness and recall in outpatient anesthesia. Anesth Analg 95:72–77

    Article  PubMed  Google Scholar 

  102. Bergman IJ, Kluger MT, Short TG (2002) Awareness during general anaesthesia: a review of 81 cases from the anaesthetic incident monitoring study. Anaesthesia 57(6):549–556

    Article  CAS  PubMed  Google Scholar 

  103. Dai S, Perouansky M, Pearce RA (2009) Amnestic concentrations of etomidate modulate GABAA, slow synaptic inhibition in hippocampus. Anesthesiology 111(4):766–773

    Article  CAS  PubMed  Google Scholar 

  104. Al-Hasan YM, Krishnan HR, Ghezzi A et al (2011) Tolerance to anesthesia depends on synaptic proteins. Behav Genet 41(5):734–745

    Article  PubMed  PubMed Central  Google Scholar 

  105. Aranake A, Gradwohl S, Ben-Abdallah A et al (2013) Increased risk of intraoperative awareness in patients with a history of awareness. Anesthesiology 119:1275

    Article  PubMed  Google Scholar 

  106. Morimoto Y, Nogami Y, Harada K et al (2011) Awareness during anesthesia: the results of a questionnaire survey in Japan. J Anesth 25:72

    Article  PubMed  Google Scholar 

  107. Yu H, Wu D (2017) Effects of different methods of general anesthesia on intraoperative awareness in surgical patients. Medicine (Baltimore) 96(42):e6428

    Article  Google Scholar 

  108. Perl T, Carstens E, Hirn A et al (2009) Determination of serum propofol concentrations by breath analysis using ion mobility spectrometry. Br J Anaesth 103:822

    Article  CAS  PubMed  Google Scholar 

  109. Ghoneim MM, Block RI, Haffarnan M et al (2009) Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg 108(2):527–535

    Article  PubMed  Google Scholar 

  110. Nunes RR, Cavalcante SL, Lobo RF (2007) Memórias explícita e implícita em anestesias com bloqueio neuromuscular e BIS. São Paulo Med J 125(Suppl):129

    Google Scholar 

  111. Nunes RR, Cavalcante SL (2007) Influência do bloqueio neuromuscular despolarizante nas entropias. São Paulo Med J 125(Suppl):126

    Google Scholar 

  112. Nunes RR, Porto VC, Miranda VT, de Andrade NQ, Carneiro LM (2012) Risk factor for intraoperative awareness. Rev Bras Anestesiol 62(3):365–374

    Article  PubMed  Google Scholar 

  113. Schuller PJ, Newell S, Strickland PA, Barry JJ (2015) Response of bispectral index to neuromuscular block in awake volunteers. Br J Anaesth 115(Suppl 1):i95

    Article  PubMed  Google Scholar 

  114. Cascella M (2018) Emergence from anesthesia: a winding way back. Anaesthesiol Intensive Ther 50(2):168–169

    Article  PubMed  Google Scholar 

  115. Cascella M, Bimonte S, Muzio MR (2018) Towards a better understanding of anesthesia emergence mechanisms: research and clinical implications. World J Methodol 8(2):9–16

    Article  PubMed  PubMed Central  Google Scholar 

  116. Thomsen JL, Nielsen CV, Eskildsen KZ et al (2015) Awareness during emergence from anaesthesia: significance of neuromuscular monitoring in patients with butyrylcholinesterase deficiency. Br J Anaesth 115(Suppl 1):i78–i88

    Article  PubMed  Google Scholar 

  117. Radovanovic D, Radovanovic Z (2011) Awareness during general anaesthesia--implications of explicit intraoperative recall. Eur Rev Med Pharmacol Sci 15(9):1085–1089

    CAS  PubMed  Google Scholar 

  118. Shanks AM, Avidan MS, Kheterpal S et al (2015) Alerting thresholds for the prevention of intraoperative awareness with explicit recall: a secondary analysis of the Michigan awareness control study. Eur J Anaesthesiol 32(5):346–353

    Article  PubMed  PubMed Central  Google Scholar 

  119. Zhang Y, Dong YJ, Webster CS et al (2013) The frequency and nature of drug administration error during anaesthesia in a Chinese hospital. Acta Anaesthesiol Scand 57(2):158–164

    Article  CAS  PubMed  Google Scholar 

  120. Cook TM, MacDougall-Davis SR (2012) Complications and failure of airway management. Br J Anaesth 109(1):i68–i85

    Article  PubMed  Google Scholar 

  121. Cascella M, Fiore M, Leone S, Carbone D, Di Napoli R (2019) Current controversies and future perspectives on treatment of intensive care unit delirium in adults. World J Crit Care Med 8(3):18–27

    Article  PubMed  PubMed Central  Google Scholar 

  122. Reshef ER, Schiff ND, Brown EN (2009) A neurologic examination for Anesthesiologists: assessing arousal level during induction, maintenance, and emergence. Anesthesiology 130:462

    Article  Google Scholar 

  123. Behne M, Wilke HJ, Harder S (1999) Clinical pharmacokinetics of sevoflurane. Clin Pharmacokinet 36:13–26

    Article  CAS  PubMed  Google Scholar 

  124. Antognini JF, Schwartz K (1993) Exaggerated anesthetic requirements in the preferentially anesthetized brain. Anesthesiology 79:1244

    Article  CAS  PubMed  Google Scholar 

  125. Wang J, Zhang L, Huang Q et al (2017) Monitoring the end-tidal concentration of sevoflurane for preventing awareness during anesthesia (MEETS--PANDA): a prospective clinical trial. Int J Surg 41:44–49

    Article  PubMed  Google Scholar 

  126. Avidan MS, Jacobsohn E, Glick D et al (2011) BAG-RECALL research group. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med 365(7):591–600

    Article  CAS  PubMed  Google Scholar 

  127. Avidan MS, Zhang L, Burnside BA et al (2008) Anesthesia awareness and the Bispectral index. N Engl J Med 358:1097–1108

    Article  CAS  PubMed  Google Scholar 

  128. Messina AG, Wang M, Ward MJ et al (2016) Anaesthetic interventions for prevention of awareness during surgery. Cochrane Database Syst Rev 10(10):CD007272. https://doi.org/10.1002/14651858.CD007272

    Article  PubMed  Google Scholar 

  129. Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on monitoring during anaesthesia. Available at: http://www.anzca.edu.au/documents/ps18-2015-guidelineson-monitoring-during-anaesthe.pdf. Updated December 2015. Accessed 8 June 2019

  130. Checketts MR, Alladi R, Ferguson K et al (2016) Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 71:85–93

    Article  CAS  PubMed  Google Scholar 

  131. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N (2014) Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev (6):CD003843

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istituto Nazionale, Tumori - IRCCS - Fondazione Pascale, Napoli, Italy

    Marco Cascella

Authors
  1. Marco Cascella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Cascella .

Editor information

Editors and Affiliations

  1. Istituto Nazionale, Tumori - IRCCS - Fondazione Pascale, Napoli, Italy

    Marco Cascella

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Science+Business Media, LLC, part of Springer Nature

About this protocol

Check for updates. Verify currency and authenticity via CrossMark

Cite this protocol

Cascella, M. (2020). The Challenge of Accidental Awareness During General Anesthesia. In: Cascella, M. (eds) General Anesthesia Research. Neuromethods, vol 150. Humana, New York, NY. https://doi.org/10.1007/978-1-4939-9891-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-9891-3_1

  • Published:

  • Publisher Name: Humana, New York, NY

  • Print ISBN: 978-1-4939-9890-6

  • Online ISBN: 978-1-4939-9891-3

  • eBook Packages: Springer Protocols

Publish with us

Policies and ethics

Search

Navigation