Skip to main content
SpringerLink
Log in

Awareness During General Anaesthesia

Extent of the Problem and Approaches to Prevention

  • Disease Management
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Awareness during general anaesthesia is still a remarkable problem in modern anaesthetic practice. Fortunately, the incidence of awareness with explicit recall of severe pain is low, with a frequency of fewer than 1 event in 3000 anaesthetic episodes. For modern routine anaesthesia the incidence of explicit recall of intraoperative perception is only slightly higher, at about 1 event in 1000 procedures. General anaesthesia for caesarean section, cardiac operations, acute trauma management or bronchoscopy seems to carry a higher risk of intraoperative awareness. The incidence of subconscious awareness with implicit recall of auditory perception, and of amnesic but conscious awareness, is methodologically very hard to assess but can be as high as 100%, depending on the anaesthetic regimen used.

The highest incidence of intraoperative awareness is associated with the use of specifically acting, mostly receptor-mediated drugs, such as opioids, benzodiazepines or the weak anaesthetic nitrous oxide, given alone or in combination. In contrast, volatile anaesthetics such as halothane, enflurane, isoflurane, sevoflurane and desflurane, as well as potent intravenous anaesthetics such as methohexital, thiopental, etomidate and propofol in appropriate concentrations, successfully block any intraoperative perceptions. Volatile anaesthetics offer the advantage that the concentration of the drug is easily controlled by monitoring end-expiratory gas concentrations. On the other hand, sophisticated dosage strategies for the use of intravenous agents, for example propofol and alfentanil, offer the chance to achieve an incidence of awareness during total intravenous anaesthesia as low as that seen for volatile anaesthetics.

Constant attention to the possibility of awareness, along with an appropriate monitoring of the depth of the anaesthesia, helps to avoid awareness. Although observing clinical signs is the most common method, it is a very poor indicator for intraoperative awareness. Electrophysiological measurements can help to guide the anaesthesiologist’s decisions. Derived parameters of the raw electroencephalogram, such as the spectral edge frequency, may help to assess relevant individual pharmacokinetic or pharmacodynamic properties for the anaesthetics used. Midlatency auditory evoked potentials seem to be a promising measure for assessing depth of anaesthesia, although further studies are needed to confirm their clinical usefulness.

Any instance of intraoperative awareness should be treated sympathetically and seriously by the responsible anaesthesiologist. Aid should be provided to the patients to minimise long lasting psychological sequelae. In the worst case a post-traumatic stress disorder syndrome may develop, requiring intensive psychological or even psychiatric treatment for the patient.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kissin I. General anesthetic action: an obsolete notion? Anesth Analg 1993; 76: 215–8

    Article  PubMed  CAS  Google Scholar 

  2. Schwender D, Kunze-Kronawitter H, Dietrich P, et al. Conscious awareness during anesthesia: patient’s perceptions, emotions, cognition and reaction. Br J Anaesth 1998; 80(2): 133–9

    Article  PubMed  CAS  Google Scholar 

  3. Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Anesthesiology 1993; 79: 454–64

    Article  PubMed  CAS  Google Scholar 

  4. Evans JM. Patients’ experiences of awareness during general anaesthesia. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 184–92

    Google Scholar 

  5. Macleod AD, Maycock E. Awareness during anaesthesia and post traumatic stress disorder. Anaesth Intensive Care 1992: 20(3): 378–82

    PubMed  CAS  Google Scholar 

  6. Blacher RS. On awakening paralyzed during surgery. JAMA 1975; 234: 67–8

    Article  PubMed  CAS  Google Scholar 

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Press, 1987: 247

    Google Scholar 

  8. Pinsker MC. Anesthesia: a pragmatic construct. Anesth Analg 1986; 65: 819–20

    Article  PubMed  CAS  Google Scholar 

  9. Bennett HL. Learning and memory in anaesthesia. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 132–9

    Google Scholar 

  10. Papper EM. The state of consciousness: some humanistic considerations. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 10–1

    Google Scholar 

  11. Prys-Roberts C. Anaesthesia: a practical or impractical construct [editorial]? Br J Anaesth 1987; 59: 1341–5

    Article  PubMed  CAS  Google Scholar 

  12. Vickers MD. Detecting consciousness by clinical means. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 12–7

    Google Scholar 

  13. Jones JG. Perception and memory during general anaesthesia. Br J Anaesth 1994; 73: 31–7

    Article  PubMed  CAS  Google Scholar 

  14. Operations without pain. Lancet 1847; I: 77

  15. Griffith HR, Johnson GE. The use of curare in general anaesthesia. Anesthesiology 1942; 3: 418

    Article  CAS  Google Scholar 

  16. Pedersen T, Johansen H. Serious morbidity attributable to anaesthesia, consideration for prevention. Anaesthesia 1989; 44: 504–8

    Article  PubMed  CAS  Google Scholar 

  17. Lyons G, MacDonald R. Awareness during caesarean section. Anaesthesia 1991; 46: 62–4

    Article  PubMed  CAS  Google Scholar 

  18. Bergstrom H, Bernstein K. Psychic reactions after analgesia with nitrous oxide for caesarean section. Lancet 1968; II: 541-2

    Google Scholar 

  19. Crawford JS. Awareness during operative obstetrics under general anaesthesia. Br J Anaesth 1971; 43: 179–82

    Article  PubMed  CAS  Google Scholar 

  20. Goldmann L, Shah MV, Hebden MW. Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intraoperative suggestion and operating room conversation. Anaesthesia 1987; 42: 596–603

    CAS  Google Scholar 

  21. Garfield JM, Garfield FB, Stone JG, et al. A comparison of psychologic responses to ketamine and thiopental-nitrous oxide-halothane anesthesia. Anesthesiology 1972; 36: 329–35

    Article  PubMed  CAS  Google Scholar 

  22. Harris TJB, Hetherington RR. Dreaming associated with anaesthesia: the influence of morphine premedication and two volatile adjuvants. Br J Anaesth 1971; 43: 172–8

    Article  PubMed  CAS  Google Scholar 

  23. Browne RA, Catton DV. Awareness during anaesthesia: a comparison of anaesthesia with nitrous-oxide-oxygen and nitrous-oxide-oxygen with Innovar. Can Anaesth Soc J 1973; 20: 763–8

    Article  PubMed  CAS  Google Scholar 

  24. Wilson J, Turner DJ. Awareness during caesarean section under general anaesthesia. BMJ 1969; 1: 280–3

    Article  PubMed  CAS  Google Scholar 

  25. Utting JE. Awareness: clinical aspects. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 174–6

    Google Scholar 

  26. Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970; 42: 535–42

    Article  PubMed  CAS  Google Scholar 

  27. Ranta S, Jussila J, Hynynen M. Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist. Acta Anaesthesiol Scand 1996; 40: 554–60

    Article  PubMed  CAS  Google Scholar 

  28. Hutchinson R. Awareness during surgery. Br J Anaesth. 1960; 33: 463–9

    Article  Google Scholar 

  29. Phillips AA, McLean RF, Devitt JH. Recall of intraoperative events after general anesthesia and cardiopulmonary bypass. Can J Anaesth 1993; 40: 922–6

    Article  PubMed  CAS  Google Scholar 

  30. Sandin R, Nordstrom O. Awareness during total IV anaesthesia. Br J Anaesth 1993; 71: 782–7

    Article  PubMed  CAS  Google Scholar 

  31. Liu WHD, Thorp TAS, Graham SG, et al. Incidence of awareness with recall during general anaesthesia. Anaesthesia 1991; 46: 435–7

    Article  PubMed  CAS  Google Scholar 

  32. Jordening H, Pedersen T. The incidence of conscious awareness in a general population of anaesthetized patients. Anesthesiology 1991; 75 Suppl. : A1055

    Article  Google Scholar 

  33. Agarwal G, Sikh SS. Awareness during anaesthesia — a prospective study. Br J Anaesth 1977; 49: 835–8

    Article  PubMed  CAS  Google Scholar 

  34. Vaughan RW, Stephan CR. Abdominal and thoracic surgery in adults with ketamine, nitrous oxide and d-tubocurarine. Anesth Analg 1974; 53: 271–80

    PubMed  CAS  Google Scholar 

  35. Moir DD. Anaesthesia for caesarean section: an evaluation of method using low concentrations of halothane and 50 per cent of oxygen. Br J Anaesth 1970; 42: 136–42

    Article  PubMed  CAS  Google Scholar 

  36. Eisele V, Weinreich A, Bartle S. Perioperative awareness and recall. Anesth Analg 1976; 55: 513–8

    Article  PubMed  CAS  Google Scholar 

  37. Mc Leskey CH, Aitkenhead AR. Prevention of awareness. ASA Newsl 1994; 58: 16–21

    Google Scholar 

  38. Cormac RS. Awareness during surgury: a new approach. Br J Anaesth 1979; 51(11): 1051–4

    Article  Google Scholar 

  39. Bogod DG, Orton JK, Yau HM, et al. Detecting awareness during general anaesthetic caesarean section. Anaesthesia 1990; 45: 297–84

    Article  Google Scholar 

  40. Bogetz MS, Katz JA. Recall of surgery for major trauma. Anesthesiology 1984; 61: 6–9

    PubMed  CAS  Google Scholar 

  41. Moore JK, Seymour AH. Awareness during brochoscopy. Ann R Coll Surg 1987; 69: 45–7

    CAS  Google Scholar 

  42. Andrade J, Munglani R, Jones JG, et al. Cognitive performance during anaesthesia. Conscious Cogn 1994; 3: 148–65

    Article  Google Scholar 

  43. Konieczko KM, Thornton C, Newton DE, et al. Psychological testing and memory during sub-MAC isoflurane anaesthesia. In: Bonke B, Fitch W, Millar K, editors. Memory and awareness in anaesthesia. Amsterdam/Lisse: Swets & Zeitlinger, 1990: 90–6

    Google Scholar 

  44. Newton DEF, Thornton C, Konieczko K. Levels of consciousness in volunteers breathing sub-MAC concentrations of isoflurane. Br J Anaesth 1990; 65: 609–15

    Article  PubMed  CAS  Google Scholar 

  45. Cheek DB. Unconscious perception of meaningful sounds during surgical anesthesia as revealed under hypnosis. Am J Clin Hypn 1959; 1: 101–13

    Article  Google Scholar 

  46. Levinson BW. States of awareness during general anaesthesia. Br J Anaesth 1965; 37: 544–6

    Article  PubMed  CAS  Google Scholar 

  47. Cheek DB. Can surgical patients react to what they hear under anaesthesia? Nurse Anesth 1965; 33: 30–6

    Google Scholar 

  48. Millar K, Watkinson N. Recognition of words presented during general anaesthesia. Ergonomics 1983; 26: 585–94

    Article  PubMed  CAS  Google Scholar 

  49. Jelicic M, Bonke B, Appelboom DK. Indirect memory for words presented during anesthesia [letter]. Lancet 1990; 336(8709): 249

    Article  PubMed  CAS  Google Scholar 

  50. Roorda-Hrdlickova V, Wolters G, Bonke B, et al. Unconscious perception during general anaesthesia, demonstrated by an implicit memory task. In: Bonke B, Fitch W, Millar K, editors. Memory and awareness in anaesthesia. Amsterdam/Lisse: Swets & Zeitlinger, 1990: 150–5

    Google Scholar 

  51. Block RI, Ghoneim MM, Sum Ping ST, et al. Human learning during general anaesthesia and surgery. Br J Anaesth 1991; 66: 170–8

    Article  PubMed  CAS  Google Scholar 

  52. Bonnebakker AE, Bonke B, Klein J. Information processing during general anaesthesia: evidence for unconscious memory. In: Bonke B, Bovil JG, Moerman N, editors. Memory and awareness in anaesthesia. 3rd ed. Amsterdam: Assen, 1996: 26–35

    Google Scholar 

  53. Bethune DW, Ghosh S, Gray B, et al. Learning during general anaesthesia: implicit recall after methohexitone or propofol infusion. Br J Anaesth 1992; 69: 197–9

    Article  PubMed  CAS  Google Scholar 

  54. Bonke B, Schmitz PIM, Verhage F, et al. Clinical study of socalled unconscious perception during general anaesthesia. Br J Anaesth 1986; 58: 957–64

    Article  PubMed  CAS  Google Scholar 

  55. Evans C, Richardson PH. Improved recovery and reduced postoperative stay after therapeutic suggestions during general anaesthesia. Lancet 1988; II: 491–3

    Article  Google Scholar 

  56. McLintock TTC, Aitken H, Downie CFA, et al. Postoperative analgesic requirements in patients exposed to positive intraoperative suggestions. BMJ 1990; 301: 788–90

    Article  PubMed  CAS  Google Scholar 

  57. Bennett HL, Davis HS, Giannini JA. Non-verbal response to intraoperative conversation. Br J Anaesth 1985; 57(2): 174–9

    Article  PubMed  CAS  Google Scholar 

  58. Bailey AR, Jones JG. Patients’ memories of events during general anaesthesia. Anaesthesia 1997; 52: 460–76

    Article  PubMed  CAS  Google Scholar 

  59. Millar K. Recall, recognition and implicit memory for intraanaesthetic events. In: Jones JG, editor. Clinical anaesthesiology. Vol. 3, No. 3. London: Bailliere Tindall, 1989: 487–510

    Google Scholar 

  60. Hughes JA, Sanders LD, Dunne JA, et al. Reducing smoking: the effect of suggestion during general anaesthesia on postoperative smoking habits. Anaesthesia 1994; 49: 126–8

    Article  PubMed  CAS  Google Scholar 

  61. Dwyer R, Bennett HL, Eger II EI, et al. Effects of isoflurane and nitrous oxide in subanesthetic concentrations on memory and responsiveness in volunteers. Anesthesiology 1992; 77: 888–98

    Article  PubMed  CAS  Google Scholar 

  62. Block RI, Ghoneim MM, Sum Ping ST, et al. Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia. Anesthesiology 1991; 75: 746–55

    Article  PubMed  CAS  Google Scholar 

  63. Westmoreland CL, Sebel PS, Winograd E, et al. Indirect memory during anesthesia — the effect of midazolam. Anesthesiology 1993; 78: 237–41

    Article  PubMed  CAS  Google Scholar 

  64. Cork RC, Kihlstrom JF, Schacter DL. Absence of explicit or implicit memory in patients anesthetized with sufentanil/nitrous oxide. Anesthesiology 1992; 76: 892–8

    Article  PubMed  CAS  Google Scholar 

  65. Liu WDH, Standen PJ, Aitkenhead AR. The influence of intraoperative therapeutic suggestions on postoperative recovery after surgical repair of fractured neck of femur. In: Sebel PS, Bonke B, Winograd E, editors. Memory and awareness in anaesthesia. Englewood Cliff (NY): Prentice Hall, 1993: 162–5

    Google Scholar 

  66. Van Leeuwen BL, Van Der Laan WH, Sebel PS, et al. Therapeutic suggestion has no effect on postoperative morphine requirements. In: Bonke B, Bovill JG, Moerman N, editors. Memory and awareness in anaesthesia. 3rd ed. Assen: Van Gorcum, 1996: 235–44

    Google Scholar 

  67. Schwender D, Kaiser A, Klasing S, et al. Mid-latency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 1994; 80: 493–501

    Article  PubMed  CAS  Google Scholar 

  68. Ghoneim MM, Block RI. Learning and consciousness during general anesthesia. Anesthesiology 1992; 76: 279–305

    Article  PubMed  CAS  Google Scholar 

  69. Tunstall ME. Detecting wakefulness during general anaesthesia for caesarean section. BMJ 1977; 1(6072): 1321

    Article  PubMed  CAS  Google Scholar 

  70. Tunstall ME. The reduction of amnesic wakefulness during caesarean section. Anaesthesia 1979; 34: 316–9

    Article  PubMed  CAS  Google Scholar 

  71. Schultetus RR, Hill CR, Dharamraj CM, et al. Wakefulness during caesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined. Anesth Analg 1986; 65: 723–8

    Article  PubMed  CAS  Google Scholar 

  72. Russell IF. Balanced anaesthesia: does it anaesthetise? Anesth Analg 1985; 64: 941–2

    Article  PubMed  CAS  Google Scholar 

  73. Russell IF. Midazolam-alfentanil: an anaesthetic? An investigation using the isolated forearm technique. Br J Anaesth 1993; 70(1): 42–6

    Article  PubMed  CAS  Google Scholar 

  74. Vuylsteke A, Djaiani G, Kneeshaw J, et al. Amnesic awareness during cardiac surgery: comparison of three different anaesthetic regimens [abstract]. Br J Anaesth 1996; 76: A81

    Article  Google Scholar 

  75. Russell IF, Wang M. Absence of memory for intraoperative information during surgery under adequate general anaesthesia. Br J Anaesth 1997; 78(1): 3–9

    Article  PubMed  CAS  Google Scholar 

  76. Smith WD, Dutton RC, Smith NT. Measuring the performance of anaesthetic depth indicators. Anesthesiology 1996; 84: 38–51

    Article  PubMed  CAS  Google Scholar 

  77. Tantisira B, McKenzie R. Awareness during laparoscopy under general anaesthesia: a case report. Anesth Analg 1974; 53: 373–4

    Article  PubMed  CAS  Google Scholar 

  78. Hug Jr CC. Does opioid ‘anesthesia’ exist? Anesthesiology 1990; 73: 1–4

    Article  PubMed  Google Scholar 

  79. Farnsworth GM. Enflurane and the incidence of awareness in caesarean section [letter]. Anaesthesia 1978; 33: 553

    Article  PubMed  CAS  Google Scholar 

  80. Tunstall ME, Sheikh A. Comparison of 1.5% enflurane with 1.25% isoflurane in oxygen for caesarean section: avoidance of awareness without nitrous oxide. Br J Anaesth 1989; 62: 138–43

    Article  PubMed  CAS  Google Scholar 

  81. Wilson SL, Vaughan RW, Stephen CR. Awareness, dreams and hallucinations associated with general anaesthesia. Anesth Analg 1975; 54: 609–17

    Article  PubMed  CAS  Google Scholar 

  82. Schwender D, Klasing S, Daunderer M, et al. Wachzustände während allgemeinanästhesie — definition, häufigkeit, klinische relevanz, Ursachen, Vermeidung und mediokolegale aspekte. Anaesthesist 1995; 44: 743–54

    Article  PubMed  CAS  Google Scholar 

  83. Bailey PL, Stanley TH. Narcotic intravenous anesthetics. In: Miller RD, editors. Anesthesia. New York (NY): Churchill Livingstone, 1990: 281–366

    Google Scholar 

  84. Heneghan CP. Clinical and medicolegal aspects of conscious awareness during anesthesia. In:Jones JG, editor. Depth of anesthesia. Boston (MA): Little, Brown and Company, 1993: 1–12

    Google Scholar 

  85. Heier T, Steen PA. Awareness in anaesthesia. Acta Anaesthesiol Scand 1996; 40: 1073–86

    Article  PubMed  CAS  Google Scholar 

  86. Nordstrom O, Engstrom M, Persson S, et al. Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade. Acta Anaesthesiol Scand 1997; 41: 978–84

    CAS  Google Scholar 

  87. Heier T, Steen PA. Assessment of anaesthesia depth. Acta Anaesthesiol Scand 1996; 40: 1087–100

    Article  PubMed  CAS  Google Scholar 

  88. Miller RD, Eger EI, Way WL, et al. Comparative neuromuscular effects of forane and halothane alone and in combination with d-tubocurarine in man. Anesthesiology 1971; 35: 38–42

    Article  PubMed  CAS  Google Scholar 

  89. Tammisto T, Olkkola KT. Neuromuscular block versus muscle relaxation: clinical applications of the difference. Finnanesth 1992; 18: 11–8

    Google Scholar 

  90. Tammisto T, Olkkola KT. Dependence of the adequacy of muscle relaxation on the degree of neuromuscular block and depth of enflurane anesthesia during abdominal surgery. Anesth Analg 1995; 80: 543–7

    PubMed  CAS  Google Scholar 

  91. Viby-Mogensen J. Neuromuscular monitoring. In: Miller RD, editor. Anaesthesia. New York (NY): Churchill Livingstone, 1990: 1209–26

    Google Scholar 

  92. Guedel AE. Inhalation anesthesia: a fundamental guide. New York (NY): Macmillan, 1937: 61

    Google Scholar 

  93. Evans JM. Clinical signs and autonomic responses. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 18–34

    Google Scholar 

  94. Russell IF. Conscious awareness during general anaesthesia: relevance of autonomic signs and isolated arm movements as guides to depth of anaesthesia. In: Jones JG, editor. Clinical anaesthesiology. Vol. 3, No. 3. London: Bailliere Tindall, 1989: 511–32

    Google Scholar 

  95. Schwender D, Faber-Züllig E, Klasing S, et al. Motor signs of wakefulness during general anaesthesia with propofol, isoflurane and flunitrazepam/fentanyl and mid-latency auditory evoked potentials. Anaesthesia 1994; 49: 476–84

    Article  PubMed  CAS  Google Scholar 

  96. Pacelli GD, Cullen BF, Starr A. Effects of thiopental and ketamine on middle latency auditory evoked responses [abstract]. Anesthesiology 1983; 59(3): A366

    Google Scholar 

  97. Clark DL, Rosner BS. Neurophysiologic effects of general anesthetics: I. The electroencephalogram and sensory evoked responses in man. Anesthesiology 1973; 38(6): 564–80

    CAS  Google Scholar 

  98. Stanski DR. Monitoring of depth of anaesthesia. In: Miller RD, editor. Anesthesia. NewYork: Churchill Livingstone, 1994: 1127–59

    Google Scholar 

  99. Scott JC, Ponganis KV, Stanski DR. EEG quantisation of narcotic effect: The comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62: 234–41

    Article  PubMed  CAS  Google Scholar 

  100. Homer TD, Stanski DR. The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology 1985; 62: 714–24

    Article  PubMed  CAS  Google Scholar 

  101. Hudson RJ, Stanski DR, Saidman LJ, et al. A model for studying depth of anaesthesia and acute tolerance to thiopental. Anesthesiology 1983; 59: 301–8

    Article  PubMed  CAS  Google Scholar 

  102. Chi OZ, Sommer W, Jasaitis D. Power spectral analysis of eeg during sufentanil infusion in humans. Can J Anaesth 1991; 38(3): 275–80

    Article  PubMed  CAS  Google Scholar 

  103. Smith NT, Dec-Silver H, Sanford TJ, et al. EEGs during high-dose fentanyl-, sufentanil-, or morphine-oxygen anesthesia. Anesth Analg 1984; 63: 386–93

    PubMed  CAS  Google Scholar 

  104. Arden JR, Holley FO, Stanski DR. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Anesthesiology 1986; 65: 19–27

    Article  PubMed  CAS  Google Scholar 

  105. Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1986; 240(1): 159–66

    Google Scholar 

  106. Rampil IJ, Matteo RS. Changes in EEG spectral edge frequency correlate with the hemodynamic response to laryngoscopy and intubation. Anesthesiology 1987; 67: 139–42

    Article  PubMed  CAS  Google Scholar 

  107. Schwilden H, Schüttler J, Stoeckel H. Quantisation of the eeg and pharmacodynamic modelling of hypnotic drugs: etomidate as an example. Eur J Anaesth 1985; 2: 121–31

    CAS  Google Scholar 

  108. Schwilden H, Schüttler J, Stoeckel H. Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans. Anesthesiology 1987; 67: 341–7

    Article  PubMed  CAS  Google Scholar 

  109. Schüttler J, Schwilden H, Stoeckel H. Pharmacokinetic and pharmacodynamic modelling of propofol (‘diprivan’) in volunteers and surgical patients. Postgrad Med J 1985; 61 Suppl. 3: 53–4

    PubMed  Google Scholar 

  110. Schüttler J, Stanski DR, White PF, et al. Pharmacodynamic modeling of the EEG effects of ketamine and its enantiomers in man. J Pharmacokinet Biopharm 1987; 15(3): 241–53

    PubMed  Google Scholar 

  111. Schwilden H, Stoeckel H. Closed-loop feedback controlled administration of alfentanil during alfentanil-nitrous oxide anaesthesia. Br J Anaesth 1993; 70: 389–93

    Article  PubMed  CAS  Google Scholar 

  112. Schwilden H, Stoeckel H. Effective therapeutic infusions produced by closed-loop feedback control of methohexital administration during total intravenous anesthesia with fentanyl. Anesthesiology 1990; 73: 225–9

    Article  PubMed  CAS  Google Scholar 

  113. Schwilden H, Stoeckel H, Schüttler J. Closed-loop feedback control of propofol anaesthesia by quantitative EEG analysis in humans. Br J Anaesth 1989; 62(3): 290–6

    Article  PubMed  CAS  Google Scholar 

  114. Drummond JC, Brann CA, Perkins DE, et al. A comparison of median frequency, spectral edge frequency, a frequency band power ratio, total power, and dominance shift in the determination of depth of anesthesia. Acta Anaesthesiol Scand 1991; 35: 693–9

    Article  PubMed  CAS  Google Scholar 

  115. Dwyer R, Rampil IJ, Eger II EI, et al. The electroencephalogram does not predict depth of isoflurane anesthesia. Anesthesiology 1994; 81(2): 403–9

    Article  PubMed  CAS  Google Scholar 

  116. Sebel PS, Bowles SM, Saini V, et al. EEG bispectrum predicts movement during thiopental/isoflurane anesthesia. J Clin Monit 1995; 11(2): 83–91

    Article  PubMed  CAS  Google Scholar 

  117. Sigl J, Chamoun N. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit 1994; 10: 392–404

    Article  PubMed  CAS  Google Scholar 

  118. Vernon JM, Lang E, Sebel PS, et al. Prediction of movement using bispectral electroencephalographic analysis during propofol/alfentanil or isoflurane/alfentanil anaesthesia. Anesth Analg 1995; 80: 780–5

    PubMed  CAS  Google Scholar 

  119. Flaishon R, Windsor A, Sigl J, et al. Recovery of consciousness after thiopental or propofol. Anesthesiology 1997; 86: 613–9

    Article  PubMed  CAS  Google Scholar 

  120. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery of ambulatory anesthesia. Anesthesiology 1997; 87: 842–8

    Article  PubMed  CAS  Google Scholar 

  121. Sebel PS, Lang E, Rampil IJ, et al. A multicenter study of bispectral analysis for monitoring anaesthetic effect. Anesth Analg 1997; 84: 891–9

    PubMed  CAS  Google Scholar 

  122. Deiber MP, Ibanez V, Fischer C, et al. Sequential mapping favours the hypothesis of distinct generators for Na and Pa middle latency auditory evoked potentials. Electroencephalogr Clin Neurophysiol 1988; 71: 187–97

    Article  PubMed  CAS  Google Scholar 

  123. Picton TW, Hillyard SA, Krausz HI, et al. Human auditory evoked potentials. I: evaluation of components. Electroencephalogr Clin Neurophysiol 1974; 36: 179–90

    Article  CAS  Google Scholar 

  124. Kaga K, Hink RF, Shinoda Y, et al. Evidence for a primary cortical origin of a middle latency auditory evoked potential in cats. Electroencephalogr Clin Neurophysiol 1980; 50: 254–66

    Article  PubMed  CAS  Google Scholar 

  125. Scherg M, Volk SA. Frequency specificity of simultaneously recorded early and middle latency auditory evoked potentials. Electroencephalogr Clin Neurophysiol 1983; 56: 443–52

    Article  PubMed  CAS  Google Scholar 

  126. Woods DL, Clayworth CC, Simpson GV, et al. Generators of middle- and long-latency auditory evoked potentials: implications from studies of patients with bitemporal lesions. Electroencephalogr Clin Neurophysiol 1987; 68: 132–48

    Article  PubMed  CAS  Google Scholar 

  127. Scherg M, von Cramon D. Evoked dipole source potentials of the human auditory cortex. Electroencephalogr Clin Neurophysiol 1986; 65: 344–60

    Article  PubMed  CAS  Google Scholar 

  128. Picton TW, Hillyard SA. Human auditory evoked potentials. II: effects of attention. Electroencephalogr Clin Neurophysiol 1974; 36: 191–9

    CAS  Google Scholar 

  129. Thornton C, Heneghan CP, James MF, et al. Effects of halothane or enflurane with controlled ventilation on auditory evoked potentials. Br J Anaesth 1984; 56: 315–23

    Article  PubMed  CAS  Google Scholar 

  130. Thornton C, Heneghan CP, Navaratnarajah M, et al. Effect of etomidate on the auditory evoked response in man. Br J Anaesth 1985; 57: 554–61

    Article  PubMed  CAS  Google Scholar 

  131. Madler C, Keller I, Schwender D, et al. Sensory information processing during general anaesthesia: effect of Isoflurane on auditory evoked neuronal oscillations. Br J Anaesth 1991; 66: 81–7

    Article  PubMed  CAS  Google Scholar 

  132. Schwender D, Klasing S, Conzen P, et al. Effects of anaesthesia with increasing endexpiratory concentrations of sevoflurane on mid-latency auditory evoked potentials. Anesth Analg 1995; 81: 817–22

    PubMed  CAS  Google Scholar 

  133. Schwender D, Klasing S, Conzen P, et al. Mid-latency auditory evoked potentials during anaesthesia with increasing endexpiratory concentrations of desflurane. Acta Anaesthesiol Scand 1996; 40: 171–6

    Article  PubMed  CAS  Google Scholar 

  134. Thornton C, Heneghan CP, Navaratnarajah M, et al. Selective effect of althesin on the auditory evoked response in man. Br J Anaesth 1986; 58: 422–7

    Article  PubMed  CAS  Google Scholar 

  135. Thornton C, Konieczko KM, Knight AB, et al. Effect of propofol on the auditory evoked response and oesophageal contractility. Br J Anaesth 1989; 63: 411–7

    Article  PubMed  CAS  Google Scholar 

  136. Schwender D, Klasing S, Madler C, et al. Mid-latency auditory evoked potentials and purposeful movements after thiopental bolus injection. Anaesthesia 1994; 49: 99–104

    Article  PubMed  CAS  Google Scholar 

  137. Schwender D, Madler C, Klasing S, et al. Mid-latency auditory evoked potentials and wakefulness during caesarean section. Eur J Anaesth 1995; 12: 171–9

    CAS  Google Scholar 

  138. Thornton C, Barrowcliffe MP, Konieczko KM, et al. The auditory evoked response as an indicator of awareness. Br J Anaesth 1989; 63: 113–5

    Article  PubMed  CAS  Google Scholar 

  139. Newton DE, Thornton C, Konieczko KM, et al. Auditory evoked response and awareness: a study in volunteers at sub-MAC concentrations of isoflurane. Br J Anaesth 1992; 69: 122–9

    Article  PubMed  CAS  Google Scholar 

  140. Schwender D, Daunderer M, Poppel E. Central anaesthetic effect and suppression of auditory information processing during general anaesthesia. Theory Bioscience 1997; 116: 267–72

    Google Scholar 

  141. Thornton C, Newton DE. The auditory evoked response: ameasure of depth of anaesthesia. In: Jones JG, editor. Clinical anaesthesiology. Vol. 3, No. 3. London: Bailliere Tindall, 1989: 559–85

    Google Scholar 

  142. Thornton C. Evoked potentials in anaesthesia. Eur J Anaesth 1991; 8: 89–107

    CAS  Google Scholar 

  143. Plourde G, Boylan JF. The auditory steady state response during sufentanil anaesthesia. Br J Anaesth 1991; 66: 683–91

    Article  PubMed  CAS  Google Scholar 

  144. Plourde G, Picton TW. Human auditory steady-state response during general anesthesia. Anesth Analg 1990; 71: 460–8

    Article  PubMed  CAS  Google Scholar 

  145. Andrade J, Sapsford DJ, Jeevaratnum D, et al. The coherent frequency in the electroencephalogram as an objective measure of cognitive function during propofol sedation. Anesth Analg 1996; 83(6): 1279–84

    PubMed  CAS  Google Scholar 

  146. Munglani J, Andrade J, Sapsford DJ, et al. A measure of consciousness and memory during isoflurane administration: the coherent frequency. Br J Anaesth 1993; 71: 633–42

    Article  PubMed  CAS  Google Scholar 

  147. Aitkenhead AR. Awareness during anaesthesia what should the patient be told? Anaesthesia 1990; 45: 351–2

    Article  PubMed  CAS  Google Scholar 

  148. Aitkenhead AR. Memory and awareness in anesthesia. In: Bonke B, Fitch W, Millar K, editors. Conscious awareness. Amsterdam/Lisse: Sweats & Zeitlinger, 1990: 386–99

    Google Scholar 

  149. Hargrove RL. Awareness: a medicolegal problem. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 149–54

    Google Scholar 

  150. Powers MJ. A lawyer’s view of the problem. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 155–60

    Google Scholar 

  151. Thompson BH. An American legal view. In: Rosen M, Lunn JN, editors. Consciousness, awareness and pain in general anaesthesia. London: Butterworths, 1987: 165–70

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany

    Michael Daunderer & Dierk Schwender

  2. Institut für Anästhesiologie, Ludwig-Maximilians-Universität München, Klinikum Groβlhadern, Marchioninistr. 15, D-81377, Münich, Germany

    Michael Daunderer

Authors
  1. Michael Daunderer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dierk Schwender
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daunderer, M., Schwender, D. Awareness During General Anaesthesia. Mol Diag Ther 14, 173–190 (2000). https://doi.org/10.2165/00023210-200014030-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200014030-00001

Keywords

Search

Navigation