Anesthesia Awareness: When the Mind Is Not Suppressed
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.
KeywordsAwareness during general anesthesia, awareness with explicit recall, intraoperative awareness, anesthesia awareness, anesthetic depth, depth of anesthesia monitor
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.
- Bigelow, HJ. 1846. Insensibility during surgical operations produced by inhalation. Boston Med Surg J 35:309–317.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.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.CrossRefPubMedGoogle 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
- Guedel, A. 1937. Inhalation anaesthesia: a fundamental guide. New York, NY: Macmillan.Google Scholar
- JCAHO. 2004. Preventing and managing the impact of anesthesia awareness. Joint Comm Persp 24(12):10–11.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
- Snow, J.D. 1847. On the inhalation of the vapour of ether in surgical operations. London: John Churchill.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.Google Scholar