Awareness under general anesthesia

General anesthesia aims to eliminate patients' awareness of excruciating pain during surgery. Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable. One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs. Awareness experiences frighten patients and impact their implicit and explicit memories in ways that can leave a lifetime of residual emotional and psychological problems ranging from sleep disturbances, nightmares, and daytime anxiety that may subside with time to development of post-traumatic stress disorder. Most anesthetists monitor depth of anesthesia by assessing intraoperative hemodynamic responses to surgical stimuli--an approach questioned by some authors. Several depth-of-anesthesia monitors are available, but there is no ideal monitor that is 100% reliable. This review provides an overview of literature that reports findings associated with the monitoring and occurrence of intraoperative awareness. These studies indicate assessment methods that can be trusted when we provide general anesthesia and what measures can be taken to prevent recall by patients under general anesthesia.