The Study of Postoperative Recall in Patients under Total Intravenous Anesthesia

The incidence of postoperative recall under total intravenous anesthesia (TIVA) is not yet fully established. Avoidance of inhalational agent is a known risk factor for awareness. In addition, lack of reliable technique to monitor drug concentration needed for adequate depth of anesthesia makes TIVA challenging. Hence, we intend to evaluate our standard anesthesia practice for postoperative recall.

This questionnaire-based observational study was done over the period of 2 years. We enrolled 1080 adult (American Society of Anesthesiologists physical status Class I or II) patients undergoing TIVA for Endoscopic retrograde cholangiopancreatography (ERCP). All patients received fentanyl, midazolam and propofol-based anesthesia. Manual boluses of propofol were given to achieve adequate sedation. (Ramsay sedation scale of 5) in accordance with clinical signs as judged by the primary anesthesiologist. Postoperatively within 12-24 h, patients were assessed for recall using Brice questionnaire. Primary outcome was number of patients reporting postoperative recall in the Brice interview. Secondary outcome was the incidence of dreaming.

On postoperative interview, none of the patients reported awareness. 12.5% of patients had dreams which were pleasant. None of the dreams was unpleasant. The worst thing about surgery was pain.

Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.