Accidental Awareness During General Anesthesia: A One-Year Follow-Up on Incidence, Risk Factors, and Cultural Context...

Accidental awareness during general anesthesia (AAGA) is rare but can lead to psychological distress, including post-traumatic stress disorder (PTSD). Limited data exists from East Asia, where cultural factors may influence symptom expression. This study examined the incidence, contributing factors, and one-year psychological outcomes of AAGA in a Taiwanese tertiary center.

We reviewed 18,976 patients who received general anesthesia at National Taiwan University Hospital in 2020. AAGA cases were identified via routine postoperative interviews and anesthesia record reviews. One year later, follow-up telephone interviews were conducted using the Chinese version of the PTSD Symptom Scale-Interview for DSM-5 (PSS-I-5), along with a culturally adapted emotional experience questionnaire.

Seven patients (0.037%) were classified as definite or possible AAGA. Most events occurred during intubated general anesthesia or propofol sedation. Human errors, such as delayed drug administration or intravenous disconnection, contributed to over half the cases. Of the four patients who completed one-year PTSD screening, none met diagnostic criteria, though two recalled vivid intraoperative experiences and later changed their anesthesia preferences. Cultural factors may have influenced symptom reporting.

Though no PTSD diagnoses were identified, AAGA had lasting effects on patient preferences. The findings highlight the need for structured follow-up and culturally sensitive care to better recognize and manage AAGA-related distress.