Feasibility of a Multicomponent Protocol to Promote Dreaming during Surgical Anesthesia

Dreaming during anesthesia is common and may have mental health benefits. However, systematic research on its incidence and outcomes in clinical settings remains limited. This study implemented a standardized propofol-based, electroencephalography (EEG)-guided emergence bundle to facilitate a preemergence state conducive to dreaming, integrating it into routine care to assess adherence, dream recall, patient experience, and safety.

In this prospective quality improvement feasibility study, 474 patients undergoing elective surgeries were anesthetized according to a five-element protocol: (1) preinduction verbal priming about dreaming; (2) propofol as emergence anesthetic; (3) EEG (SedLine, Masimo Corporation, USA) monitoring to guide emergence; (4) 10 min or longer of minimized stimulation before emergence; and (5) immediate postemergence interviews regarding dream recall, valence, and subjective sleep quality. In a subset of breast cancer patients (N = 106), preregistered analyses examined postanesthesia recovery unit outcomes.

Of 452 patients interviewed, 69% reported dreaming. Among 57 patients with full adherence to all protocol elements, 93% reported dreaming. Most dreams were positive (86%), with no very negative dreams. Dreamers (mean ± SD, 9.16 ± 1.57) reported higher sleep quality than nondreamers (7.65 ± 2.86; P < 0.001). The protocol was safe, with no intraoperative awareness. Recovery times and analgesic and antiemetic use did not differ between groups. Feasibility was supported by high adherence to most elements (100% for verbal priming and propofol use, greater than or equal to 90% for EEG monitoring, and 95% for immediate interviews), although adherence to the no-stimulation emergence period was low (14%).

This study demonstrates the feasibility of using a standardized anesthetic protocol in real-world clinical setting to facilitate anesthesia dreaming. With full adherence, dream recall rates approached experimental studies. The protocol was safe and linked to positive patient experiences, although dream recall was unrelated to postanesthesia care unit outcomes. These findings align with Enhanced Recovery After Surgery principles and provide a foundation for exploring potential therapeutic applications of anesthesia dreaming.