Awareness and recall during general anesthesia. Facts and feelings

Experiences of awareness and recall during general anesthesia can be most distressing for patients. To obtain relevant information, the authors systematically interviewed patients in whom awareness during surgery had occurred, and questioned them about their experiences.

Twenty-six patients, referred by colleagues, described the facts and feelings they had experienced during the period of awareness, and whether these had had any consequences. Available anesthetic records were independently judged by three experienced anesthesiologists for relevant parameters.

Auditory perception and the sensation of paralysis were most frequently mentioned, followed by the sensation of pain. Patients' feelings were mostly related to anxiety, panic, powerlessness, and helplessness. Eighteen patients (70%) experienced unpleasant aftereffects, including sleep disturbances, dreams and nightmares, and flashbacks and anxiety during the day. Only nine patients (35%) had informed their anesthesiologists about what had taken place. Twelve anesthetic records were assessed. In three, the occurrence of awareness had been indicated, while, in a fourth, it was noted that an amnesic drug had been given at a moment of increased blood pressure. Experienced anesthesiologists were unable to reliably distinguish awareness cases from matched controls when judging the records.

Details recalled from the period of awareness correspond with data from the literature. The anesthesiologist's role in discussing, and dealing with, traumatic experiences related to anesthesia may be of great importance. The hand-written anesthetic record is of limited value in retrospectively explaining why awareness and recall have occurred.