Awareness and recall during general anesthesia

Abstract

Anesthesia awareness is defined as both consciousness and recall of surgical events. New research has been conducted out to test this phenomenon. However, testing methods have not proven reliable, including those using devices based on electroencephalographic techniques to detect and prevent intraoperative awareness. The limitations of a standard intraoperative brain monitor reflect our insufficient understanding of consciousness. Moreover, patients who experience an intraoperative awareness can develop serious post-traumatic stress disorders that should not be overlooked. In this review, we introduce the incidence of intraoperative awareness during general anesthesia and discuss the mechanisms of consciousness, as well as risk factors, various monitoring methods, outcome and prevention of intraoperative awareness.

What should I tell my patient? Disclosure in anaesthesiology: difficulties, requirements, guidelines and suggestions

“…Your patient is a young man who had impacted wisdom teeth removed under GA. As usual, you used a totally intravenous (TIVA) technique combined with non-depolarising relaxants, and did explain this preoperatively, though you omitted the fact that the incidence of awareness may be higher under TIVA plus relaxants, and did not offer an alternative. 20 Neither did you mention the possibility of awareness during GA (in one study, 25/19 575 cases or 1-2/1 000, plus 45 possibly aware 21 ).…”

Effects of different methods of general anesthesia on intraoperative awareness in surgical patients

“…Intraoperative awareness, also named general anesthesia awareness with recall, is described as postoperative recall of the consciousness and events during the general anesthesia. [ 1 ] Despite of the low occurrence rate, intraoperative awareness is a severe complication of anesthesia that may significantly influence the cognitive and psychological functions of the patients, even causing post-traumatic stress disorder (PTSD). [ 2 , 3 ] Until now, the commonly used methods for intraoperative awareness monitoring include depth of anesthesia monitoring and brain-function monitoring.…”

Mechanisms underlying brain monitoring during anesthesia: limitations, possible improvements, and perspectives

“…Despite substantial advances in our understanding of both neuroscientific and pharmacodynamic aspects of anesthetics, we do not yet have an overall picture of what happens to the brain during GA [ 1 ]. Consequently, anesthesiologists often refer to landmarks to induce narcosis correctly, avoiding a deeper state of anesthesia that can cause postoperative cognitive disorders, other postoperative complications, morbidity [ 2 ], and sudden emergencies that carry an increased risk of anesthesia awareness (AA) [ 3 4 ]. These points of reference encompass clinical and instrumental parameters, including the monitoring of ventilator parameters and anesthesia gas delivery.…”