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Awareness

  • Tomas Carvajal
  • Lopa Misra
  • Michael Molloy
  • Veerandra KoyyalamudiEmail author
Chapter

Abstract

Awareness and recall under general anesthesia generally occurs where there is an imbalance between the depth of anesthesia being provided and the degree of stimulus to which a patient is being exposed. Although the incidence of awareness or recall may be reduced with preventive measures, it may not possible to completely obviate the risk. The incidence of awareness and recall under general anesthesia ranges from 1 to 2/1000 general anesthetics with a higher incidence of cardiac, obstetric, emergency, and trauma surgery. Studies have not consistently shown if age is a factor in the risk of intraoperative awareness though the female sex seems to be more affected. Anesthetic factors which may present a higher risk include prolonged and difficult intubation, total intravenous anesthesia, use of neuromuscular blocking drugs, avoidance of premedication with benzodiazepines, anesthesia provider errors, and anesthesia equipment failure. Clinical signs of awareness are unreliable in detection, and studies have shown contrasting results on the effectiveness of processed electroencephalogram monitoring. Studies have shown a dose-dependent suppression of mid-latency auditory evoked potentials with both intravenous and inhalation anesthetics leading to the notion that mid-latency auditory evoked potential measurements could be a useful depth of monitoring tool. The effectiveness of mid-latency auditory evoked potential monitoring in reducing intraoperative awareness in humans needs further validation. Intraoperative awareness has been found to be associated with long-term sequelae including post-traumatic stress disorder. The American Society of Anesthesiology Committee on Professional Liability initiated the development of the Anesthesia Awareness Registry to help physicians understand the patient’s perspective of intraoperative awareness and provide support for patients affected.

Keywords

Awareness Intraoperative awareness Awareness under general anesthesia Recall Intraoperative recall Intraoperative dreams Post-traumatic stress disorder Processed electroencephalogram Mid-latency auditory evoked potentials Clinical signs of awareness 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tomas Carvajal
    • 1
  • Lopa Misra
    • 1
  • Michael Molloy
    • 1
  • Veerandra Koyyalamudi
    • 1
    Email author
  1. 1.Department of Anesthesiology and Perioperative MedicineMayo ClinicPhoenixUSA

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