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


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.


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 


  1. 1.
    American Society of Anesthesiologists Task Force on Intraoperative Awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the american society of anesthesiologists task force on intraoperative awareness. Anesthesiology [Internet]. 2006 [cited 2017 Nov 27];104(4):847–64. Available from:
  2. 2.
    Mashour GA, Avidan MS. Intraoperative awareness: controversies and non-controversies. Hemmings HC, editor. Br J Anaesth [Internet]. 2015 [cited 2017 Nov 27];115 Suppl 1(suppl 1):i20–6. Available from:
  3. 3.
    Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data. Br J Anaesth [Internet]. 2014 [cited 2017 Nov 27];113(4):540–8. Available from:
  4. 4.
    Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth [Internet]. 1970 [cited 2017 Nov 27];42(6):535–42. Available from:
  5. 5.
    Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, et al. Anesthesia awareness and the bispectral index. N Engl J Med [Internet]. 2008 [cited 2017 Nov 27];358(11):1097–108. Available from:
  6. 6.
    Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, et al. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med [Internet]. 2011 [cited 2017 Nov 27];365(7):591–600. Available from:
  7. 7.
    Myles P, Leslie K, McNeil J, Forbes A, Chan M. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet [Internet]. 2004 [cited 2017 Nov 27];363 had undergone general anesthesia, 28 reports were generated (9423):1757–63. Available from:
  8. 8.
    Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, et al. The incidence of awareness during anesthesia: a Multicenter United States Study. Anesth Analg [Internet]. 2004 [cited 2017 Nov 27];99(3):833–9. Available from:
  9. 9.
    Wennervirta J, Ranta SO-V, Hynynen M. Awareness and recall in outpatient anesthesia. Anesth Analg [Internet]. 2002 [cited 2017 Nov 27];95(1):72–7, table of contents. Available from:
  10. 10.
    Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet [Internet]. 2000 [cited 2017 Nov 27];355(9205):707–11. Available from:
  11. 11.
    Ranta SO-V, Herranen P, Hynynen M. Patients’ conscious recollections from cardiac anesthesia. J Cardiothorac Vasc Anesth [Internet]. 2002 [cited 2017 Nov 27];16(4):426–30. Available from:
  12. 12.
    Davidson AJ, Smith KR, Blussé van Oud-Alblas HJ, Lopez U, Malviya S, Bannister CF, et al. Awareness in children: a secondary analysis of five cohort studies. Anaesthesia [Internet]. 2011 [cited 2017 Nov 27];66(6):446–54. Available from:
  13. 13.
    Paech MJ, Scott KL, Clavisi O, Chua S, McDonnell N, ANZCA Trials Group. A prospective study of awareness and recall associated with general anaesthesia for caesarean section. Int J Obstet Anesth [Internet]. 2008 [cited 2017 Nov 27];17(4):298–303. Available from:
  14. 14.
    Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology [Internet]. 1999 [cited 2017 Nov 27];90(4):1053–61. Available from:
  15. 15.
    Mihai R, Scott S, Cook TM. Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia [Internet]. 2009 [cited 2017 Nov 27];64(8):829–35. Available from:
  16. 16.
    Morimoto Y, Nogami Y, Harada K, Tsubokawa T, Masui K. Awareness during anesthesia: the results of a questionnaire survey in Japan. J Anesth [Internet]. 2011 [cited 2017 Nov 27];25(1):72–7. Available from:
  17. 17.
    Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg [Internet]. 2009 [cited 2017 Nov 27];108(2):527–35. Available from:
  18. 18.
    Nunes RR, Porto VC, Miranda VT, de Andrade NQ, Carneiro LMM. Risk factor for intraoperative awareness. Brazilian J Anesthesiol [Internet]. 2012 [cited 2017 Nov 27];62(3):365–74. Available from:
  19. 19.
    Ghoneim MM. Incidence of and risk factors for awareness during anaesthesia. Best Pract Res Clin Anaesthesiol [Internet]. 2007 [cited 2017 Nov 27];21(3):327–43. Available from:
  20. 20.
    Wilson SL, Vaughan RW, Stephen CR. Awareness, dreams, and hallucinations associated with general anesthesia. Anesth Analg [Internet]. [cited 2017 Nov 27];54(5):609–17. Available from:
  21. 21.
    Blussé van Oud-Alblas HJ, van Dijk M, Liu C, Tibboel D, Klein J, Weber F. Intraoperative awareness during paediatric anaesthesia. BJA Br J Anaesth [Internet]. 2009 [cited 2017 Nov 27];102(1):104–10. Available from:
  22. 22.
    Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, et al. Awareness during anesthesia in children: a prospective cohort study. Anesth Analg [Internet]. 2005 [cited 2017 Nov 27];100(3):653–61. Available from:
  23. 23.
    Malviya S, Galinkin JL, Bannister CF, Burke C, Zuk J, Popenhagen M, et al. The incidence of intraoperative awareness in children: childhood awareness and recall evaluation. Anesth Analg [Internet]. 2009 [cited 2017 Nov 27];109(5):1421–7. Available from:
  24. 24.
    Tsuruta S, Satsumae T, Mizutani T, Inomata S, Shimizu T, Takahashi S, et al. Minimum alveolar concentrations of sevoflurane for maintaining bispectral index below 50 in children. Pediatr Anesth [Internet]. 2011 [cited 2017 Nov 27];21(11):1124–7. Available from:
  25. 25.
    Errando CL, Sigl JC, Robles M, Calabuig E, Garcia J, Arocas F, et al. Awareness with recall during general anaesthesia: a prospective observational evaluation of 4001 patients. Br J Anaesth [Internet]. 2008 [cited 2017 Nov 27];101(2):178–85. Available from:
  26. 26.
    Pollard RJ, Coyle JP, Gilbert RL, Beck JE. Intraoperative awareness in a regional medical system: a review of 3 years’ data. Anesthesiology [Internet]. 2007 [cited 2017 Nov 27];106(2):269–74. Available from:
  27. 27.
    Liu WH, Thorp TA, Graham SG, Aitkenhead AR. Incidence of awareness with recall during general anaesthesia. Anaesthesia [Internet]. 1991 [cited 2017 Nov 27];46(6):435–7. Available from:
  28. 28.
    Aranake A, Gradwohl S, Ben-Abdallah A, Lin N, Shanks A, Helsten DL, et al. Increased risk of intraoperative awareness in patients with a history of awareness. Anesthesiology [Internet]. 2013 [cited 2017 Nov 27];119(6):1275–83. Available from:
  29. 29.
    Guerra F. Awareness and recall. Int Anesthesiol Clin [Internet]. 1986 [cited 2017 Nov 27];24(4):75–99. Available from:
  30. 30.
    Ghoneim MM, Block RI. Learning and memory during general anesthesia: an update. Anesthesiology [Internet]. 1997 [cited 2017 Nov 27];87(2):387–410. Available from:
  31. 31.
    Brundidge PK, Leavell ME, Tempelhoff R. EEG-controlled “overdosage” of anesthetics in a patient with a history of intra-anesthetic awareness. J Clin Anesth [Internet]. [cited 2017 Nov 27];6(6):496–9. Available from:
  32. 32.
    Ghoneim MM, Block RI. Learning and consciousness during general anesthesia. Anesthesiology [Internet]. 1992 [cited 2017 Nov 27];76(2):279–305. Available from:
  33. 33.
    Chung HS. Awareness and recall during general anesthesia. Korean J Anesthesiol [Internet]. 2014 [cited 2017 Nov 27];66(5):339. Available from:
  34. 34.
    Tammisto T, Tigerstedt I. The need for halothane supplementation of N2O-O2-relaxant anaesthesia in chronic alcoholics. Acta Anaesthesiol Scand [Internet]. 1977 [cited 2017 Nov 27];21(1):17–23. Available from:
  35. 35.
    Tammisto T, Takki S. Nitrous oxide-oxygen-relaxant anaesthesia in alcoholics: a retrospective study. Acta Anaesthesiol Scand Suppl [Internet]. 1973 [cited 2017 Nov 27];53:68–75. Available from:
  36. 36.
    Ezri T, Sessler D, Weisenberg M, Muzikant G, Protianov M, Mascha E, et al. Association of ethnicity with the minimum alveolar concentration of sevoflurane. Anesthesiology [Internet]. 2007 [cited 2017 Nov 27];107(1):9–14. Available from:
  37. 37.
    Mashour GA, Wang LY-J, Turner CR, Vandervest JC, Shanks A, Tremper KK. A retrospective study of intraoperative awareness with methodological implications. Anesth Analg [Internet]. 2009 [cited 2017 Nov 27];108(2):521–6. Available from:
  38. 38.
    Ghoneim MM. Awareness during anesthesia. Anesthesiology [Internet]. 2000 [cited 2017 Nov 27];92(2):597–602. Available from:
  39. 39.
    Bogetz MS, Katz JA. Recall of surgery for major trauma. Anesthesiology [Internet]. 1984 [cited 2017 Nov 27];61(1):6–9. Available from:
  40. 40.
    Orser BA, Mazer CD, Baker AJ. Awareness during anesthesia. Can Med Assoc J [Internet]. 2008 [cited 2017 Nov 27];178(2):185–8. Available from:
  41. 41.
    Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology [Internet]. 2005 [cited 2017 Nov 27];103(2):429–37. Available from:
  42. 42.
    Crawford JS. Awareness during operative obstetrics under general anaesthesia. Br J Anaesth [Internet]. 1971 [cited 2017 Nov 27];43(2):179–82. Available from:
  43. 43.
    Famewo CE. Awareness and dreams during general anaesthesia for Caesarian section a study of incidence. Can Anaesth Soc J [Internet]. 1976 [cited 2017 Nov 27];23(6):636–9. Available from:
  44. 44.
    Lubke GH, Kerssens C, Gershon RY, Sebel PS. Memory formation during general anesthesia for emergency cesarean sections. Anesthesiology [Internet]. 2000 [cited 2017 Nov 27];92(4):1029–34. Available from:
  45. 45.
    Lyons G, Macdonald R. Awareness during caesarean section. Anaesthesia [Internet]. 1991 [cited 2017 Nov 27];46(1):62–4. Available from:
  46. 46.
    Bogod DG, Orton JK, Yau HM, Oh TE. Detecting awareness during general anaesthetic caesarean section. An evaluation of two methods. Anaesthesia [Internet]. 1990 [cited 2017 Nov 27];45(4):279–84. Available from:
  47. 47.
    King H, Ashley S, Brathwaite D, Decayette J, Wooten DJ. Adequacy of general anesthesia for cesarean section. Anesth Analg [Internet]. 1993 [cited 2017 Nov 27];77(1):84–8. Available from:
  48. 48.
    Goldmann L, Shah MV, Hebden MW. Memory of cardiac anaesthesia. Psychological sequelae in cardiac patients of intra-operative suggestion and operating room conversation. Anaesthesia [Internet]. 1987 [cited 2017 Nov 27];42(6):596–603. Available from:
  49. 49.
    Phillips AA, McLean RF, Devitt JH, Harrington EM. Recall of intraoperative events after general anaesthesia and cardiopulmonary bypass. Can J Anaesth [Internet]. 1993 [cited 2017 Nov 27];40(10):922–6. Available from:
  50. 50.
    Ranta S, Jussila J, Hynynen M. Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist. Acta Anaesthesiol Scand [Internet]. 1996 [cited 2017 Nov 27];40(5):554–60. Available from:
  51. 51.
    Dowd NP, Cheng DC, Karski JM, Wong DT, Munro JA, Sandler AN. Intraoperative awareness in fast-track cardiac anesthesia. Anesthesiology [Internet]. 1998 [cited 2017 Nov 27];89(5):1068–73; discussion 9A. Available from:
  52. 52.
    Wang Y, Yue Y, Sun Y, Wu A, Wu Q, Zhang Y, et al. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China. Chin Med J [Internet]. 2005 [cited 2017 Nov 27];118(14):1190–4. Available from:
  53. 53.
    Moore JK, Seymour AH. Awareness during bronchoscopy. Ann R Coll Surg Engl [Internet]. 1987 [cited 2017 Nov 27];69(2):45–7. Available from:
  54. 54.
    Fraser GC. Awareness during bronchoscopy. Ann R Coll Surg Engl [Internet]. 1987 [cited 2017 Nov 27];69(5):248. Available from:
  55. 55.
    Mummaneni N, Rao TL, Montoya A. Awareness and recall with high-dose fentanyl-oxygen anesthesia. Anesth Analg [Internet]. 1980 [cited 2017 Nov 27];59(12):948–9. Available from:
  56. 56.
    Hilgenberg JC. Intraoperative awareness during high-dose fentanyl--oxygen anesthesia. Anesthesiology [Internet]. 1981 [cited 2017 Nov 27];54(4):341–3. Available from:
  57. 57.
    Kelly JS, Roy RC. Intraoperative awareness with propofol-oxygen total intravenous anesthesia for microlaryngeal surgery. Anesthesiology [Internet]. 1992 [cited 2017 Nov 27];77(1):207–9. Available from:
  58. 58.
    Miller DR, Blew PG, Martineau RJ, Hull KA. Midazolam and awareness with recall during total intravenous anaesthesia. Can J Anaesth [Internet]. 1996 [cited 2017 Nov 27];43(9):946–53. Available from:
  59. 59.
    Enlund M, Hassan HG. Intraoperative awareness: detected by the structured Brice interview? Acta Anaesthesiol Scand [Internet]. 2002 [cited 2017 Nov 27];46(4):345–9. Available from:
  60. 60.
    Nordström O, Engström AM, Persson S, Sandin R. Incidence of awareness in total i.v. anaesthesia based on propofol, alfentanil and neuromuscular blockade. Acta Anaesthesiol Scand [Internet]. 1997 [cited 2017 Nov 27];41(8):978–84. Available from:
  61. 61.
    Sandin R, Norström O. Awareness during total i.v. anaesthesia. Br J Anaesth [Internet]. 1993 [cited 2017 Nov 27];71(6):782–7. Available from:
  62. 62.
    Winterbottom EH. Insufficient anaesthesia. Br Med J [Internet]. 1950 [cited 2017 Nov 27];1(4647):247. Available from:
  63. 63.
    Hutchinson R. Awareness during surgery. A study of its incidence. Br J Anaesth [Internet]. 1961 [cited 2017 Nov 27];33:463–9. Available from:
  64. 64.
    Bergman IJ, Kluger MT, Short TG. Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic incident monitoring study. Anaesthesia [Internet]. 2002 [cited 2017 Nov 27];57(6):549–56. Available from:
  65. 65.
    Ranta SO, Laurila R, Saario J, Ali-Melkkilä T, Hynynen M. Awareness with recall during general anesthesia: incidence and risk factors. Anesth Analg [Internet]. 1998 [cited 2017 Nov 27];86(5):1084–9. Available from:
  66. 66.
    Caplan RA, Vistica MF, Posner KL, Cheney FW. Adverse anesthetic outcomes arising from gas delivery equipment: a closed claims analysis. Anesthesiology [Internet]. 1997 [cited 2017 Nov 27];87(4):741–8. Available from:
  67. 67.
    Tong D, Chung F. Recall after total intravenous anaesthesia due to an equipment misuse. Can J Anaesth [Internet]. 1997 [cited 2017 Nov 27];44(1):73–7. Available from:
  68. 68.
    Wang J, Zhang L, Huang Q, Wu G, Weng X, Lai Z, et al. Monitoring the end-tidal concentration of sevoflurane for preventing awareness during anesthesia (MEETS-PANDA): a prospective clinical trial. Int J Surg [Internet]. 2017 [cited 2017 Nov 27];41:44–9. Available from:
  69. 69.
    Kumar SM, Pandit SK, Jackson PF. Recall following ketamine anesthesia for open-heart surgery: report of a case. Anesth Analg [Internet]. [cited 2017 Nov 27];57(2):267–9. Available from:
  70. 70.
    Mark JB, Greenberg LM. Intraoperative awareness and hypertensive crisis during high-dose fentanyl-diazepam-oxygen anesthesia. Anesth Analg [Internet]. 1983 [cited 2017 Nov 27];62(7):698–700. Available from:
  71. 71.
    Consciousness, Awareness, and Pain in General Anesthesia; In: Rosen.M editor. Butterworth-Heinemann, Oxford, United Kingdom; 1987 p. 171–9.Google Scholar
  72. 72.
    Wilson J, Turner DJ. Awareness during caesarean section under general anaesthesia. Br Med J [Internet]. BMJ Publishing Group; 1969 [cited 2017 Nov 27];1(5639):280–3. Available from:
  73. 73.
    Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev [Internet]. 2014 [cited 2017 Nov 28];(6):CD003843. Available from:
  74. 74.
    Ekman A, Lindholm M-L, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand [Internet]. 2004 [cited 2017 Nov 28];48(1):20–6. Available from:
  75. 75.
    Depth of anaesthesia monitors – Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M - Guidance and guidelines [Internet]. 2012 [cited 2017 Jan 1]. Available from:
  76. 76.
  77. 77.
    Smith WD, Dutton RC, Smith NT. Measuring the performance of anesthetic depth indicators. Anesthesiology [Internet]. 1996 [cited 2017 Nov 29];84(1):38–51. Available from:
  78. 78.
    Schwender D, Klasing S, Madler C, Pöppel E, Peter K. Do auditory evoked potentials assess awareness? In: Schwilden H, editor. Control and automation in anaesthesia: Springer; 1995. p. 107–18.Google Scholar
  79. 79.
    Thornton C, Barrowcliffe MP, Konieczko KM, Ventham P, Doré CJ, Newton DE, et al. The auditory evoked response as an indicator of awareness. Br J Anaesth [Internet]. 1989 [cited 2017 Nov 29];63(1):113–5. Available from:
  80. 80.
    Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth [Internet]. 2000 [cited 2017 Nov 29];84(1):6–10. Available from:
  81. 81.
    Studdert DM, Thomas EJ, Burstin HR, Zbar BI, Orav EJ, Brennan TA. Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care [Internet]. 2000 [cited 2017 Nov 29];38(3):250–60. Available from:
  82. 82.
    Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med [Internet]. 2006 [cited 2017 Nov 29];354(19):2024–33. Available from:
  83. 83.
    Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, et al. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard medical practice study III. N Engl J Med [Internet]. 1991 [cited 2017 Nov 29];325(4):245–51. Available from:
  84. 84.
    Domino KBCD. Awareness under anesthesia. In: Miller R, Pardo M, editors. Basics of anesthesia. 6th ed: Elsevier, Philadelphia, United States; 2011. p. 739.Google Scholar
  85. 85.
    Payne JP. Awareness and its medicolegal implications. Br J Anaesth [Internet]. 1994 [cited 2017 Nov 29];73(1):38–45. Available from:
  86. 86.
    Blacher RS. On awakening paralyzed during surgery. A syndrome of traumatic neurosis. JAMA [Internet]. 1975 [cited 2017 Nov 29];234(1):67–8. Available from:
  87. 87.
    Huycke LI, Huycke MM. Characteristics of potential plaintiffs in malpractice litigation. Ann Intern Med [Internet]. 1994 [cited 2017 Nov 29];120(9):792–8. Available from:
  88. 88.
    Kachalia A, Kaufman SR, Boothman R, Anderson S, Welch K, Saint S, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med [Internet]. 2010 [cited 2017 Nov 29];153(4):213–21. Available from:
  89. 89.
    Cass NM. Medicolegal claims against anaesthetists: a 20 year study. Anaesth Intensive Care [Internet]. 2004 [cited 2017 Nov 29];32(1):47–58. Available from:
  90. 90.
    Cobcroft MD, Forsdick C. Awareness under anaesthesia: the patients’ point of view. Anaesth Intensive Care [Internet]. 1993 [cited 2017 Nov 29];21(6):837–43. Available from:
  91. 91.
    Robertson GB. The efficacy of the medical malpractice system: a Canadian perspective. Ann Heal law [Internet]. 1994 [cited 2017 Nov 29];3:167–78. Available from:
  92. 92.
    Kent CD. Awareness during general anesthesia: ASA closed claims database and anesthesia awareness registry. ASA Newsl. 2010;74(2):14–6.Google Scholar
  93. 93.
    Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry [Internet]. [cited 2017 Nov 29];23(4):198–204. Available from:
  94. 94.
    Lennmarken C, Bildfors K, Enlund G, Samuelsson P, Sandin R. Victims of awareness. Acta Anaesthesiol Scand [Internet]. 2002 [cited 2017 Nov 29];46(3):229–31. Available from:
  95. 95.
    Mashour GA. Posttraumatic stress disorder after intraoperative awareness and high-risk surgery. Anesth Analg [Internet]. 2010 [cited 2017 Nov 29];110(3):668–70. Available from:
  96. 96.
    Birnbach D, Browne I. Anesthesia for obstetrics. In: Miller R, editor. Anesthesia. Philadelphia: Elsevier; 2005. p. 2307–44.Google Scholar

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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