AWARENESS AND RECALL DURING GENERAL-ANESTHESIA - FACTS AND FEELINGS

Background. Experiences of awareness and recall during general anesthe sia can be most distressing for patients. To obtain relevant informati on, the authors systematically interviewed patients in whom awareness during surgery had occurred, and questioned them about their experienc es. Methods: Twenty-six patients, referred by colleagues, described th e facts and feelings they had experienced during the period of awarene ss, and whether these had had any consequences. Available anesthetic r ecords were independently judged by three experienced anesthesiologist s for relevant parameters. Results. Auditory perception and the sensat ion of paralysis were most frequently mentioned, followed by the sensa tion of pain. Patients' feelings were mostly related to anxiety, panic , powerlessness, and helplessness. Eighteen patients (70%) experienced unpleasant aftereffects, including sleep disturbances, dreams and nig htmares, 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 a n amnesic drug had been given at a moment of increased blood pressure. Experienced anesthesiologists were unable to reliably distinguish awa reness cases from matched controls when judging the records. Conclusio ns: Details recalled from the period of awareness correspond with data from the literature. The anesthesiologist's role in discussing, and d ealing with, traumatic experiences related to anesthesia may be of gre at importance. The hand-written anesthetic record is of limited value in retrospectively explaining why awareness and recall have occurred.