Dr Mark Moore MD
Tallahassee's Anesthesiologist


Anesthesia Awareness
By: Ray S. Magill

What is anesthesia awareness or intra-operative awareness? Anesthesia awareness is a common phrase used to describe the phenomenon of being aware, alert, conscious during surgery or recalling events that happen during a surgical procedure. However, the connotation inherent in the phrase "anesthesia awareness" suggests that a person is aware despite being under the influence of anesthesia. This is somewhat of an oxymoron since anesthesia is defined as the loss of sensation, such that although a person may be aware mentally they still may not have sensation physiologically due to the anesthesia. Thus the term intra-operative awareness may be more fitting to the phenomenon. Specifically, the goal of anesthesia is not always unconsciousness so that in some procedures awareness is completely acceptable and/or even desired. For example, during epidural and other regional anesthetic techniques an individual is aware albeit they may be given sedatives to ease the anxiety of the experience.

Whatever one chooses to call it, intra-operative awareness can be a significant concern for individuals facing surgery, and rightfully so. The prospect of being "awake" while a surgeon performs his work is not an inviting proposition. However, the incidence of intra-operative awareness during general anesthesia is very rare. Recent studies and data released by the American Society of Anesthesiologist's (ASA) indicates that the reported incidences are between 0.1 to 0.2%. Furthermore, these numbers are likely to include benign experiences of awareness such as having brief recollection with no pain whatsoever or even false memories, and dreams, that can be induced by anesthetic and peri-anesthetic drugs. This, and the inherent difficulty in confirming intra-operative awareness presents difficulties in producing exacting figures. Thus, the incidence of traumatic intra-operative awareness may be significantly less. Yet, for the individual requiring surgery and the anesthesia professional providing care, even a small risk is a concern.

The incidences of intra-operative awareness during general anesthesia are very unlikely, however, the rate of incidence is higher in certain types of surgery, such as trauma surgery, cardiothoracic surgery, and obstetrics (labor and delivery). During emergent life saving procedures the anesthesia professional must balance the patient's comfort level with the risks involved with the administration of certain anesthetic drugs. For example, some of the drugs associated with anesthesia have the effect of decreasing or affecting the heart rate which could be life threatening if administered to someone who is already in a state of cardiac distress. Another concern may be the effect certain anesthetic drugs may have on an unborn child due to the drug's ability to cross the placenta, again, the anesthesia professional must balance patient comfort with known risks and the preservation of life. Furthermore, in all surgical procedures there is an individual aspect to each operation. Thus, there are potential risks involving the specific physiology and reactivity to anesthetics that each patient may display. Therefore, each case is weighed individually according to a patient's medical history and physiological condition. Minimizing the risks involved is thus the goal in every situation, but risks are inherent and cannot be absolutely eliminated. This said however, anesthesiology professionals are committed to delivering the safest and most comfortable operative experience feasible. In addition, this is why It is important to discuss all the concerns and review a complete medical history in detail with an anesthesiology professional prior to surgery.

An individual can guard against experiencing intra-operative awareness by being proactive in his/her medical care. Patient's have rights concerning anesthesia care and a patient can request specific anesthesia professional for their case if they so desire and arrangements can be made to try and accommodate those requests. The number one defense against experiencing intra-operative awareness is a skilled and knowledgeable anesthesia professional whose experience and clinical training provide the necessary know how to minimize the risks to their clients.


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