Awareness during anesthesia: a rare but disturbing complication.

1 Awareness during anesthesia: A rare but disturbing complication According to the American Society of Anesthesiologists (ASA), intraoperative awareness with recall occurs “when a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events” (ASA). Patients remember sounds, voices, tugging, and pain. Even without painful sensory perceptions, being awake but unable to communicate with the surgical team can cause severe distress and lasting psychological damage, including posttraumatic stress disorder (PTSD). Some patients describe awareness with recall as their “worst hospital experience” (Joint Commission). Awareness with recall is thought to occur in approximately 1 to 2 cases per 1,000 in the general population undergoing general anesthesia (Mashour et al. 2011) or about 21,000 to 42,000 cases annually in the United States (Joint Commission). In high-risk cases, such as cesarean sections, it is 10 times as common. Because not all patients who experience awareness with recall report it, the true occurrence may be even higher.