Unwanted wakefulness during general anesthesia
Daunderer M, Schwender D.
Klinik fur Anasthesiologie,
Ludwig-Maximilians-Universitat, Munchen,
Anaesthesist. 2004 Jun;53(6):581-94.


Intraoperative wakefulness ("awareness") is still a relevant problem. Different stages of wakefulness exist: conscious awareness with explicit recall of pain in 0.03% and with nonpainful explicit recall in 0.1-0.2% of all anesthesias; amnesic awareness or implicit recall may occur with unknown, even higher incidences. Sufficient analgesia minimizes possible painful perceptions. Opioids, benzodiazepines, and N(2)O alone or combined lead to the highest incidences of nonpainful intraoperative wakefulness. Volatile anesthetics, etomidate, barbiturates, and propofol in sufficient doses effectively block any sensory processing and therefore abolish intraoperative wakefulness. Intraoperative awareness with recall may lead to sustained impairment of the patients, in severe cases even to a post-traumatic stress disorder (PTSD). The observation of clinical signs does not reliably detect intraoperative wakefulness in all cases; monitoring of end-tidal gas concentrations, EEG, or evoked potentials may help in prevention. Active information is recommended only for patients at higher risk. Complaints about recall of intraoperative events should be taken seriously; in cases of sustained symptoms psychological help may be necessary.
Horace Wells
John Collins Warren
Obstetric anaesthesia
Molecular mechanisms
Crawford Williamson Long
Anaesthesia/16th October 1846
Hinckley's oil painting "The First Operation Under Ether"

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Good Drug Guide
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World