Awareness during anesthesia.

The number of patients who have preoperative anxiety over possibly "waking up" in the middle of surgery has increased dramatically over the last decade. McCleane and Cooper found that more than 50% of 247 patients were concerned that they would not be asleep during their surgery. Even after having an adequate anesthetic, 25% were still worried about being asleep with future anesthetics. With increased media coverage, these anxieties are not likely to go away anytime soon. For the patient, awareness or recall while under general anesthesia is a frightening experience that can lead to debilitating emotional injury and even post-traumatic stress disorder. For anesthesiologists, awareness under anesthesia ranks second only to death as a "dreaded" complication. This chapter reviews the incidence, etiology, psychological sequelae, medicolegal consequences, and prevention of awareness during anesthesia.