What is Awareness Under Anaesthesia?
Awareness under anaesthesia is a rare but serious complication where a patient becomes conscious during surgery and recalls intraoperative events. This may include hearing voices, feeling pressure, or, in severe cases, experiencing pain. Though the incidence is low (1–2 cases per 1,000), it can cause significant psychological trauma.
Causes and Risk Factors
Several factors contribute to this condition. Inadequate dosing, equipment malfunction, or deliberate light anaesthesia in high-risk procedures such as cardiac, obstetric, or trauma surgeries can all increase risk. Patients with prior anaesthesia awareness, chronic pain medication use, or substance abuse are particularly vulnerable.
Recognising and Reporting
Signs like increased heart rate, movement, or tearing may indicate awareness, but are not always reliable under neuromuscular blockade. Postoperative interviews help identify suspected cases, allowing early psychological support.
Prevention and Monitoring
Proper patient evaluation, preoperative communication, and individualised drug planning are essential. BIS (Bispectral Index) and other EEG-based monitors help anaesthetists assess consciousness depth more accurately, reducing risk. Continuous vigilance and documentation are key in avoiding awareness.
Psychological Impact and Management
Awareness can lead to anxiety, nightmares, depression, or post-traumatic stress disorder (PTSD). Timely counselling and therapy are crucial. Prevention, recognition, and support form the triad of effective management.
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