[Accidental Awareness during General Anaesthesia]

Abstract

Accidental awareness during general anaesthesia (AAGA) is a rare but severe complication. The reported incidence of AAGA may depend on the assessment of intraoperative awareness with explicit recall and there are substantial variations between subspecialties and groups of patients. The majority of prospective studies using structured interviews reported an incidence of AAGA at 0.1-0.2% during general anaesthesia, however, higher values were observed in paediatric (0.2-1.2%) and obstetric patients (0.47%). Risk factors that predispose to AAGA are patient conditions, ASA status, female gender, patient age, history of AAGA, surgical procedure, anaesthetic drug type, muscle relaxation, dosages of hypnotic or analgesic drugs, monitoring and malfunction of anaesthesia systems. Preventive strategies include careful assessment of risk factors, avoidance of underdosages of hypnotics and analgetics during general anaesthesia and monitoring of depth of anaesthesia in risk patients. The health-related consequences can be serious and psychopharmacological and psychotherapeutic interventions are indicated in patients who have experienced AAGA.