If you’re having major surgery, such as a knee replacement or back surgery, you most likely will receive general anesthesia and be unconscious during the procedure. Very rarely, patients who have general anesthesia become aware or conscious during the procedure when the intention was for the patient to be unconscious. This is called anesthesia awareness, and it happens in only one or two out of every 1,000 medical cases involving general anesthesia in adults. Although it can be very unsettling, patients who experience awareness generally do not feel pain.

Anesthesia awareness is not the same thing as remembering some activities surrounding your procedure, such as just before the anesthesia starts working, or when its effects begin wearing off after the surgery. These are expected and normal. You might even dream during surgery, and only think you have experienced awareness.

What Does Anesthesia Awareness Feel Like?

People who have experienced awareness under anesthesia report different levels of awareness. Some people have brief, vague recollections. Others remember a specific moment of surgery or the surroundings. In some cases, people recall a feeling of pressure. Depending on the person and the event, the experience can be disturbing and some patients benefit from counseling after surgery to help cope with feelings of confusion or stress.

Always rare, anesthesia awareness occurred in one or two out of every 100 surgeries 40 years ago, while now it occurs in only one or two out of every 1,000 due to improvements in anesthesia care. Physician anesthesiologists are committed to further reducing this already low incidence of awareness under anesthesia and are involved in research to lessen the chance of it happening.

Why Does Anesthesia Awareness Happen?

There are a few different reasons awareness can occur. Every person reacts differently to a given dose of anesthesia. In some high-risk or emergency surgeries such as trauma, heart surgery, or cesarean sections (C-sections), or when a patient has multiple medical conditions, providing the standard dose of anesthesia will increase the risk of harm. That means that in order to ensure your safety it might not be possible to provide the level of anesthesia necessary to ensure unconsciousness.

Providing the right amount of anesthesia for a patient requires high levels of skill and expertise. That’s why it’s important that your anesthesia care is led by a physician anesthesiologist, a medical doctor specializing in anesthesia, pain, and critical care medicine who works with your other physicians to develop and administer your anesthesia care plan. With 12 to 14 years of education and 12,000 to 16,000 hours of clinical training, these highly trained medical specialists ensure safe, high-quality care.

How Can the Chance of Anesthesia Awareness be Reduced?

Before your surgery, your physician anesthesiologist will meet with you to learn about any health conditions you may have as well as your previous experience with anesthesia. Be sure to let your physician anesthesiologist know if you have any questions or concerns, especially if you have had any problems with anesthesia in the past, including any experience with awareness. Your physician anesthesiologist will ask about medications you are taking, including prescription, over-the-counter and herbal supplements as well as if you have a history of drug or alcohol abuse, which can increase the risk of anesthesia awareness. All of this information helps the physician anesthesiologist provide the best and safest care and reduce the risk of problems, including awareness.

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