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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

The Incidence of Awareness During Anesthesia: A Multicenter United States Study

Peter S. Sebel, MB BS, PhD, MBA^*, T. Andrew Bowdle, MD PhD, Mohamed M. Ghoneim, MD, Ira J. Rampil, MD, Roger E. Padilla, MD^||, Tong Joo Gan, MB BS, FRCA, FFARCSI^¶, and Karen B. Domino, MD MPH^#

*Emory University School of Medicine, Atlanta, Georgia; University of Washington Medical Center, Seattle, Washington; University of Iowa, Iowa City, Iowa; State University of New York, Stony Brook, New York; ||Memorial Sloan-Kettering Cancer Center, New York, New York; ¶Duke University, Durham, North Carolina; and #Harborview Medical Center, Seattle, Washington

Address correspondence to Peter Sebel, MB BS, PhD, MBA, Department of Anesthesiology, Emory University School of Medicine, 49 Jesse Hill Jr. Dr., S.E., Atlanta, GA 30303. Address e-mail to peter_sebel{at}emoryhealthcare.org Reprints will not be available from the authors.

Awareness with recall after general anesthesia is an infrequent, but well described, phenomenon that may result in posttraumatic stress disorder. There are no recent data on the incidence of this complication in the United States. We, therefore, undertook a prospective study to determine the incidence of awareness with recall during general anesthesia in the United States. This is a prospective, nonrandomized descriptive cohort study that was conducted at seven academic medical centers in the United States. Patients scheduled for surgery under general anesthesia were interviewed in the postoperative recovery room and at least a week after anesthesia and surgery by using a structured interview. Data from 19,575 patients are presented. A total of 25 awareness cases were identified (0.13% incidence). These occurred at a rate of 1–2 cases per 1000 patients at each site. Awareness was associated with increased ASA physical status (odds ratio, 2.41; 95% confidence interval, 1.04–5.60 for ASA status III–V compared with ASA status I–II). Age and sex did not influence the incidence of awareness. There were 46 additional cases (0.24%) of possible awareness and 1183 cases (6.04%) of possible intraoperative dreaming. The incidence of awareness during general anesthesia with recall in the United States is comparable to that described in other countries. Assuming that approximately 20 million anesthetics are administered in the United States annually, we can expect approximately 26,000 cases to occur each year.

IMPLICATIONS: Data from 19,575 patients indicate that the incidence of awareness with recall after surgery under general anesthesia is 0.13%. This means that the minimum incidence of awareness is 1.3 patients per 1000.

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