title: Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry.
abstract: BACKGROUND
  Anaesthetic awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry.
  
  
  METHODS
  The Registry recruited subjects who self-identified as having had anaesthetic awareness. Inclusion criteria were a patient-reported awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA.
  
  
  RESULTS
  Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD.
  
  
  CONCLUSIONS
  Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Box 356540, 1959 NE Pacific Street, Seattle, WA 98195-6540, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Kent
authors.forename: G A
authors.initials: GA
authors.lastname: Mashour
authors.forename: N A
authors.initials: NA
authors.lastname: Metzger
authors.forename: K L
authors.initials: KL
authors.lastname: Posner
authors.forename: K B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000523:psychology*; D000768:Anesthesia, General / Q000009:adverse effects / Q000523:psychology*; D016292:Procedural Sedation / Q000009:adverse effects / Q000523:psychology*; D003625:Data Collection; D004644:Emotions; D005260:Female; D006801:Humans; D058926:Intraoperative Awareness / Q000523:psychology*; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D011183:Postoperative Complications / Q000523:psychology; D012042:Registries; D012677:Sensation / Q000502:physiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D055815:Young Adult