Recall during general anesthesia has been reported to occur in approximately 1 to 2 per 1000 anesthetic procedures.1Most providers are familiar with press reports and litigations by patients to recover damages as a result of recall and suffering while under general anesthesia.2I would like to report a phenomenon which I have observed to be occurring more frequently in my practice.

During my preoperative visit, I commonly ask the patient about previous anesthetic exposures. Lately, several patients have stated that they remember most if not all of their last anesthetic. When asked what type of procedure they had that they recall so well, they have invariably replied, colonoscopy, cataract, cardiac catheterization, or similar procedures. When I question this recall event further, it is clear that the procedure they recall was done under sedation and not general anesthesia. Indeed, all of the patients I have interviewed so far who have had other procedures that required general anesthesia, e.g. , cholecystectomy, were able to discern the difference in the depth of anesthesia and had no recall of the more invasive procedure. A brief explanation that sedation for endoscopies and similar procedures does not reliably ablate recall has been accepted by all patients and to date has eased apprehension that if the current procedure requires a general anesthetic, they will most likely not have any recall or intraoperative awareness.

I get the impression that many patients undergoing endoscopy, catheterization, cataract extraction, and many other procedures that utilize conscious sedation or even moderate sedation are being told they will not remember the procedure. I think it will serve us well to remind our colleagues in the endoscopy suites and the catheterization labs that such is not the case. In addition, we practitioners of anesthesia should not tell patients undergoing spinal, epidural, regional, or monitored anesthetic care that the sedation we may provide will ablate all intraoperative awareness and recall.

The general public has difficulty distinguishing between different levels of sedation and general anesthesia; in fact, this concept is not clearly defined within our own specialty. Caution needs to be exercised when discussing matters of recall and awareness with patients. First, find out if they truly had a general anesthetic. Second, do not make assurances of memory ablation if you do not plan a general anesthetic and even then be careful what you promise. Third, talk with your colleagues in the endoscopy and catheterization laboratories. I think they are making well-intentioned assurances of memory ablation and are unaware of how often they fail to provide the amnesia they wish to give.

University of Kansas School of Medicine, Wichita, Kansas. hwcollier@hotmail.com

1.
Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB: The incidence of awareness during anesthesia: A multicenter United States Study. Anesth Analg 2004; 99:833–9
2.
Domino KB, Posner KL, Caplan RA, Cheney FW: Awareness during anesthesia. Anesthesiology 1999; 90:1053–61