Anesthesia Awareness during General Anesthesia

Formerly Position Statement Number 2.12

Printer Friendly Version

An anesthesia awareness incident during general anesthesia may cause serious, and potentially disabling, psychological injury that can progress to post-traumatic stress disorder (PTSD). Multiple studies have found the frequency of anesthesia awareness to range between 0.1 percent to 0.2 percent of adult patients undergoing general anesthesia, or one to two patients per 1,000.1,2 In the pediatric population over the age of 3 years, studies have reported the incidence of anesthesia awareness to be 0.6 percent to 2.7 percent.3,4,5 While the incidence of anesthesia awareness is very low, there is a greater incidence in cardiac surgery (1.1-1.5%), obstetrical surgery (0.4%), and major trauma surgery (11-43%).6 
The AANA recommends that every anesthetizing location where general anesthesia is administered have a well-defined policy that focuses on the prevention and management of anesthesia awareness. This policy should, at a minimum, include:
  • structured education offerings for all healthcare practitioners caring for patients who receive general anesthesia;
  • a method for the identification of patients who may be at higher risk of experiencing anesthesia awareness;
  • methods for identifying and managing an occurrence of anesthesia awareness;
  • an established referral pathway for patients who experience anesthesia awareness;
  • mitigation strategies for the prevention of future anesthesia awareness events; and
  • a requirement for perioperative team debriefings when an anesthesia awareness event occurs.

With their expertise in anesthesia care, Certified Registered Nurse Anesthetists (CRNAs) are encouraged to become actively involved with creation of such a policy. The AANA’s Considerations for Policy Development Number 4.3, "Anesthesia Awareness during General Anesthesia," has been developed to assist CRNAs in addressing this clinical situation. 


  1. Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. Feb 26 2000;355(9205):707-711.
  2. Sebel PS, Bowdle TA, Ghoneim MM, Rainpil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study.  Anesth Analg. Sep 2004; 99(3):833-839.
  3. Blusse van Oud-Albas HJ, van Dijk M, Liu C, Tibboel D, Klein J, Weber F.  Intraoperative awareness during paediatric anaesthesia.  Br J Anaesth. Jan 2009;102(1):104-110.
  4. Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, Stargatt R.  Awareness during anesthesia in children: a prospective cohort study.  Anesth Analg.  Mar 2005;100(3):653-661.
  5. Malviya S, Galinkin JL, Bannister CF, Burke C, Zuk J, Popenhagen M, Brown S, Voepel-Lewis T.  The incidence of intraoperative awareness in children: childhood awareness and recall evaluation.  Anesth Analg. Nov 2009;109(5):1421-1427.
  6. Ghoneim MM. Awareness during anesthesia. Anesthesiology. Feb 2000;92(2):597-602. 

Approved by AANA Board of Directors February 2005.
Revised by AANA Board of Directors April 2012.