Accidental awareness during general anaesthesia

This narrative vignette illustrates accidental awareness during general anaesthesia through the case of a 40-year-old woman who experienced vivid recall of intraoperative events during myomectomy, including suffocation sensations and abdominal pain, leading to post-traumatic stress disorder despite debriefing. Accidental awareness during general anaesthesia is defined as unintended consciousness occurring despite planned absence of consciousness during anaesthesia. Awareness stems from inadequate anaesthetic delivery, which fails to disrupt thalamocortical circuits and higher order processing. It manifests as explicit recall (detailed memories) or implicit (subtle behavioural changes). Incidence varies by method used to identify the phenomenon: 1:19,600 for spontaneous reports (NAP5) versus 1–2:1000 via direct questioning, with elevated risks in obstetrics (1:256–670), obesity, emergencies and when using neuromuscular blocking drugs. Prevention involves vigilant dosing, risk assessment and monitoring; management emphasises immediate debriefing, root-cause investigation and psychological support to mitigate distress.