INTRAOPERATIVE AWARENESS DURING GENERAL ANESTHESIA: RISK FACTORS, PREVENTION, AND PSYCHOLOGICAL IMPACT

Abstract

Intraoperative awareness, also referred to as awareness with recall, consists of the unexpected recovery of perception during general anesthesia, with subsequent explicit memory of events that occurred when the patient should have remained unconscious. Although rare, it is associated with acute distress, psychological sequelae, and medicolegal repercussions that justify ongoing attention. This narrative review, of a critical nature, aimed to analyze the risk factors, prevention strategies, and psychological impact of the phenomenon, drawing on the literature indexed in the main health databases and published between 2000 and 2026, without excluding fundamental classic studies. The spectrum of states of consciousness under anesthesia, the divergence in incidence between prospective studies and spontaneous-reporting audits, the factors related to the patient, the procedure, and the technique, and the comparative evidence on depth-of-anesthesia monitoring were discussed. The psychological consequences, including post-traumatic stress disorder, were also addressed, and a practical care pathway integrating risk stratification, prevention, postoperative detection, and management was proposed. It is concluded that no single technology eliminates the risk, with multimodal prevention and structured follow-up being the pillars of safety.