What are the factors that i̇nfluence awareness under general anesthesi̇a?

In our study, we investigated the factors affecting the level of intraoperative awareness in patients who underwent middle ear surgery under general anesthesia. Besides, we aimed to obtain information with dreaming and dream contents under general anesthesia with postoperative interview using Modified Brice Questionnaire. This study was carried out with 80 patients between the ages of 18-70, ASA class I or II who were admitted to the informed consent form at the Manisa Celal Bayar University Medical School Hospital under elective conditions for middle ear surgery. In addition to routine anesthesia monitoring, patients underwent anesthesia depth monitoring with PSI to provide standard general anesthesia management with sevoflurane at a concentration of 1.5-2% with PSI values of 25-50 (surgical anesthesia). Patient demographic data and PSI values were recorded at regular intervals throughout the operation. The necessary compilation was provided and the Modified Brice Questionnaire was applied to the interview done at the 4th postoperative hours after the patient was delivered to service. The results were analyzed with SPSS 15.0 program and it was accepted at p <0.05 level at 95% confidence interval. As a result of the postoperative interviews, no intraoperative awareness was found in the patients. Of the 80 patients who made up the study group, 34 reported that they had dreamed during the operation and 13 of them declared that the content of the dream was 'disturbing'. In patients with alcohol use, who underwent anesthetic premedication, prolonged periods of surgery and duration of anesthesia and who had peroperative additional opiate administrations statistically significant high level of dreaming was found. In patients with general anesthesia history, chronic illnesses, and chronic drug use, statistically significant high level of disturbing dream content was found. When PSI values that were continuously monitored during the operation and recorded at defined intervals were compared, PSİ values at the beginning of surgery of the dreamed cases were found to be statistically significantly higher than those that did not dream. The mean PSI value for uneventful cases was 31,6, while 36 for dreaming cases and these values were statistically significant. We believe that anesthesia depth monitoring can reduce potential complications, especially posttraumatic stress disorder, increase patient safety and improve satisfaction with anesthesia service, especially in high risk patients.