Awareness

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The prime duty of the anaesthetist is to maintain the safety of the patient and to ensure that he/she is asleep, unaware and painfree. Awareness may cause considerable stress and psychological sequelae. For purposes of discussion, awareness can be divided into four categories:

1. Conscious awareness with recollection: This occurs when a patient remembers intraoperative events. It is very rare and is what most of us associate with being 'awake during an operation'. Awareness is often due to faulty anaesthetic technique or failure to check equipment [1].

2. Conscious awareness without recollection: There may have been response to intraoperative events but no recollection afterwards.

3. Subconscious awareness without recollection: A response to intraoperative events or commands may be triggered afterwards, say by hypnosis.

4. No awareness or recollection: This state is what most of us associate with being anaesthetised. However, some evidence suggests that patients are, to some degree, partially aware during anaesthesia but have no recollection.

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