Post-Traumatic Stress Disorder Following Intraoperative Awareness

Intraoperative awareness (IA) is an anesthesia complication defined as the unexpected and explicit recall by patients of events that occurred during anesthesia. This complication represents a potentially traumatic event as it may lead to psychological or psychiatric consequences, such as post-traumatic stress disorder (PTSD). PTSD is the most frequently reported psychiatric consequence of IA. However, the accurate proportion of PTSD following IA is not known. Due to the low incidence of IA, little is known about risk factors for developing psychiatric or psychological sequelae following IA. However, risk factors for the development of PTSD following trauma, in general, have been extensively explored and can be applied to IA. The common risk factors for PTSD are female gender, younger age, minority status, single status, low socioeconomic status, low level of education, low intelligence, psychiatric history, substance abuse or dependence, severity of the trauma, peritraumatic emotional responses, peritraumatic dissociation, lack of social support, low perceived support following the event, history of past traumatic event(s), life stress, childhood adversity, and family psychiatric history. PTSD symptoms may be experienced in the hours or days following IA but can also be delayed and appear months after the traumatic event. They are variable in duration, from a few weeks to several years. To make a diagnosis, they must be present for at least 1 month. Although PTSD is the more frequently reported psychiatric consequence of IA, it is important to note that other syndromal or subsyndromal mental disorders such as the acute stress disorder and the subsyndromal PTSD may develop following IA. Early management strategies have to be provided in order to reduce the deleterious outcomes of IA, including taking complaints about IA seriously and offering early psychiatric care.