Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery

// Marco Cascella 1 , Roberta Fusco 2 , Domenico Caliendo 1 , Vincenza Granata 2 , Domenico Carbone 3 , Maria Rosaria Muzio 4 , Giuseppe Laurelli 5 , Stefano Greggi 5 , Francesca Falcone 5 , Cira Antonietta Forte 6 and Arturo Cuomo 1 1 Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 2 Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 3 Department of Emergency Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italia 4 Division of Infantile Neuropsychiatry, UOMI, Maternal and Infant Health, Torre del Greco, Napoli, Italia 5 Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia 6 Psychology, Division of Pain Medicine, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia Correspondence to: Marco Cascella, email: m.cascella@istitutotumori.na.it Keywords: anesthesia, anesthesia awareness, deep, intravenous, sedation Received: February 27, 2017     Accepted: March 21, 2017     Published: April 19, 2017 ABSTRACT Background. Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods. Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results. Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions. Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.