I. Awareness with explicit recall during general anaesthesia: current status and issues

Recently, the incidence of awareness data from NAP5 project (the national UK survey of intraoperative awareness during general anaesthesia) have been published in this journal. These baseline data offer an estimated incidence of awareness with recall, as reported by participant anaesthetists, as low as 1:15 414. However, due to the characteristics of the survey, that is, voluntary report by doctors, the results should be considered with caution. If one can deduce the importance of a scientific topic, or its interest to the scientific community, from the numberof Editorials in a journal, awareness with explicit recall during general anaesthesia (AWR) would be considered very important. Since 1981, 11 Editorials have been published in the British Journal of Anaesthesia alone, and four of these were published very recently. – 5 However, the incidence published in the recent article would suggest that the problem is rare, hence quantitatively ‘not so important’. After we published our study on AWR in this journal, the information started to expand in the field of incidence and prevention of this problem. 8 However, controversy immediately started despite large size studies, especially about the adequacy and economic feasibility of the use of bispectral index (BIS), – 12 which is considered to be a possible instrument for prevention. A review of the prevention of AWR is probably due, in part, because it would be impossible to decrease the incidence to zero. The controversy can broaden if anaesthesiarelated mortality, and the role of BIS, is also considered. In real life, however, the problem persists for both the anaesthetists and the patients. 15 – 17 Sensory perceptions as hearing sounds, pain and immobility, together with extreme anxiety and distress because of these thoughts, and the longlasting effects (nightmares, anxiety, nervous depression, postraumatic stress disorder) deserve attention and underline the importance of the problem. From the clinical anaesthetists’ perspective, there are questions which require answers.