Awareness during Anesthesia

To the Editor: All anesthesiologists will join me in extending sincere sympathy to Ms. Hoogewerf, who was aware during surgery for an ovarian cyst (Can J Anaesth 1998; 45: 821). This mishap is one of the twenty sudden occurrences which anesthesiologists most dread while they administer anesthesia. Though very rare, some physicians become so fearful of encountering such an event that they withdraw from the practice of anesthesia. However, Ms. Hoogewerf makes the very important point that the administration of anesthesia is very difficult, and fraught with uncertainty, because we are not dealing with predictable programmable inanimate objects, but are anesthetizing people, whose condition may change with startling rapidity. This morning I anesthetized two consecutive patients: the first required only 20% of the expected quantity of anesthetic agent and recovered within 20 mins while the family asked three times why recovery was so slow. The second patient required 100% more anesthesia than the average patient, but was adequately anesthetized and recovered normally. We should all be grateful to your correspondent for highlighting the problems of providing anesthesia, and resolve to be aware of the difficulties and the possibility of awareness during light anesthesia.