Are We Unconscious During General Anesthesia?

A question that many patients anxiously ask before undergoing general anesthesia for surgery is ‘‘will I be totally out during the whole operation?’’ The answer is usually something like this ‘‘most certainly, but you will not remember anything anyway.’’ It is the latter possibility that concerns us for it is a medical and ethical dilemma if forgetting some possibly unpleasant experience would negate its significance and possible later psychologic effects on the individual. The issue is not that the experience may be consciously recalled (the distinction between implicit and explicit memory is discussed elsewhere in this volume) but that if there was any experience in the first place. Historically, there has been a tendency in anesthesiology to equate intraoperative awareness with postoperative awareness, that is, experience with the recall of prior experience. As some would say, ‘‘What difference does it make if you don’t remember anything?’’ We contend that it does make a difference. For how long can you expose someone to a hurtful condition without causing permanent psychologic damage under the cover of amnesic treatment? This ethical quandary compels us to research the ways to reliably assess and prevent awareness, not just to prevent the recall of intraoperative awareness.