Intraoperative Recall
reformatted from handout by Jennifer Sanderson, MD

• The Problem
• 7% of closed claims from intraoperative recall
• usually underdiagnosed because of inadequate questioning by anesthesiologist (and denial by pt)
• can lead to PTSD and poor post-op recovery
• Types of Recall
• Explicit: conscious, deliberate recollection of events
• Implicit: change in behavior attributable to intraoperative event
• Etiology
• 70% due to technique (light anesthesia)
• 20% due to equipment (empty vaporizer or faulty ventilator/circuit)
• 10% unknown
• Risk (Incidence)
• 0.2 – 2.0% of all GA
• increased in ...
• OB: 7 – 28%
• major trauma: 11 – 48%
• cardiopulmonary bypass: 23%
• bronchoscopy: 8%
• Preoperative Preparation
• Inform patient about risk of explicit and implicit memory, and assure the patient that you will be there at all times.
• If possible, allow the patient option of earplugs, music, or tape to listen to during operation (esp. if history of intra-op recall).
• Use an amnestic agent pre-op. [Ed. I'd think an adequate induction dose followed by rapid administration of a volatile agent at high concentrations - overpressure - would be all that's needed; not everyone needs preop midazolam.]
• Intra-op Management
• maintain at least one twitch if muscle relaxation necessary
• BIS
• excess induction agent if possible, or supplement if more time required to    control airway
• spontaneous ventilation when possible
• reverse muscle relaxation well before decreasing anesthetic
• Postop Followup: Ask ...
• last thing remembered before going to "sleep"
• first thing remembered after waking up
• anything in between ... could it have been a dream?
• Bottom Line:  Watch what is said in the OR (good & bad)!!

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