Medically reviewed by Dr. Daniel Cole, MD, August 8, 2024.

Anesthesia Awareness (Waking Up) During Surgery

If you’re having major surgery, you will most likely receive general anesthesia and be unconscious during the procedure. This means you should have no awareness of the procedure once the anesthesia takes effect, and you won’t remember it afterward.

Very rarely—in only one or two of every 1,000 medical procedures involving general anesthesia—a patient may become aware or conscious. With this condition, called anesthesia awareness (or waking up) during surgery, the patient can recall their surroundings or events that occurred during surgery despite the induction of general anesthesia. Although it can be upsetting, patients usually do not feel pain when experiencing anesthesia awareness.

Anesthesia awareness is not the same as remembering some activities surrounding your procedure, such as something that happened just before the anesthesia started working or when its effects began to wear off after surgery. This is normal. You might even dream during surgery.

Although it can be upsetting, patients usually do not feel pain when experiencing anesthesia awareness.

Why do some patients experience anesthesia awareness?

Anesthesia awareness during surgery can happen for a few reasons. It can be more common in patients with multiple medical conditions, and certain surgeries or circumstances increase the risk of awareness because the usual dose of required anesthesia cannot be used safely. These surgeries are often emergencies, such as emergency C-sections, certain types of heart surgery, and surgery that’s needed after a traumatic injury.

What happens if you have anesthesia awareness during surgery?

People who have experienced awareness while undergoing general anesthesia report varied levels of awareness. Some people have brief, vague recollections. Others remember a specific moment of surgery or their surroundings. In some cases, people recall a feeling of pressure.

With procedures that do not involve general anesthesia, patients may be awake and aware throughout the procedure, or they may recall all or part of it afterward. This is perfectly normal and is not anesthesia awareness. It may happen with the following types of anesthesia:

• Intravenous, or twilight sedation, which is often used for minor procedures such as colonoscopies, certain types of biopsies, and dental procedures.
• Local or regional anesthesia, such as an epidural, spinal analgesia, or nerve analgesia, which temporarily numbs the area being treated during the surgery.

Depending on the person and the event, anesthesia awareness while undergoing general anesthesia can be disturbing and even traumatic. If it should happen to you, be sure to describe your experience to your anesthesiologist after your surgery. Some patients benefit from counseling after surgery to help cope with feelings of confusion and stress.

How do you reduce the risk of anesthesia awareness?

Before your surgery, your anesthesiologist will meet with you to learn about any health conditions you may have as well as your previous experiences with anesthesia. To reduce your risk of experiencing awareness during general anesthesia, it is important to give your anesthesiologist as much information about your health as possible, including the following:

• Previous problems with anesthesia, including a history of being aware during surgery
• All medications and supplements you are taking, including prescription and over-the-counter drugs and herbal supplements
• Concerns you may have about surgery, including fear of awareness after general anesthesia has been administered
• History of drug or alcohol use, which can increase the risk of anesthesia awareness

Anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management, and critical care medicine with the education and training that can mean the difference between life and death.