Should disclosure of the danger of awareness during general anesthesia be a part of preanesthesia consent?

Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a series of untoward effects, among them symptoms compatible with the posttraumatic stress syndrome (PTSS). Incidence of AGA ranges between 0.1% and 0.7%, most of the reports indicating a 0.2% rate of all general anesthesias. Nevertheless, some patients are considered to be in a higher than usual risk for developing this incident. The list of AGA high-risk situations include caesarian section, open heart surgical procedures, marked obesity, major trauma with hemodynamic instability and chronic use of drugs, alcohol or tobacco smoking. The usual preanesthetic informed consent does not mention AGA among the possible undesired effects of general anesthesia, neither in Israel nor in other parts of the world. This paper rises the question of the indication to discuss the AGA matter, as part of the informed consent, with any patient who is prone develop it in a significant higher percentage than the general population. The topic can be discussed by the primary care physician or by the surgeon, but this represents the obvious task of the anesthesiologist during his/her first contact with the patient before anesthesia and surgery. It is the authors belief that a preoperative discussion on AGA might substantially reduce the magnitude of repercussions of AGA among high-risk patients to develop this anesthetic complication.