Awareness during emergence from anesthesia: Features and future research directions

Table 2 Prophylactic strategies for prevention of awareness in the awakening phase

Preoperative phase

Identification of patients at risk and correction of modifiable risk factors

Careful information of patients at risk such as those who have experienced awareness

Check of anesthesia devices and instruments

Intraoperative management

Use of neuromuscular monitoring (quantitative > qualitative)

Maintenance of an adequate anesthesia state until complete recovery of the neuromuscular block

Careful dose adjustment of neuromuscular blocking drugs

Careful management of the reversal (train of four at least 4)

Avoid, if possible, extubation with a fully conscious patient

Use of brain monitoring devices (especially in high-risk patients)

Set threshold alarms of devices following the manufacturer’s specifications

Maintain professionalism in the theatre