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Dreaming during anaesthesia is defined as any recalled experience (excluding awareness) that occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Dreaming is a commonly-reported side-effect of anaesthesia. The incidence is higher in patients who are interviewed immediately after anaesthesia (≈22%) than in those who are interviewed later (≈6%). A minority of dreams, which include sensory perceptions obtained during anaesthesia, provide evidence of near-miss awareness. These patients may have risk factors for awareness and this type of dreaming may be prevented by depth of anaesthesia monitoring. Most dreaming however, occurs in younger, fitter patients, who have high home dream recall, who receive propofol-based anaesthesia and who emerge rapidly from anaesthesia. Their dreams are usually short and pleasant, are related to work, family and recreation, are not related to inadequate anaesthesia and probably occur during recovery. Dreaming is a common, fascinating, usually pleasant and harmless phenomenon.
Leslie et al. “Dreaming during anaesthesia in adult patients”
Best Practice & Research Clinical Anaesthesiology
Volume 21, Issue 3, September 2007, Pages 403-414
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BMC Anesthesiol. 2016 Aug 2;16:53. doi: 10.1186/s12871-016-0214-1
“Dreaming under anesthesia: is it a real possiblity? Investigation of the effect of preoperative imagination on the quality of postoperative dream recalls”
Judit Gyulaházi et al.
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“The relationship between different bispectral index and the occurrence of dreams in elective surgery under general anesthesia: protocol for a randomized controlled clinical trial”
Yufei Zhang, Bijia Song & Junchao Zhu
Trials, volume 24, Article number: 205 (2023)
Abstract
Introduction
Dreaming reported after anesthesia remains a poorly understood phenomenon. At present, there is a hypothesis that dreaming occurs intraoperatively and is related to light or inadequate anesthesia; thus, in order to further verify the hypothesis, we choose elective surgery under general anesthesia to observe whether the generation of dreams is related to the dose of general anesthetics maintenance.
Introduction
Dreaming is a familiar and mysterious mode of cognitive function, and we involuntarily return to this mode every night. Dreaming during sleep is defined as “any type of cognitive activity that occurs during sleep” and is “a subjective experience that can only be obtained through the dreamer’s memories after waking up.” Despite more than a century of scientific exploration, dreams continue to arouse the interest of sleep scientists, but they are still not fully understood [1, 2]. Moreover, its rigorous scientific exploration is a recent development, dating back to the discovery of rapid eye movement (REM) sleep in the 1950s. When this stage of sleep was first described in humans, researchers quickly noticed that people who awakened from REM sleep often reported dreaming (in 74% of cases, only 17% of non-REM [NREM] sleep). Therefore, dreaming is equivalent to rapid eye movement sleep, and this concept seems to be consistent with the electrophysiological characteristics of this sleep stage: closing the eyeballs under the eyelids, as if the sleeper is watching an animated scene [3, 4]. General anesthesia causes a drug-induced state of unconsciousness and is a non-physiological process that is similar to natural sleep. Its purpose is to create a state of sensory deprivation wherein patients are unresponsive to stimuli and thus leads to explicit amnesia [5]. Dreaming is also a common, long-lasting, and fascinating part of the anesthesia experience, but its cause and timing are still elusive. Patients usually report that they dreamed during anesthesia, but the actual time of dreaming during anesthesia is unknown. Dreaming during anesthesia can be defined as “any experience (excluding awareness) that a patient is able to recall and which he or she thinks occurred between induction of anaesthesia and the first moment of consciousness after anaesthesia” [6]. Patients receiving propofol for general anesthesia often report a higher incidence of dreaming compared with patients maintained with volatile anesthetics [7]. One explanation is that propofol and volatile anesthetics have different pharmacological effects in the central nervous system [8, 9]. Another explanation is that propofol can wake up from anesthesia faster than the volatile anesthetics, allowing patients to report their dreams before they are forgotten [10]. Why is the investigation of dreams during anesthesia important? Dreaming is one of the most common side effects of anesthesia, but it is still puzzling and requires explanation [7, 11]. Dreaming can sometimes make patients feel distressed and may reduce satisfaction with care [12]. Some patients who report dreaming worry that their anesthetic is insufficient; their experience is actually consciousness. At present, there is a hypothesis that dreaming occurs intraoperatively and is related to light or inadequate anesthesia; thus, in order to further verify the hypothesis, we choose elective surgery under general anesthesia to observe whether the generation of dreams is related to the dose of general anesthetics maintenance.
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“Dreaming during gastrointestinal endoscopy under propofol, ciprofol, or remimazolam anesthesia: study protocol for a parallel-design double-blind, single-center trial”
Le-Qiang Xia et al
Trials, volume 25, Article number: 2 (2024)
Abstract
Background
Dreaming sometimes occurs during sedation. It has been reported that factors such as different anesthetics, depth of anesthesia, age, sex, and preoperative psychological state may affect dreams. Ciprofol and remimazolam are novel choices for painless endoscopy. Herein, we aimed to investigate dreaming during gastrointestinal endoscopy under propofol, ciprofol, and remimazolam anesthesia respectively.
Methods
This is a prospective, parallel-design double-blind, single-center clinical trial. Three hundred and sixty subjects undergoing elective painless gastroscopy, colonoscopy, or gastroenteroscopy will be enrolled. Eligible subjects will undergo propofol-, ciprofol-, or remimazolam-induced anesthesia to finish the examination. Interviews about the modified Brice questionnaire will be conducted in the recovery room. Incidence of dreaming is set as the primary outcome. Secondary outcomes include type of dreams, improvement of sleep quality, evaluation of patients, incidence of insufficient anesthesia, and intraoperative awareness. Safety outcomes are the incidences of hypotension and hypoxia during examination and adverse events during recovery.
Discussion
This study may observe different incidences of dreaming and diverse types of dreams, which might lead to different evaluations to the anesthesia procedure. Based on the coming results, anesthesiologists can make a better medication plan for patients who are going to undergo painless diagnosis and treatment.
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Discussion
In recent years, the amount of painless gastrointestinal endoscopy has been increasing. It was reported that approximately one-fifth to one-quarter of them experienced dreams during painless gastrointestinal endoscopy [5, 19, 20]. Xu et al. [20] observed that among the dreamers, approximately one-third reported pleasant dreams. Studies have demonstrated that the main factors influencing dreams during anesthesia include the kind and dosage of anesthetics, depth of anesthesia, sex, and preoperative psychological pretreatment [4, 5, 20,21,22,23]. Furthermore, Yoshida et al. [24] found that a less than 11 depression score of the HADS was highly correlated with positive dreams.
In the present study, we intended to investigate dreaming during painless gastrointestinal endoscopy under propofol, ciprofol, and remimazolam anesthesia respectively. The primary aim of this study is to analyze the incidence of dreaming in the three groups. Since the duration of examination and recovery is short, we did not choose complicated scales. Instead, we selected the modified Brice questionnaire which has been widely applied by researchers to determine whether there is a dream or intraoperative awareness [3, 25, 26]. For those who have a dream, patients simply need to tell pleasant, unpleasant, or indifferent to evaluate the quality of the dreams.
To minimize the mentioned confounding factors, we plan to take some measures. First, we will test the HADS for the patients. In this way, some patients with severe undiagnosed anxiety and depression can be excluded. Second, the Narcotrend index will be monitored for its good consistency between sedation depth and propofol or benzodiazepines [27, 28]. Considering that the stimulus intensity of gastrointestinal endoscopy is relatively mild, sufficient anesthesia is defined as grade C of the Narcotrend index. This is similar to a previous study in which no intraoperative awareness was observed even though quite a few Narcotrand values were above 70 [29].
There are some limitations in the study. On the one hand, we do not prescribe a limit to the category of endoscopy. Gastroenteroscopy is more likely to take more time and drugs than gastroscopy. However, these two factors are not the outcome parameters. On the other hand, we do not administer the anesthetics in a continuous way, which may cause fluctuations in sedation. Since it is difficult for us to predict the duration of endoscopy, continuous administration may lead to explosive suppression of the brain. In addition, this is a single-center trial, and multicenter studies are still needed.
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Anaesthesia Dream Therapy
Inside the emerging world of anesthesia “dream therapy”
“The amount of interest is enormous,” says anesthesiologist Boris Heifets. “People are dropping in and coming out of the woodwork, trying to understand how to do this.”
Key Takeaways
- Anesthesia-induced dreams, once considered random side effects, are being studied for their therapeutic potential.
- Stanford researchers Harrison Chow and Boris Heifets are exploring how these dreams, which often feature hyper-vivid and structured narratives uncharacteristic of “normal” dreaming, may help ease anxiety and trauma.
- Big Think contributor Saga Briggs recently visited the Stanford team to explore the origins and future of this emerging field — and the curious parallels between anesthesia dreams and psychedelic experiences.
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American Journal of Psychiatry Volume 181, Issue 6 ,June 01, 2024
Pages 461-564
ARTICLE
“Reduction in Trauma-Related Symptoms After Anesthetic-Induced Intra-Operative Dreaming”
Laura M. Hack, Pilleriin Sikka, Kelly Zhou, Makoto Kawai, Harrison S. Chow and Boris Heifets
To the Editor: While dreaming during anesthesia is common (1), it is not known whether this phenomenon differs from normal dreaming or has post-surgical benefits. We present two cases of female patients who experienced rapid and sustained reduction of posttraumatic stress disorder (PTSD) symptoms immediately following anesthetic-based EEG-guided intraoperative dream induction. Both patients underwent surgeries and received propofol/opioid-based anesthetics. Upon finishing the surgery but before emergence, we maintained a pre-emergent anesthetic state characterized by specific frontal cortical activity for several minutes: reduced alpha power and enhanced beta power (2). Based on previous findings showing that dreaming during anesthesia is associated with more high-frequency frontal power before emergence (3) or as compared to connected consciousness (1), we believe this cortical activity reflects dreaming while being sedated. Patients were interviewed immediately upon emergence, and both reported having had vivid dreams.
Both patients were identified as part of a quality-improvement program to enhance recovery after surgery, which includes informing patients of the possibility of dreaming without priming content, minimizing likelihood of emergence agitation through use of intravenous rather than inhalational anesthesia, minimal sensory input during gradual anesthetic emergence (4), and assessment for intraoperative awareness and dreaming immediately on emergence using a modified Brice Questionnaire (5). After identification, both patients provided informed consent for retrospective psychiatric diagnostic interviews. Patients were not identified preoperatively. Anesthetic adjustments, assessment, and diagnostic interviews adhere to established standards of care, received approval from the IRB, or fall under IRB exemption (IRB exempt protocols #54043, #59783, #65538, #67245; informed consent provided on IRB protocol #67399).
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Dreamyoga 