A standardized propofol-based anesthesia protocol with EEG monitoring and verbal priming about dreaming led 69% of 452 surgical patients to report dreaming, and 93% of those who received all protocol elements did so. Most dreams were positive (86%), and dreamers reported higher subjective sleep quality than nondreamers. The protocol was safe, with no intraoperative awareness, and recovery times and medication use did not differ between groups. Adherence was high for most elements but low for the no-stimulation emergence period. The approach is feasible in routine clinical care and aligns with Enhanced Recovery After Surgery principles.
Dreaming during anaesthesia is common and has been documented for over a century, but remains poorly understood. This review of 157 studies from 1921 to 2024 involving 87,866 participants found that dream recall rates vary widely, from 3% to 8% in large clinical trials to 40% to 80% in experimental settings. Ketamine and propofol are most consistently associated with recall. Dreams are predominantly pleasant and feature everyday autobiographical content. Dream recall is not linked to intraoperative awareness, challenging the idea that dreams indicate inadequate anaesthetic depth. Higher home dream recall, preoperative suggestion, and immediate post-emergence assessment increase recall rates. Unpleasant dreams reduce willingness to undergo the same anaesthetic again. The positive nature and suggestibility of anaesthesia dreams suggest potential therapeutic uses.