[Incidence and quality of dreaming during anesthesia with propofol in comparison with enflurane].
H Käsmacher, M Petermeyer, C Decker
Der Anaesthesist February 1996 DOI: 10.1007/s001010050249 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 230 |
| Population | ASA I-II patients undergoing minor elective surgery |
| Interventions | Propofol Enflurane Fentanyl Vecuronium Nitrous oxide Flunitrazepam Etomidate |
| Dose | Propofol 2 mg/kg induction, then approximately 10 mg/kg.h saturation phase, then 5-6 mg/kg.h maintenance; etomidate 2 mg/kg; enflurane 0.8%-1.5%; flunitrazepam 1 mg |
| Duration | Interviews preoperatively, just after recovery, and 24 h later |
| Topics | Dreaming |
| Key findings | Propofol anaesthesia produced far more intraoperative dreaming than enflurane (60% vs 11%), with nearly all propofol dreams described as very pleasant and 37% recalled one day later. No evidence of intraoperative awareness appeared. The authors argue these experiences are dreams rather than stimulus-related perceptions and propose dreaming as a specific side effect of propofol that does not reduce anaesthesia quality. |
Abstract
Since the introduction of propofol into clinical practice, dreaming during general anaesthesia has been frequently reported with this drug. We investigated the incidence and character of these dreams with regard to distinction from intraoperative awareness and in comparison with habitual dreams or dreams during general anaesthesia with enflurane. A total of 230 patients (ASA I-II) undergoing minor elective surgery were randomly assigned to one of two groups. Both groups received the same premedication (1 mg flunitrazepam) the previous evening. After induction using etomidate 2 mg/kg, anaesthesia in group I was maintained using 0.8%-1.5% enflurane supplemented in the sense of "balanced anaesthesia" with fentanyl, vecuronium, and nitrous oxide. Anaesthesia in group II was induced with propofol 2 mg/kg. After a saturation phase of approximately 10 mg/kg.h, 5-6 mg/kg.h was administered for maintenance supplemented by fentanyl, Vecuronium, and N2O as in group I. Interviews were conducted preoperatively, just after recovery from anaesthesia, and 24 h later. We inquired about preoperative fears or concerns, sensory perceptions, and the incidence and character (pleasant, unpleasant, indifferent) of habitual dreams. After recovery the patients were asked if they had had any conscious perceptions, whether they believe them to be dreams or reality, and repeated the preoperative questions as to common feelings and the character of sensory perceptions. The two groups were not entirely comparable due to the distribution of sex and age, but we did not find any differences in preoperative grades of fear and incidence of dreams. Of the propofol patients, 60% dreamed intraoperatively versus 11% in the enflurane group. No evidence of any intraoperative awareness was found. Because of the low incidence of dreams in the enflurane group, a comparison of detailed information between the groups could not be provided. Except for 1, all patients in the propofol group had very pleasant dreams compared to their habitual dreams (4.5% in the enflurane group). One day after surgery 37% of all patients in the propofol group remembered having dreamed intraoperatively. We did not found any correlation to the incidence of habitual dreaming, preoperative fear, age, sex, duration of anaesthesia, or total dose of propofol. Furthermore, intraoperative dreams differed from habitual dreams in character and content. We conclude that sensory experiences during propofol anaesthesia are not stimulus-related perceptions or awareness, but dreams similar to normal ones. In view of the absence of clear signs of stimulus-related response, we presume that dreaming is a specific side effect of propofol. Because of the absence of difficulties, dreaming during propofol anaesthesia appears not to be a disadvantage with regard to the quality of anaesthesia.
Comparable studies
Other randomized controlled trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Combat veterans of Operation Enduring Freedom and/or Operation Iraqi Freedom (mean age... | 2013 | Randomized controlled trial | n = 40 |
| Lucid Dreaming Treatment for Nightmares: A Pilot Study Chronic nightmare sufferers | 2006 | Randomized controlled trial | n = 23 |
| Testing the involvement of the prefrontal cortex in lucid dreaming: A tDCS study Participants spending three consecutive nights in a sleep laboratory | 2013 | Randomized controlled trial | n = 19 |
| The Beneficial Effects of One Treatment Session and Recording of Nightmares on Chronic Nightmare Sufferers Adults with chronic nightmares (mean duration 17.2 years) | 1992 | Randomized controlled trial | n = 20 |
| Pre-sleep treatment with galantamine stimulates lucid dreaming: A double-blind, placebo-controlled, crossover study Adults with high dream recall and an interest in lucid dreaming | 2018 | Randomized crossover trial | n = 121 |
Citations in the library
Cited by 7
- Are we really unconscious in "unconscious" states? Common assumptions revisited. Frontiers in Human Neuroscience 2022
- Propofol dose and incidence of dreaming during sedation. European journal of anaesthesiology October 2009
- Dreaming and electroencephalographic changes during anesthesia maintained with propofol or desflurane. Anesthesiology September 1, 2009
- Dreaming during anaesthesia in adult patients. Best practice & research. Clinical anaesthesiology September 2007
- Dreams recall and auditory evoked potentials during propofol anaesthesia. Neuroreport May 1, 2007
and 2 more in the library