Anesthesiology. 2026 Feb 3. doi: 10.1097/ALN.0000000000005968. Online ahead of print.
ABSTRACT
BACKGROUND: Dreaming during anesthesia is common and may have mental health benefits. However, systematic research on its incidence and outcomes in clinical settings remains limited. We implemented a standardized propofol-based, EEG-guided emergence bundle to facilitate a pre-emergence state conducive to dreaming, integrating it into routine care to assess adherence, dream recall, patient experience, and safety.
METHODS: In this prospective quality improvement feasibility study, 474 patients undergoing elective surgeries were anesthetized according to a five-element protocol: (1) pre-induction verbal priming about dreaming; (2) propofol as emergence anesthetic; (3) EEG (SedLine) monitoring to guide emergence; (4) ≥10 minutes of minimized stimulation before emergence; and (5) immediate post-emergence interviews regarding dream recall, valence, and subjective sleep quality. In a subset of breast cancer patients (N = 106), preregistered analyses examined post-anesthesia recovery unit (PACU) outcomes.
RESULTS: Of 452 patients interviewed, 69% reported dreaming. Among 57 patients with full adherence to all protocol elements, 93% reported dreaming. Most dreams were positive (86%), with no very negative dreams. Dreamers (M = 9.16 ± 1.57) reported higher sleep quality than non-dreamers (M = 7.65 ± 2.86; p < 0.001). The protocol was safe, with no intraoperative awareness. Recovery times, analgesic and antiemetic use did not differ between groups. Feasibility was supported by high adherence to most elements (100% for verbal priming and propofol use; ≥90% for EEG monitoring, 95% for immediate interviews), though adherence to the no-stimulation emergence period was low (14%).
CONCLUSIONS: We demonstrate the feasibility of using a standardized anesthetic protocol in real-world clinical setting to facilitate anesthesia dreaming. With full adherence, dream recall rates approached experimental studies. The protocol was safe and linked to positive patient experiences, although dream recall was unrelated to PACU outcomes. These findings align with ERAS principles and provide a foundation for exploring potential therapeutic applications of anesthesia dreaming.
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