Authors: Sikka P et al.
Source: Anesthesiology, February 03, 2026, 10.1097/ALN.0000000000005968
Summary:
This prospective quality improvement feasibility study evaluated whether a standardized, multicomponent anesthetic protocol could reliably promote dreaming during surgical anesthesia in routine clinical practice. Dreaming under anesthesia is common and has been hypothesized to carry potential mental health or experiential benefits, but prior research has largely been experimental rather than embedded in real-world perioperative workflows.
The authors implemented a five-element, propofol-based, EEG-guided emergence protocol in 474 adult patients undergoing elective surgery. The protocol included pre-induction verbal priming about dreaming, use of propofol as the emergence anesthetic, EEG monitoring to guide emergence, a ≥10-minute period of reduced stimulation before emergence, and structured post-emergence interviews assessing dream recall, emotional valence, and perceived sleep quality. Outcomes focused on feasibility, adherence, safety, and patient experience, with additional preregistered PACU outcome analyses in a subset of breast cancer patients.
Among the 452 patients who completed post-emergence interviews, 69% reported dreaming during anesthesia. When the protocol was fully adhered to, the dream recall rate increased to 93%, approaching rates reported in tightly controlled experimental settings. Most dreams were described as positive, with no reports of very negative dream experiences. Patients who reported dreaming also described significantly better perceived sleep quality compared with those who did not dream.
From a safety perspective, no cases of intraoperative awareness occurred, and recovery profiles were similar between dreamers and non-dreamers. There were no differences in recovery times, analgesic requirements, or antiemetic use, suggesting that the protocol did not adversely affect standard perioperative outcomes. Adherence was high for most protocol elements, including verbal priming, propofol use, EEG monitoring, and post-emergence interviews, although adherence to the reduced-stimulation emergence window was notably low.
Overall, the study demonstrates that anesthesia dreaming can be systematically facilitated using a structured protocol integrated into everyday anesthesia care. The authors conclude that while dream recall did not translate into measurable PACU outcome differences, the high incidence of positive dreaming and improved subjective sleep quality support further investigation into potential therapeutic or experiential benefits, consistent with patient-centered and ERAS-aligned care models.
Key Points:
• Dreaming during anesthesia can be intentionally facilitated in routine practice
• A multicomponent, EEG-guided propofol emergence protocol is feasible and safe
• Full protocol adherence resulted in very high dream recall rates
• The majority of anesthesia dreams were emotionally positive
• Dreaming was associated with improved subjective sleep quality
• No adverse effects on PACU recovery, analgesia, or antiemetic use were observed
• Findings support future research into therapeutic and patient-experience benefits
Thank you to Anesthesiology for allowing us to summarize and discuss this article.