Authors: Sikka P et al.
Anesthesiology, February 03, 2026, 10.1097/ALN.0000000000005968
This prospective quality improvement study evaluated whether a structured anesthetic protocol could increase the likelihood of dreaming during surgical anesthesia. Previous research has shown that dreaming during anesthesia occurs in a subset of patients and may be associated with positive subjective experiences and potential mental health benefits. However, little research has examined whether anesthesia teams can deliberately influence dreaming through modifications in anesthetic management.
The investigators implemented a multicomponent protocol designed to create conditions believed to favor dream generation during emergence from anesthesia. The study was conducted in a real-world clinical setting and included 474 patients undergoing elective surgical procedures.
The protocol consisted of five elements. First, patients received pre-induction verbal priming in which they were informed that dreaming during anesthesia is possible. Second, propofol was used as the primary anesthetic agent during emergence. Third, electroencephalographic monitoring using the SedLine system was used to guide anesthetic depth and emergence. Fourth, clinicians attempted to minimize stimulation for at least ten minutes before emergence. Finally, patients were interviewed immediately after awakening regarding dream recall, emotional tone of the dream, and perceived sleep quality.
Of the 474 enrolled patients, 452 completed post-emergence interviews. Overall, 69% reported experiencing dreams during anesthesia. Among the smaller subgroup of patients in whom all five protocol elements were successfully implemented, dream recall increased to 93%. These findings suggest that systematic adjustments in anesthetic management may substantially increase the probability of dream recall.
Most dreams were positive in emotional tone. Eighty-six percent of reported dreams were described as pleasant or positive, and none were reported as strongly negative. Patients who reported dreaming also rated their sleep quality significantly higher than those who did not report dreams.
The study also evaluated clinical outcomes in a subset of 106 patients undergoing breast cancer surgery. The investigators examined several recovery-related measures in the post-anesthesia care unit, including recovery time, analgesic use, and antiemetic administration. No differences were found between dreamers and non-dreamers for these outcomes, suggesting that the protocol did not adversely affect routine postoperative recovery.
Importantly, the protocol appeared safe. No cases of intraoperative awareness were reported during the study period. This finding is particularly relevant because protocols designed to facilitate dreaming could theoretically raise concerns about insufficient anesthetic depth. EEG monitoring was incorporated specifically to minimize that risk.
The study also assessed feasibility in routine clinical practice. Adherence was high for several components of the protocol. Verbal priming and the use of propofol during emergence were achieved in all patients, and EEG monitoring and immediate interviews were performed in more than 90% of cases. However, adherence to the low-stimulation emergence period was much lower, occurring in only 14% of patients. This reflects the practical challenges of maintaining minimal stimulation during routine operating room workflows.
The authors conclude that promoting dreaming during anesthesia appears feasible and safe when guided by EEG monitoring and structured anesthetic practices. Although dreaming was associated with more positive subjective sleep quality, it did not affect standard postoperative recovery outcomes. The investigators suggest that further research could explore whether anesthesia-induced dreaming may have therapeutic value, potentially aligning with enhanced recovery and patient experience initiatives.
What You Should Know
Dreaming during anesthesia occurs naturally in many patients and may be associated with positive subjective experiences.
This study showed that a structured anesthetic protocol can increase dream recall rates to nearly 70% overall and over 90% with full protocol adherence.
Most reported dreams were positive, and none were strongly negative.
Dreaming did not change PACU recovery times, analgesic requirements, or antiemetic use.
The protocol appeared safe and did not increase the risk of intraoperative awareness.
Key Points
A five-element anesthetic protocol was designed to promote dreaming during anesthesia.
Elements included verbal priming, propofol-based emergence, EEG monitoring, minimal stimulation before emergence, and immediate postoperative interviews.
Overall dream recall occurred in 69% of patients.
With full adherence to all protocol components, dream recall reached 93%.
Dreamers reported better subjective sleep quality than non-dreamers.
The protocol was feasible in routine clinical care and did not affect postoperative recovery outcomes.
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