Background: Intraoperative awareness under general anesthesia is a rare but distressing complication with potential long-term psychological consequences. Despite advancements in anesthetic techniques and monitoring, its occurrence remains a concern in clinical practice. Aim: To determine the incidence of intraoperative awareness and recall, and to identify associated risk factors and outcomes among patients undergoing elective surgeries under general anesthesia. Methods: This prospective observational study was conducted at a tertiary care center over 18 months from June 2025 to December 2026. A total of 2800 adult patients undergoing elective surgeries under general anesthesia were included. Standardized anesthesia protocols and monitoring were employed. Postoperative assessment of awareness was conducted using a structured interview based on the modified Brice questionnaire at multiple time points. Data were analyzed to determine incidence and associated risk factors. Results: The incidence of intraoperative awareness was 0.57% (16/2800). Among these, 62.5% reported vague perceptions, while 37.5% experienced vivid recall. Auditory perceptions (56.25%) and sensations of paralysis (37.5%) were the most commonly reported experiences. Prolonged surgery duration (>4 hours) (OR 3.21, p<0.05) and use of neuromuscular blocking agents (OR 2.89, p<0.01) were significantly associated with increased risk of awareness. Conclusion: Intraoperative awareness, though infrequent, remains clinically relevant. Identification of high-risk factors and implementation of vigilant anesthetic practices, along with routine postoperative assessment, are essential to minimize its occurrence and improve patient safety.

Intraoperative awareness, General anesthesia, Recall, Bispectral Index, Neuromuscular blocking agents, Patient safety