Propofol injection discomfort recall after monitored anesthesia care or general anesthesia: a prospective observational cohort study.

PURPOSE: Pain during propofol injection is common, yet little is known about how often patients remember this experience after anesthesia or which perioperative factors influence memory formation during induction.

METHODS

In this prospective single-center observational cohort study, English-speaking adults (≥ 18 years) receiving propofol under general anesthesia (GA) or monitored anesthesia care (MAC) were enrolled. Perioperative characteristics, intravenous access details, anesthetic medications and clinician-observed injection pain were recorded. On postoperative day 1, patients were interviewed using a standardized questionnaire assessing recall of discomfort during induction. Univariate and multivariate logistic regression analyses calculated adjusted odds ratios (aOR) and identified factors associated with recall.

RESULTS

Of the 1,699 enrolled patients, 1,319 completed the postoperative day 1 assessment; 8.1% reported recall of injection discomfort. Multivariate analysis indicated that younger age (aOR = 1.03; 95% CI = 1.01-1.04; p < 0.001), female gender (aOR = 1.69; 95% CI = 1.02-2.82; p = 0.044), hand IV placement (aOR = 2.164; CI 95% = 1.287-3.636; p = 0.004), and absence of midazolam premedication (aOR = 2.62; 95% CI = 1.44-4.78; p = 0.002) were associated with increased recall.

CONCLUSION

Approximately one in twelve patients recalled discomfort during propofol injection. Patient characteristics and modifiable anesthetic practices, particularly premedication and intravenous access site, were associated with memory of propofol injection discomfort. These findings highlight that memory formation during induction represents a distinct and clinically relevant patient-centered outcome.