Dissociative identity disorder (DID) is a psychiatric condition characterized by multiple distinct personalities and repeated dissociative amnesia. In this case, we performed general anesthesia on a DID patient with 20 distinct personalities that could emerge during periods of increased mental stress or anxiety. The patient was a 36-year-old man with a history of left cleft lip and palate undergoing a secondary alveolar bone graft from a tibial donor site. Several of his alternate personalities emerged during the perioperative period, including a 7-year-old boy who arrived the morning of surgery. However, by minimizing external stressors in the operating room and using a combination of propofol, sevoflurane, and remifentanil, we delivered general anesthesia safely without any emergence delirium or delayed awakening, and the surgery was successfully completed. Upon awakening, the patient was in his host personality and had no memory of entering the operating room. Postoperatively, the patient's personality switched several...

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