A look at what anesthetic awareness is, what causes it and how it can be prevented.
On November 30, a new movie, Awake, opened. Featuring Jessica Alba and Hayden Christensen, it tells the fictional story of a dying patient who undergoes a heart transplant, only to find himself fully awake on the operating table but unable to move or speak due to the paralysing drugs and breathing tubes. He cannot scream out or move an inch and he feels every cut.
It is an extremely scary script, but did you know it can actually happen?
According to the American Association of Nurse Anesthetists, the condition known as Anesthetic Awareness occurs in 1 in 1,000 patients undergoing surgeries. They state that it 'occurs infrequently' and is 'highly unusual'. Many patients would think this is contradictory, as 1 in 1,000 cannot be considered to be infrequent or unusual. Some studies into the phenomena have found the rate to be as high as 2 in every 1,000.
In the USA, 21 million patients have surgery every year. Using these figures would mean that a staggering 20,000 to 40,000 people would experience anesthetic awareness in any one year.
Very often it is not as severe as in the movie Awake, as there are varying levels of awareness. 48% of cases who were studied after the event, described being able to hear the surgeons but they experienced no pain. The same 48% also described feeling as if they couldn't breathe.
28% were completely aware and able to feel the pain of the operation.
Most survivors of anesthetic awareness suffer from depression and post traumatic stress disorder as a result, from which many do not recover.
What Causes Anesthetic Awareness?
Doctors are unsure of the exact reasons why a person may be aware during surgery, but it may be due to a variety of factors, including:
- Faults with hospital equipment
- Human error - administration of the wrong drug or not enough of the drug
- Hypersensitivity to drugs - some patients who react badly to anesthetics are given lighter doses which may increase the risk of anesthetic awareness.
- Drug abuse - heroin addicts take large quantities of morphine so they would need a larger than usual dose of anesthetic to put them to sleep
- Emergency trauma situations, e.g. car crash victims. These patients have often lost a lot of blood and could not tolerate large doses of anesthetics so surgeons purposefully give a lighter dose which may result in awareness
- Emergency Caesarians - a larger proportion of women undergoing emergency caesarian sections have experienced awareness because some surgeons do not like to use very deep anesthetic for this.
- Sometimes a patient wakes up before the operation is complete because the level of sedation is not kept up.
- Heart patients are also at higher risk of awareness because high doses of anesthetics could cause heart failure.
Carol Weihrer, founder of the Anesthetic Awareness Campaign, had an awareness experience herself in 1998.
'While my right eye was being surgically removed, I received no anesthesia but plenty of paralytic and I was totally unable to move or communicate in any way but absolutely aware of what was going on,' she said, 'I was screaming inside my own head and literally thought I was dying.'
She set up the campaign about three months after her ordeal. Today she suffers from post traumatic stress disorder, has panic attacks, doesn't like crowds, can't sleep in a bed and no longer has REM sleep.
What Can Be Done To Prevent It?
- Always go over your medical history with the surgeon, including any previous morphine use.
- Where possible, opt for surgery using epidural anesthetics so you can remain awake and tell the surgeon if something is hurting, e.g. caesarian delivery of your baby.
- Don't have a surgery which isn't done for medical reasons, like cosmetic surgery.
- Ask your surgeon if he can monitor your brain during surgery. Some hospitals do record patients brain waves as these indicate whether the person has any awareness, and studies have shown they can be effective at preventing anesthetic awareness. If your hospital won't monitor you, consider asking for another hospital.
- If you are having inhaled anesthetics, make sure your hospital has canisters which have an alarm on them to tell doctors when the anesthetic is running out. Some don't and cases of anesthetic awareness have occurred then.
- Make sure your nurse anesthetist checks all drips throughly to reduce the risk of an IV fault.
If you have suffered from anesthetic awareness, please contact:
Carol Weihrer, President and Founder
Anesthesia Awareness Campaign, Inc.
1658 Parkcrest Circle 200
Reston, VA 20190-4946
e-mail: anesawareness@aol.com
