It is a terrible situation - like the torments of hell visited upon the living. This is a disaster, a situation which all anesthesiologists dread having happen with their patients. Usually this situation is immediately recognized and appropriately dealt with, but some people react so minimally to the pain of their operations that the situation is not recognized. These people then suffer the torments of the damned. Profoundly upsetting to anesthesiologists, and for the patients themselves - horrible, horrible.
Monitoring of awareness during anesthesia The mainstays of monitoring and detecting awareness during general anesthesia still remain suspicion, the bodily reactions of the person, and supplementation of these things with diverse monitors.
Not everyone reacts exactly the same to standard dosages of anesthetic drugs. So some people may tell of awareness during previous general anesthetics, even though previous anesthetic records from that person reveal that the dosages of the drugs used, and the anesthetic technique was more than adequate to ensure unconsciousness. That person has a higher than normal chance of awareness during a subsequent anesthetic.
Sometimes a person is so critically ill, that lower dosages of general anesthetic drugs must be used, or the effect of even normal doses of these drugs will cause even more severe problems with the functioning of that person's body.
Such a person has a higher than normal chance or being aware during an operation, and all good anesthesiologists are aware of this risk and act accordingly. Anesthesiologists always carefully check for signs of possible awareness. The results, published in , found that the overall prevalence was just 1 in 19, patients undergoing anaesthesia. The figure was higher — around 1 in 8, — if the anaesthesia included paralysing drugs, which is to be expected, since they prevent the patient from alerting the anaesthetist that there is a problem before it is too late.
These low numbers were comforting news. For one thing, the National Audit Project relied on patients themselves reporting directly to the hospital — but many people may feel unable or unwilling to come forward, and would instead prefer to just put the experience behind them. There are also the amnesiac effects of the drugs themselves. So memory goes well before consciousness goes. To investigate this phenomenon, researchers are using what they call the isolated forearm technique.
This means that, for a brief period, the patient is still able to move their hand. So a member of staff could ask them to squeeze their hand in response to two questions: whether they were still aware, and, if so, whether they felt any pain. Read more in this short on how doctors are trying to detect anaesthesia awareness. In the largest study of this kind to date, Robert Sanders at the University of Wisconsin—Madison recently collaborated with colleagues at six hospitals in the US, Europe and New Zealand.
Of the patients studied, 4. That is hundreds of times greater than the rate of remembered awareness events that had been noted in the National Audit Project. And around four in ten of those patients who did respond with the hand squeeze — 1. These results raise some ethical quandaries. And without those long-term consequences, you might conclude that the momentary awareness is unfortunate, but unalarming.
Opinions were mixed. Given that the vast majority of patients will emerge from general anaesthesia without traumatic memories, there is the danger that reports of anaesthesia awareness — including this one — will needlessly increase anxiety before operations. Typically these monitor the EEG , which represents the electrical activity of the cerebral cortex , which is active when awake but quiescent when anesthetized or in natural sleep.
The monitors usually process the EEG signal down to a single number, where corresponds to a patient who is fully alert, and zero corresponds to electrical silence. General anesthesia is usually signified by a number between 60 and 40 this varies with the specific system used. There are several monitors now commercially available. None of these systems are perfect. For example, they are unreliable at extremes of age e. Secondly, certain agents, such as nitrous oxide , may produce anesthesia without reducing the value of the depth monitor.
Thirdly, they are prone to interference from other biological potentials such as EMG , or external electrical signals such as electrosurgery. This means that the technology that will reliably monitor depth of anesthesia for every patient and every anesthetic does not yet exist. This may in part explain why a systematic review and meta analysis concluded depth of anaesthesia monitors had a similar effect to standard clinical monitoring on the risk of awareness during surgery .
The incidence of this anesthesia complication is variable and seems to affect 0. This variation reflects the surgical setting as well as the physiological state of the patient. Thus, the incidence is 0. The incidence is halved in the absence of neuro-muscular blockade. The incidence of anesthesia awareness is higher and has more serious sequelae when muscle relaxants or neuromuscular-blocking drugs are used. One study has indicated this phenomenon occurs in about 1 or 2 per patients or 0.
Post operative interview by an anesthetist is common practice to elucidate if awareness occurred in the case. If awareness is reported a case review is immediately performed to identify machine, medication, or operator error. Patients who experience full awareness with explicit recall may have suffered an enormous trauma.
Some patients experience post traumatic stress disorder PTSD , leading to long-lasting after-effects such as nightmares , night terrors , flashbacks , insomnia , and in some cases even suicide. A study from Sweden in attempted to follow up 18 patients for approximately 2 years after having been previously diagnosed with awareness under anesthesia. All of these patients had experienced anxiety during the period of awareness, but only one had stated feeling pain.
Another three patients had less severe, transient mental symptoms, although they could cope with these in daily life. Two patients denied any lasting effects from their awareness episode.
From Wikipedia, the free encyclopedia. The rapid redistribution of induction agents and the strong stimuli of laryngoscopy and intubation tend to awaken the patients if an inadequate dose has been administered. Supplemental doses of induction agents should also be given when a difficult intubation necessitates a protracted period of repeated intubation attempts. Avoid muscle paralysis unless absolutely necessary, and even then, avoid total paralysis.
Autonomic responses to noxious stimuli during light anesthesia; i. Therefore, observation of voluntary movements or movement responses to noxious stimuli is the best clinical measure available for detecting wakefulness or impending wakefulness during surgery.
When inhalational agents are used alone, at least 0. Data obtained from volunteers and patients before surgery may underestimate the concentrations of anesthetic necessitated during surgery. A prudent anesthesiologist may elect to use higher doses whenever feasible.
There is no direct evidence for this possibility, but there are a few anecdotal reports 5,10,12 of unfavorable comments, which were voiced during anesthesia and retrieved during hypnosis, that caused psychologic disorders. Periodic maintenance of the anesthesia machine and its vaporizers and meticulous checking of the machine and its ventilator before administration of anesthesia. Regular checking of flow meters and the vaporizer and the level of the anesthetic in the vaporizer; monitoring of the concentrations of inspired and expired gases and inhalation agents; and general vigilance should eliminate cases caused by inadequate anesthetic delivery.
Discussion of the potential for awareness—auditory masking. It has been suggested that, in some cases, the anesthesiologist should talk to the patient about the potential for awareness or use measures such as earplugs and audiocassette earphones playing music or positive therapeutic suggestions. Informing the patient about the possibility of awareness should be restricted to cases in which such a risk is relatively high; e. Measures to prevent the patient from hearing operating room sounds fall short of alleviating most patient complaints; e.
Nevertheless, because patients are most likely to recall emotionally threatening remarks, 14 it is prudent for the operating room team to avoid voicing negative or derogatory remarks about the patient or the prognosis.
Cobcroft and Forsdick, 18 after reviewing a series of cases of awareness, concluded that, in most cases, understanding of the phenomenon and its management by medical personnel were poor or entirely lacking. In the Moerman et al. Monitor for awareness. There is interest in the development and use of a monitor of anesthetic depth. This subject will be discussed in a subsequent article.
A study published in the "New England Journal of Medicine" August 18, has actually shown that relying on a BIS brain monitor can actually increase the incidence of intraoperative awareness vs. This sounds counter-intuitive, but to me is not surprising. Here's why The BIS monitor which I use for other information gives a number that is indicates the level of consciousness.
In my experience disclaimer-based on only my experience, not scientific study , the changes in vital signs happen first. Heart rate goes up before you see a change in the BIS number. That means that providers who rely only on the BIS number and ignore the changes in vital signs may be missing the chance to prevent awareness.
The awareness may have already happened before the change in BIS number is seen. There is a lag between the event and the change in BIS. Personally, I try to use all the data available to me and not rely on the BIS monitor for prevention of awareness. Vital signs to me are more reliable, happen earlier before awareness can occur in most cases and should not be ignored to focus on the BIS monitor.
The BIS does provide other useful info, but is not as reliable as the manufacturer may claim to prevent awareness. If you have had a case of genuine intraoperative awareness, let your doctor, surgeon, or anesthesiologist know right away. Many people do well with just an explanation of why it might have happened.
Others suffer short-term or even long-term post-traumatic stress disorder. In those cases, an evaluation by a psychologist or psychiatrist and possible medications may be needed, usually on a short-term basis. If you aren't sure if you had true anesthesia awareness, speak to your surgeon or contact the anesthesiologist.
Most people who aren't sure have had one of the other experiences -- like sedation, dreaming, or waking at the end and being confused about the time -- and feel much better after having their questions answered.
Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
That could have caused blood blisters , pending on your skin sensitivity. I was told no people vomit sometimes when they see someone cutting into their body. The nerve damage would be from your carpal tunel syndrome if it wasnt corrected within a certain time of having the symptoms , not using hand brace etc.
I have an upcoming surgery. I'm very afraid and nervous. Do you have any suggestions to calm my nervousness? Also, is it true that you can't eat before surgery, or does it depend on what type of surgery? He went under general anesthesia. January 18, -- Revised brochure on Anesthesia Awareness! Anesthesia Awareness Campaign is one of the co-signatories. A lot of positive collaboration went into this document.
Please read it thoroughly and send it to friends and doctors!.Mar 12, · Anesthesia awareness, also called intraoperative awareness refers to a specific situation where a person is under general anesthesia for surgery and regains consciousness during the surgical procedure. The definition of general anesthesia includes induction and maintenance of loss of consciousness. This means that you should not be able to wake.