Medicine / Anesthesiology
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Awake during surgery.

August 21, 2007

Matthew Vasey, MD



I presume at one point or another, everyone has heard of a patient being awake during a surgical operation lying motionless, unable to notify anyone. Experiencing events or sensations while under anesthesia is termed "awareness". Mind you, "awareness" is not a black and white term for an entire surgical procedure, rather most often subtle events experienced by the patient that should not have been experienced. This does not necessarily, translate to horrifying, excruciating pain living a nightmare. Awareness is reported in the literature to occur between 0.1% and 0.9% of cases. (2,3,4,6,7)

A private anesthesiology group studied data on 87,361 patients that they put under over a 3 year period hoping to show that less of their patients experienced "awareness" during surgery than what had been previously reported outside of the United States and in academic institutions in the United States, which is the number I mentioned above. They succeeded by finding only 6 patients who experienced awareness in their group of 87,361, giving an incidence of 0.0068%, or 1 in 14,560 cases. (5)

These are the questions that they asked the patients after the surgery. (1)
1. What was the last thing you remember before surgery?
2. What is the first thing you remember once you woke up?
3. Did you have any dreams while you were asleep for surgery?
4. Were you put to sleep gently?
5. Did you have any problems going to sleep?

Some sensations those 6 patients uniquely reported being aware of were a vague motion in the chest, a little pain in the groin, feeling the initial chest incision and hearing a vague buzzing. Fortunately, none of these elicited a feeling of pain or concern experienced by the patient. One patient, however, did specifically recall pulling on chest and stapling with a feeling of being unable to do anything and extreme pain. This patient was quoted "I knew no one could hear me", and "They were pulling on my chest it hurt so bad". (5)

There are a lot of things to take into consideration when deciding to go forward with a surgical procedure that must be discussed between you and your doctor. While, "awareness" has been known to occur, I do not believe it should weigh heavily when assessing the risks and benefits of a particular operation. Modern medicine and anesthesia have come along way from the days of the American Civil War when limb amputations were done on the battlefield with a bullet to bite on and a bottle of grain alcohol to swig.

REFERENCES:

1. Brice DD, Hetherington RR, Utting JE: A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970; 42:535-42
2. Jones JG: Perception and memory during general anesthesia. Br J Anaesth 1994;73: pages 31-37
3. Liu WH, Thorp TA, Graham SG, Aitkenhead AR: Incidence of awareness with recall during general anaesthesia. Anaesthesia 1991; 46:435-7
4. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM: Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients. Br J Anaesth 2000; 84:6-10
5. Pollard, R., Coyle, JP., Gilbert, RL. Et al. Intraoperative Awareness in a Regional Medical System: A Review of 3 Years' Data. Anesthesiology. Volume 106(2), February 2007, pp 269-274
6. Ranta SO, Laurila R, Saario J, Ali-Melkkila T, Hynynen M: Awareness with recall during general anesthesia: Incidence and risk factors. Anesth Analg 1998; 86:1084-9
7. Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB: The incidence of awareness during anesthesia: A multicenter United States study. Anesth Analg 2004; 99:833-9
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