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spearfish25 · 11-03-2009, 07:35 PM

As a surgeon, I'd like to make a few points before everyone starts to freak out about this phenomenon called 'anesthesia awareness'. First, it happens in about 1 out of 40,000 cases. That's a small number but even that is too much. Further, given the volume of surgeries in our country, you're bound to hear about these cases at some point in time. Second, the type of anesthesia determines whether this phenomenon has even occurred. A patient undergoing a procedure under local anesthesia is completely awake. They are supposed to tell the surgeon they're uncomfortable so more local anesthetic can be injected. Another form of anesthesia is MAC or monitored anesthesia care. Under MAC, patients are heavily sedated but not 'asleep'. They are responsive, breath on their own, and are not under general anesthesia. These patients will frequently move during surgery if the anesthesia gets too 'light' and may be able to hold conversations or follow commands depending on the depth of the MAC. Again, this is not anesthesia awareness. Depending on the anesthetic used, a short term amnesia is also common...most patients won't remember what happened to them in the OR, even if they 'woke up'.

The final type of anesthesia is general anesthesia where a patient is supposed to be completely asleep and requires a ventilator due to the depth of the anesthetic. In some specific cases, a paralytic is also given to prevent muscle twitches or bowel contraction (peristalsis) during the surgery. As the numbers show, it's extremely uncommon for an anesthesiologist to give enough paralytic to completely paralyze a patient but also fail to give enough sedative to keep the patient unconscious. Despite paralytics, pain and stress responses should be readily noticed by an anesthesiologist through changes in the patient's vitals. Pain causes hypertension and tachycardia...blood pressure skyrockets and the heart beats quickly. These are indicators that anesthesiologists often use to note a patient is uncomfortable.

Given these odds for anesthesia awareness, let me fill you in on a secret. You should worry much more about the quality of your surgeon or anesthesiologist than having this phenomenon occur for you. I wouldn't be surprised that the patients who have experienced this have actually had pretty crumby anesthesiologists managing their care.

11-03-2009, 07:35 PM	#12 (permalink)
spearfish25 A True Z Fanatic Join Date: Mar 2009 Location: Naples, FL Posts: 4,117 Drives: to work Rep Power: 1856	As a surgeon, I'd like to make a few points before everyone starts to freak out about this phenomenon called 'anesthesia awareness'. First, it happens in about 1 out of 40,000 cases. That's a small number but even that is too much. Further, given the volume of surgeries in our country, you're bound to hear about these cases at some point in time. Second, the type of anesthesia determines whether this phenomenon has even occurred. A patient undergoing a procedure under local anesthesia is completely awake. They are supposed to tell the surgeon they're uncomfortable so more local anesthetic can be injected. Another form of anesthesia is MAC or monitored anesthesia care. Under MAC, patients are heavily sedated but not 'asleep'. They are responsive, breath on their own, and are not under general anesthesia. These patients will frequently move during surgery if the anesthesia gets too 'light' and may be able to hold conversations or follow commands depending on the depth of the MAC. Again, this is not anesthesia awareness. Depending on the anesthetic used, a short term amnesia is also common...most patients won't remember what happened to them in the OR, even if they 'woke up'. The final type of anesthesia is general anesthesia where a patient is supposed to be completely asleep and requires a ventilator due to the depth of the anesthetic. In some specific cases, a paralytic is also given to prevent muscle twitches or bowel contraction (peristalsis) during the surgery. As the numbers show, it's extremely uncommon for an anesthesiologist to give enough paralytic to completely paralyze a patient but also fail to give enough sedative to keep the patient unconscious. Despite paralytics, pain and stress responses should be readily noticed by an anesthesiologist through changes in the patient's vitals. Pain causes hypertension and tachycardia...blood pressure skyrockets and the heart beats quickly. These are indicators that anesthesiologists often use to note a patient is uncomfortable. Given these odds for anesthesia awareness, let me fill you in on a secret. You should worry much more about the quality of your surgeon or anesthesiologist than having this phenomenon occur for you. I wouldn't be surprised that the patients who have experienced this have actually had pretty crumby anesthesiologists managing their care. __________________ 2013 Cadillac V-Wagon, RIP Z Last edited by spearfish25; 11-03-2009 at 07:37 PM.