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SOME PATIENTS HEARD THEIR OWN SURGERY UNDER ANESTHESIA
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OKAY BACK FROM THE OPERATING TABLE 🏥
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TWO PATIENTS WHO WOKE DURING SURGERY 🦶
A Neurosurgeon Recalled A Case From Long Ago In The BMJ In 2002
The Patient Was A Vicar's Wife In Her 50s
She Had Developed A Sudden Agonizing Headache
Angiography Revealed A Right Posterior Communicating Artery Aneurysm
The Team Decided To Operate As Soon As Possible
After 30 Minutes In Recovery She Had Her Sense Of Humor Back
She Said She Heard All Of It And Was Awake Throughout The Operation
Her Account Included A Remark That The Aneurysm Looked About To Burst
She Prayed It Would Not
In Her Account She Could Just Wriggle Her Right Big Toe
She Hoped Someone Would Notice And Nobody Did
Her Husband Questioned The Chief Executive And The Head Of Anesthesia
The Main Reason For Her Awareness Was Inadequate Monitoring Equipment
She Had Also Been Given 100 Percent Oxygen With No Anesthetic Gas
The Second Case Was A 33 Year Old Woman In For Nose Surgery
During The Operation She Became Aware That She Was Awake
She Heard The Conversation Among The Surgical Team
Pressure On Bone In Her Nose Was Felt But Pain Was Not
The Breathing Tube Felt Pushed Against The Inside Of Her Throat
It Was Impeding Her Ability To Breathe
Unable To Move She Recalls A Monumental Effort To Make A Small Groan
That Noise Alerted The Surgeon That She Was Awake
At Her First Follow Up The Surgeon Did Not Raise It So She Did
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WHAT 45 AWARE PATIENTS HEARD AND FELT 👂
A Study Interviewed 45 Patients About Awareness During Surgery
Of The 45 Patients 21 Answered Advertisements And 24 Were Referred
Volunteers And Referrals Are Not A Random Sample Of Patients
All 45 Patients Mentioned Hearing Sounds Or Voices
33 Of 45 Patients Understood And Recalled Conversations
21 Of 45 Patients Had Visual Perceptions
12 Of Those 21 Recognized Things Or Faces
29 Of 45 Patients Felt Being Touched
Three Patients Had The Sensation Of Moderate Pain
Eight Patients Were In Severe Pain
Their Feelings Mostly Related To Paralysis Helplessness And Anxiety
That Was 28 Of 45 For Helplessness And 27 Of 45 For Paralysis
22 Of 45 Patients Described Anxiety And Fear
18 Of The 45 Were In Severe Panic
All 45 Patients Recognized The Situation As A Real Event
Twenty Of 45 Were Especially Attentive To Emotionally Relevant Remarks
The Remarks Concerned Them And Their Disease And Their Operation
A Separate Study Had Twenty Six Patients Referred By Colleagues
They Described The Facts And Feelings Of The Period Of Awareness
Hearing And The Sensation Of Paralysis Were Mentioned Most Often
The Sensation Of Pain Was Mentioned Next Most Frequently
Feelings Mostly Involved Anxiety Panic Powerlessness And Helplessness
Only Nine Of Them Or 35 Percent Had Told Their Anesthesiologists
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HOW OFTEN PATIENTS REMEMBER WAKING 📊
Estimates Of How Often Awareness Happens Vary Widely
One Report Gives Estimates Ranging From 1 In 500 To 1 In 19,000
Another Source Quotes 1 To 2 Per Every 1000 Patients
It Says Awareness Is Best Assessed By Formal Interviews After Surgery
Researchers In Sweden Ran A Separate Study
11785 Patients Under General Anesthesia Were Interviewed
Each Was Interviewed On Three Occasions
The First Was Before They Left The Post Anesthesia Care Unit
Later Interviews Came 1 To 3 Days And 7 To 14 Days After Surgery
The Researchers Identified 18 Cases Of Awareness
17 Cases Were Identified At The Final Interview
An Interview Only At Recovery Would Have Detected No More Than 11
NAP5 Was An Audit In Great Britain And Ireland
Its Estimate Used Reports Of Accidental Awareness As The Numerator
A National Survey Of Anesthetic Activity Gave The Denominator
The Estimate Was About 1 In 19,600 Anesthetics
It Covered Certain Probable And Possible Accidental Awareness Cases
Researchers In Sweden Asked Patients Directly About Awareness
NAP5 Counted Reports Of Awareness Instead
Their Numbers Come From Different Methods
