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Stuff of nightmares: Waking up during surgery

Any of us, who have found ourselves on the operating table, whether for a routine procedure like gall bladder surgery or an emergency surgery, know that fear as the anesthesiologist puts us under that we might wake up during surgery. According to an article on CNN, “‘I couldn’t move: Patients who wake up during surgery,” although this is not a common occurrence, it does happen and when it does, it can have long-lasting effects on the patient.

Any of us, who have found ourselves on the operating table, whether for a routine procedure or an emergency surgery, know the same fear — as the anesthesiologist puts us under, we worry that we might wake up during surgery. According to an article on CNN, though this is not a common occurrence, it does happen and when it does, it can have long-lasting effects on the patient.

Carol Weihrer of Reston, Virginia, who had eye surgery in 1998, described to CNN what it was like when it happened to her.

"I was awake but paralyzed. I could hear the surgeon telling his trainee to 'cut deeper into the eye,'" she said. "I was screaming, but no one could hear me. I felt no pain, just a tugging sensation. I tried to move my toes or even push myself off the operating table, but I couldn't move. I thought I was dying."

Today, sixteen years later, Weihrer still suffers from post-traumatic-stress-disorder. For the last sixteen years, she has had to sleep in a recliner because when she lies flat, she experiences flashbacks of being back on the operating table.

New research on this anesthetic awareness called "accidental awareness during general anesthesia" has found that there are deep psychological repercussions that result from this traumatic experience. A study published in Anaesthesia found that out of a patient population pool of over 3 million patients who received general anesthesia in the United Kingdom and Ireland, one in every 19,600 of them woke up during surgery. Numbers calculated in different studies in the United States found a greater frequency of one in 1,000 patients. In the new study, the patients self-reported which could askew the numbers.

Anesthetic awareness tended to happen more often in surgeries where the patient received paralytics with the anesthesia. Because they could not move, there was no way to communicate with the doctor.

The study also found that the patient in general woke up either before or after the actual procedure and not mid-incision.

According to CNN, "patients described a range of sensations, including choking, paralysis, pain, hallucinations, and near-death experiences. Most episodes were short-lived, with 75% of them lasting under five minutes."

Almost half of all patients who experienced anesthetic awareness suffered from psychological effects like PTSD and depression. The study found that even the short-lived episodes could adversely impact the patient.

Jaideep Pandit, a consultant anesthetist at Oxford University Hospitals and lead author of the study found it wasn't the pain, but the feeling of paralysis that lead to the most distress.

According to Pandit, "paralysis is terrifying and has never been experienced by most people."

While the paralytic seems to be the biggest suspect in these incidences, it is important to note that they do provide a service. Surgeons will use it to help the patient stay relaxed and still, especially when working in certain areas of the body where muscle tension could cause problems or when trying to insert a breathing tube. With it, there is less chance the patient will unknowingly do himself harm by making unexpected movements during the procedure.

What can be done to prevent this?

Pandit believes that all surgical patients and their families need to be educated about the possibility of this happening, while Dr. Daniel Cole, vice president of the American Society of Anesthesiologists (ASA) advocates only doing so with those at the most risk for it, mainly those being given only a light dose of anesthesia, or when a patient brings up the concern himself.

"Patients who were told about awareness before surgery were prepared and not distressed when they experienced it," Pandit said.

There are also monitors that can be used in the operating room which could help alert the doctor if the patient wakes up during surgery. Brain monitors have been suggested as one possible solution allowing the doctor to keep brain activity under a certain level throughout the surgery. Unfortunately, this technique has shown spotty results and so the ASA only recommends it to be used on a case by case situation for those patients considered high risk. Pandit also recommends that nerve stimulators be used to ensure that only minimum amounts of the paralytic are given, so that if a patient does wake up, he is capable of some movement.

More support needed for patients

Doctors not just the patients also need further education on this phenomenon and how it can change a person's life.

A mother, Kristen, told CNN about how her young son woke up during tonsil surgery. Soon after the surgery, she noticed that he wasn't acting like himself.

"Our son's behavior was very odd. He had severe separation anxiety."

They took him to therapists who proclaimed him a "difficult child" and it wasn't until a year later when their son began talking about the experience that they realized what had happened. He now suffers from PTSD and has severe anxiety and flashbacks that can be triggered by ordinary every day events.

"When anesthetic awareness does occur, doctors need to be more proactive in supporting patients, Pandit said. "We can't dismiss the concerns of these patients. We need to offer immediate treatment to avoid long-term psychological harm."

Weihrer also believes that early support would have helped her tremendously. "My anesthetist told me, 'At least you weren't hurt, don't worry."