Waking up during surgery is almost unthinkable. Yet Unintended Awareness is a terrifying phenomenon that affects one or two out of every 1,000 patients-about 100 patients daily-according to the American Society of Anesthesiologists. Unintended Awareness is when a patient wakes up while undergoing surgery; patients can feel excruciating pain without being able to move or cry out and involves the patient having some recollection of events during surgery, including hearing sounds and feeling sensations or pain. It is more likely to occur in patients whose condition is unstable, or in emergency or trauma situations. Patients who wake up from general anesthesia during surgery and have a clear memory of the event may develop acute distress and emotional reactions such as helplessness, panic, and fear. In some cases, later onset or long-term psychological issues such as nightmares, anxiety, flashbacks, and post-traumatic stress disorder occur.
Generally, waking up during surgery is caused by improper anesthetic dosing. In 2005, guidelines were developed and approved that established protocol to help prevent this form of medical malpractice. The guidelines state that doctors should keep watch for the occurrence of Unintended Awareness by checking clinical signs such as movement and using conventional monitoring systems such as electrocardiograms, blood pressure monitors, and heart-rate monitors. The group did not include the use of a new generation of brain-function monitors as a standard to measure patient awareness-a device specifically designed to indicate whether the patient is awake or asleep-and instead suggested doctors use those devices on a case-by-case basis, especially in trauma surgeries, Caesarean sections, and in cases where the patient cannot tolerate deep anesthesia. The group did recommend funding more research into the usefulness of the technology. The group said it isn’t possible to eliminate all episodes of awareness in all cases since anesthesiologists must sometimes opt for lighter anesthesia to ensure patient safety. The guidelines advise anesthesiologists to treat any patient who reports awareness with compassion and respect and to refer them for counseling as appropriate.
On Wednesday, a court awarded $11,000.00 to a woman who claims she woke up during major abdominal surgery but was unable to tell her surgical team that she was in terrible pain. The 62-year-old retiree in the southern Austrian province of Carinthia had demanded more than $57,000 in compensation for mental and physical suffering during the October 2002 operation; however, the court rejected that amount, saying there was insufficient proof that the woman regained full consciousness, dismissing her claim of malpractice. Her lawyer argued that the anesthesiologist neglected to attach a tube through which the patient was to be kept under sedation. The woman testified she could feel the surgeons using a scalpel and other instruments on her, but was unable to speak or move. Wednesday’s ruling ended a three-year legal battle.
Most surgical anesthetics consist of a cocktail of drugs: One to put the patient to sleep, a painkiller, and a paralyzing agent. When the paralytic is working, the patient is unable to speak or move and is unable to do anything, including advising doctors that the sleep agent is not working.
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