Waking up during surgery is more common than you think

[pacific breeze]

USATODAY.com - Study: 100 patients a day in USA wake up during surgery

Posted 10/12/2003 9:00 PM Updated 10/13/2003 9:22 AM
Study: 100 patients a day in USA wake up during surgery
By Robert Davis, USA TODAY

Anesthesia failure that allows a patient to wake up during surgery, paralyzed and unable to cry for help, occurs 100 times a day in the USA, a study reports Monday.

The rate is similar to those documented by previous international studies, but many doctors have long questioned the prevalence. This is the first time in more than 30 years that the problem has been quantified in U.S. hospitals.

These findings, and the results of two similar trials also to be released today, led the Food and Drug Administration late Friday to broaden its approval of a device it says has reduced the risk of patients waking up during surgery. The BIS monitor, which is used in one-third of U.S. hospitals, turns the brain's EEG waves into a number that can tell anesthesiologists at a glance how deeply a patient is sedated.

Another study of 1,200 patients found that using the BIS monitor reduced the frequency of surgical awareness by 82%.

Such study results are viewed as preliminary. "Awareness is clearly a problem," says Jeffrey Apfelbaum, professor and chairman of anesthesia and critical care medicine at the University of Chicago. "But these studies have not been vetted through the peer-reviewed process. We are all anxious to find a way to minimize the incidence of this problem, but we need to do it through sound science."

The makers of the monitor, Aspect Medical Systems of Newton, Mass., financed the studies, which are being presented at the annual meeting of the American Society of Anesthesiologists in San Francisco. BIS stands for bispectral index technology.

Anesthesiologists have led the medical profession in patient safety efforts. But many of them have resisted the use of BIS monitors, saying they do not need help determining whether their patients were adequately sedated. "They have their head in the sand," says the study's lead investigator, Peter Sebel, a professor of anesthesiology at Emory University School of Medicine. "They say they have never had a case in their career. I think they may have, they just don't know about it."

His study of nearly 20,000 surgical patients found that for every 1,000 who receive general anesthesia, 1 to 2 people become aware of what is happening to them. Half of them feel pain.

"I did not feel cutting, but I felt tremendous pulling," says Carol Weihrer, who awoke during eye-removal surgery. "It takes a lot of torque to get an eye out."

Since her 45-minute ordeal in 1998, during which she felt surgical tools on her chest, listened to the music played in the surgical suite and felt like gagging because of the tube down her throat, she has become a patient advocate.

"It has been described as worse than rape or kidnapping in that you can't squirm or scream," she says. "There is no way to release your fear or your frustration." She and other patient advocates say patients should ask for a BIS monitor.

[Penny Lane]

This is one of my biggest fears. I saw a documentary of a woman who was having eye surgery and she saw EVERYTHING. She saw the scalpel going at her, she felt the actual incision being made, and she was fully aware of everything throughout the entire procedure. It's HORRIFYING to think about..

[Daphne]

I was put under anasthesia twice in the last two years. About a week before my second procedure, I happened to catch a Discovery Health special on people who had woken up during surgery. It really was horrifying.

[sputnik]

i know a couple of people this has happened to. neither one felt any pain, they were just awake and aware of what was going on, but unable to do anything about it. i'd be scared of feeling pain but i think i could deal with it if i woke up and felt nothing.

[A*O]

My cousin is an anaesthetist and he won't officially admit it happens, but unoffically he says it does. Usually because the patient has an underlying medical condition that makes the drugs less effective. However, as sputnik says you may be 'aware' of what's happening but it's highly unusual for you to feel actual pain. Among the drugs they give you are powerful muscle relaxants so you are paralysed during the proceeding which is the scary part.

[dangerous]

Omg, this happened to me now that I think about it. I woke up in the middle of a procedure but did not feel pain, luckily.

[Aella]

This has happened to my mum-she woke up while having appendicitis surgery at age 11. She DID feel pain-luckily, the shock means she's repressed most of the memory, but apparently her screams could be heard through the entire ward. I get chills just thinking about it.

[Mariesoleil]

I woke up while I had my tounsils removed (although I don't remember but the doctors told me) it was before they even started the procedure. Supposedly I sat up straight on the table and said: "I want to go home!" I was 15 at the time.

[darksithbunny]

This happened to me TWICE. Once during dental surgery and once during a laproscopy. I remember both of them. The dental one, they were like, "Oh. No. No. Not time yet, dear. Give her more, please." And then they asked me afterwards if I remembered it and was I in any pain. No pain.

The second time. The nurse FREAKED. Her exact words: "Oh SHIT! She's alert!." Then I heard the doctor started to ask me about my tat that is on my leg!" and then I was back out. The doctor asked if I remembered and I said yes and why did he start asking me about my tat? He laughed and said it was to take my mind else where so I wouldn't be upset and he apologized. I tell you what, the tat question DID get me to forget for one second I was in the middle of having surgery!

[Tati]

I've read that red-heads need more anaesthesia, for some reason. I wonder if that or other genetic issues could be at play with these statistics. Could also be that docs are more worried about over-anaesthetizing (like that dentist whose child patient died) than under, which I wouldn't blame them for.

[McJag]

Our family has a herditary anesthesia thing-we have lost 2 family members and had a bad scare with 4-we just don't wake up! Anesthesiologists are familiar with it and as long as they know and can avoid certain drugs, we are ok. My son (before we figured it out) had minor surgery at 8AM & was to be home by noon. He woke up at 8PM-the poor anesthesiologist had to stay right with him the whole time. Scary! That is why I think "wake-ups" might run in families also.

[VenusInFauxFurs]

This is the stuff of bad dreams.

[Chilly Willy]

Shut up, people! I don't even want to hear about it!

[lalala]

The anesthesiologist asked me just as I was waking up from my operation if I remembered anything - it freaked me out because I knew this could happen and I know that a product that makes you forget the trauma is also given during the operation - so I won't ever know what happened then but I always feel unwell when I think about it

[Penny Lane]

Apparently, a shortage of analgesic is what allows a patient to feel pain during a surgical procedure. I read that anesthesia awareness happens to 20 to 40,000 patients a year.. something like 0.2% of all patients who undergo a surgical procedure involving anesthetics. Muscle relaxants and paralyzers are usually what lead to the patient not being able to move but feel every inicision being made.

It's always freaked me out that Caeserian Section patients are fully conscious.. nothing more between a face and an exposed stomach than a thin white curtain. Eek.