Anaesthetic Awareness

loumalone

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L
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Hi Everyone, (this is my first post! hurray!)

A couple of nights ago i watched a documentry about anaesthetic awareness in which people were telling of experiences of being awake under a general anaesthetic and feeling all the pain and trauma of all kinds of surgical procedures.
The programme was portrayed as factual journalism but some things about it just didn't ring true.
I can't seem to find any skeptical oppinion when searching and wondered if anyone here knows anything about it.

Alot of the information featured definately was true. For instance i guess it is possible for an anaesthetist to give a weakened dose during an operation because this apparently is the norm during C-sections for the well being of the child, and a paralysing agent is administered along with the anaesthetic which would stop you being able to alert the staff. But at least one of the case studies was telling of her heart beating faster due to the panic and this was the first paradox.
Surely the heart/pulse monitor would be reading a freakishly high heart rate and someone would notice. No?
Another thing was that all the 'victims' (who had all had large pay-offs by the hospital i might add) had had their lives ruined by post traumatic stress including flash backs, re-accurring dreams and vivid memory of horrific pain endured at the hands of the surgeon.

That's what got my skeptic raydar going. You see millions of women go through terrible experiences during child birth everyday (sorry if thats exaggerated, don't know the stats) and go on to have more children. My own experience is of a terrible labour with my first child which was practically ripped out of me with forceps when she became distressed and wouldn't budge and although i remember screaming and crying and begging them to stop i don't physically remember the pain and went on to have another with very little thought.

Isn't it a well known fact that the trauma of childbirth is quickly forgotten?

Also, what about people who survive horrific road traffic accidents and the like who could have been lying with a severed limb for hours without pain relief and live on afterwards without being tormented by the memory of physical pain?

The health professionals who were 'chosen' to give evidence during the documentary reckoned that this awareness happened in 1 in 1000 operations! So how come after more than a hundred years of anaesthesia is this only coming to light now?

Is this fact or just another documentary jumping on the bandwagon of hysterical people with false memory? By the way a couple of the experiences expressed sounded very like the experience of sleep paralysis which i have had myself a couple of times.

Hope someone knows more.

Cheers!
 
First off let me say that I'm not an expert on this subject, but I do find it fascinating. Any medic should feel free (if not obligated) to correct any errors I make.

Modern anesthesia is a combination of several different drugs, and has only been around since 1942. After this date anesthetists started using curare to paralyse patients so that their muscles relaxed and were easier to cut through. There have also been great advances in analgesics and anesthetics. One of the problem is that it is possible for for the analgesics and anesthetics to wear off during the operation, and since the patient is paralysed they are unable to make the surgeon or anesthetist aware of this. For this reason many simple procedures are done under local anesthetic with the patient fully awake. However, since the patients heart rate is monitored throughout the operation any increase in stress should be registered and dealt with appropriately.

As to your other point, childbirth can be a painful experience, but expectant mothers are always told that chirldbirth may be painful, and there's also the fact that the pain is mollified by the arrival of the baby. This may go someway to explaining the lack of PTS.
People in bad accidents do sometimes suffer from PTS, different people react differently to situations.
 
The Straight Dope had an article on this:
http://www.straightdope.com/classics/a990226.html

He treats as a fact with several reports in medical journals, although all the examples are ancedotal he cites a statistic of 2 per 1000 general surgeries (which seems really high given the number of surgeries performed per day).
 
Awareness under anesthesia occurs in perhaps two cases per thousand in general surgery, and at a substantially higher rate in cases involving trauma or cesarean section. (Not all incidents are as horrifying as the ones described; sometimes the patient knows he's being sliced open but feels no pain.)
Click to expand...

But awareness is a lot different that feeling pain. I became aware when I had my wisdom teeth taken out; I could hear drilling and people talking, but that was all. Didn't feel anything at all.

It's also difficult to tell whether the Straight Dope stories are normal occurances or doctor error. (At least one is the latter.)
 
Operation

Since 1996 I've had five surgeries and one car crash. Up until then, my life had been blessedly dull.

The wreck happened quickly and I had only minor injuries, which I didn't feel at the time. A day or two later though, I did have flashbacks and felt shaky when I had to get into a car. I still feel nervous when crossing an intersection.

My first surgery was a bunionectomy during which I was partly conscious some of the time, but the foot had been numbed with local anesthetic and during the more painful parts, the nurse anesthetist put me more deeply under.

During other surgeries I was completely out. Because I worked for the Health Department and had friends in the hospital, I got a lot of joking from some of the crew. The anesthesiologist told me he charged $10 to knock me out, but $1400 to wake me up,no doubt a favorite of these guys. My experiences have been positive.

However, my job taught me a lot about what the profession likes to call "medical misadventure." I've heard the stories of someone being conscious during surgery, but always in another state, several years ago, etc. Just like near death experiences, the info is usually second or third hand.

There are other things to worry about, such as the wrong limb being amputated, two patients getting mixed up in pre-op and losing the wrong organ. I wasn't sure if I felt comforted or not when my surgeon, before my mastectomy, wrote on the left breast with a black marker "Yes," and on the right, "No."

I would advise no one to go to a hospital for an extended stay without assurance that someone who cares will be present much of the time while you are semi-conscious or unable to take care of yourself or call for help. It's not just during surgery that bad things happen.
 
Back in the mid-1970s, I was premed and spends a few vacations volunteering as a surgical assistant on a cardiovascular service. We were cautioned by a few surgeons to keep the banter down or at least non-scary - there was some concern about patients being able to recall parts of some conversations that occurred while they were under.

While I was volunteering there (a hospital in Chicago), there was talk about what had happened at another Chicago hospital - someone had put an x-ray in backwards in the operating room and they took out the wrong kidney.

Regarding breasts, "Yes", and "No" - Does "Yes" mean "yes, keep this one, it is good" or "yes, this is the one to remove"? Ambiguity in these matters sort of defeats the purpose.

I believe that writing on the parts to be operated on and those to be spared is standard practice these days.
 
Complexity said:
While I was volunteering there (a hospital in Chicago), there was talk about what had happened at another Chicago hospital - someone had put an x-ray in backwards in the operating room and they took out the wrong kidney.
Click to expand...
It happens a bit more often than you'd hope for, really:

Backwards X-Rays again, and who knows what happened here. Either way, the magic marker route may be very common but it's not universal. Seems a sensible thing to do, though.

Re: the coming awake under anaesthetic... is there any idea of what proportion of these cases are actually dreams? People report all manner of odd things happening while under anaesthetic, out-of-body experiences (oobe), sexual assaults and so on. The oobes can be dismissed as a dream, and so can some (but not all) of the assaults. Could some of the awakenings fall under the same category? How could we tell?
 
Outhere said:
The wreck happened quickly and I had only minor injuries, which I didn't feel at the time. A day or two later though, I did have flashbacks and felt shaky when I had to get into a car. I still feel nervous when crossing an intersection.
Click to expand...


Yeah, PTS is definately real but i've never heard of anyone in any other circumstances re-living the feeling of actually physical pain.
 
richardm said:
Re: the coming awake under anaesthetic... is there any idea of what proportion of these cases are actually dreams? People report all manner of odd things happening while under anaesthetic, out-of-body experiences (oobe), sexual assaults and so on. The oobes can be dismissed as a dream, and so can some (but not all) of the assaults. Could some of the awakenings fall under the same category? How could we tell?
Click to expand...
I heard at the time that some patients had been able to recall specific bits of conversation that they should not have been able to guess.
 
I, too, was supposed to be completely under while having wisdom teeth pulled but remember the doctors talking, the pulling and grinding, and sensations that bordered on pain. When I was brought out of it I voiced my concern to the doctor about this and he didn't believe me and told me I was dreaming until I repeated some the conversation and the order my teeth were pulled. What made me mad was that he just had an "oh, well" attitude about it. Had I not been in the military at a military dentist I would have thought about some kind of action against him, not so much for waking up but for his attitude afterwards.
 
When asked to count down from 10 after receiving anaesthesia, being a smartarse, I did so in German, because the anaesthetist was german.

I only remember getting to "funf ", but he told me afterwards I got to "eins" understandably. So my conscious memory and my conscious awareness were mismatched by about five seconds. Trivial, but it may be longer for others- and it may work the other way too- they remember , but were not demonstrably aware.
 
loumalone said:
Yeah, PTS is definately real but i've never heard of anyone in any other circumstances re-living the feeling of actually physical pain.
Click to expand...


It can certainly happen. Pain - any sensory experience really - can be part of the PTSD symptomatology (regardless of the cause of the PTSD). In fact, we recently published a case series on just this topic - pain in PTSD following postanesthetic awareness. I provide some other examples in the thread I linked to previously.

Janet Osterman is one of the world's authority on this topic. Try googling her for more info.
 
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