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Surgery Nightmare -- Yikes!

Rouser2

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The nightmare is visited upon an estimated 20,000 to 40,000 surgical patients each year. It happens when the patient, under general anesthesia "wakes up" right in the middle of the procedure. One quarter of them report feeling excruciating pain while being unable to cry out.
"The sensation is described by some as being like 'entombed in a corpse.''

The Joint Commissions on Accreditation of Healthcare Organizations sent out an alert as to the extent of the experience to thousands of hospitals across the country urging them to take steps to prevent the experience.

"'Some patients describe these occurrences as their 'worst hospital experience' and some determine to never again undergo surgery."

-- Chicago Sun Times, AP, 10/6/04

Hmmm. Another reason to think twice before entering Modern Medicine's Temple of Doom.
 
Fine, Rouser, just keep your necrotising appendicitis. Some clouds do have a silver lining....

Rolfe.
 
Interesting phenomenon though. One immediately thinks of hypnogogic dreaming which sounds rather similar. I do wonder exactly what it is that is "awake" at these times.

One for Interesting Ian perhaps...
 
It is a very rare thing but it does happen. Estimated prevalence is about .02% of general anaesthesia inductions. There was a recent case series linking it to the development of post-traumatic stress disorder.

A google of "awareness" and "anaesthesia" will bring up many relevant links.

I've published in this area so don't want to be biased and link my own stuff ... :D

I am no longer in that area, btw.
 
Rouser2 said:
Hmmm. Another reason to think twice before entering Modern Medicine's Temple of Doom.
Click to expand...

Yes. And considering that most of these awakenings happen during Caesarian sections (since the anaesthesia levels need to be kept low in order to minimise damage to the foetus), maybe it's best to just let an obstructed delivery continue till the uterus ruptures.

Of course, the other option is to encourage widespread use of the BIS monitor which allows evaluation of the depth of anaesthesia, but why bother, when you can just do away with the Temple of Doom altogether and simply let people suffer the agonies of their illness itself?
 
0.02% of general anaesthesia introductions. That is, overall, a 1 in 5,000 chance. But if the majority are Caesarians, we need to subtract these before we can give the real chance of it happening to a male.

Never mind, Rouser, please don't let us dissuade you from refusing surgery for that gripping pain over the McBurney point, no, not at all....

Rolfe.
 
there's a higher incidence in cardiac surgery as well

However, there is a problem of definition. Often patients remember incidents during the induction of anaesthesia. This doesn't really count but it is difficult to differentiate. Also, it can be difficult to verify the accuracy of reports. Sometimes patients recall things which are inaccurate - the colour of the scrubs or the music or gender of the nurses may be wrong. Perhaps this is an error or a dream fragment. Sometimes they recall things which are extremely difficult to verify such as smells or conversation which the staff do not recall and which were not documented. Hard to know what to make of such things.
 
My father woke up during surgery more then once. I don't know if he felt anything when he woke up or not or any other details since he told only my mother and she mentioned it to me before I went in for surgery. I told the anesthesiologist that I was scared the same thing would happen to me, and it never did but knowing it happened to my dad makes me nervous about surgery.
 
Rouser2 said:
The nightmare is visited upon an estimated 20,000 to 40,000 surgical patients each year. It happens when the patient, under general anesthesia "wakes up" right in the middle of the procedure. One quarter of them report feeling excruciating pain while being unable to cry out.
"The sensation is described by some as being like 'entombed in a corpse.''

The Joint Commissions on Accreditation of Healthcare Organizations sent out an alert as to the extent of the experience to thousands of hospitals across the country urging them to take steps to prevent the experience.

"'Some patients describe these occurrences as their 'worst hospital experience' and some determine to never again undergo surgery."

-- Chicago Sun Times, AP, 10/6/04

Hmmm. Another reason to think twice before entering Modern Medicine's Temple of Doom.
Click to expand...

I don't believe this at all. These data are extrapolated from limited experience, and fails to take into account differing practices at different hospitals.

Therefore, I'm not going to get the things we use in our OR at the hospital I'm currently rotating at like BIS monitoring, maintaing 1.3-1.4 vapor MAC during all cases, giving numerous IV drugs in addition to the vapors they breathe to add to that MAC, and inducing anterograde amnesia with other drugs to specifically prevent such episodes.

Does awareness happen? Rarely. And, when it does, it is often in the POST-operative period as the patient is awakening while still paralyzed by the drugs used to keep them from moving and often while they are still intubated. Is it uncomfortable? Is it scary? Probably would be to most and, to some patients, very much so. Is the patient's life ever in danger? ABSOLUTELY not!

In the hospital that I'm currently rotating at, they have 3 separate ORs and do approximately 16,000 major medical procedures per year in which patient's undergo general anesthesia. As part of the anesthesiology department's diligence in tracking this phenomenon, every patient is asked in the recovery room whether or not they "remembered" anything during their procedure.

Last year, they had 1 patient who experienced awareness during anesthesia. ONE! And, after further investigation, it was found to be due to an extremely delayed awakening secondary to a fairly uncommon anomaly of her body's biochemistry that causes one of the paralytic agents used during the case to hang around in the body longer than expected. Could anyone have known this beforehand? No! And, she was very understanding afterwards when why this episode occurred was explained to her.

Nonetheless, let's do the calcuation for this hospital: that's 1 out of 16,000... a 0.0000625% chance of this happening to you at this hospital! Yeah, this is a real problem that should cause people "to think twice before entering Modern Medicine's Temple of Doom." Let's just let people who need operations suffer and perhaps die instead.

:rolleyes:

-TT

(Edit: to "tone it down a bit"... Rouser2 really pushed my buttons with this one, perhaps unwittingly)
 
I never liked the idea of being rendered unconscious. That's partially why I opted for conscious sedation when I had my spermatocele removed. The other part is that when someone has a knife near my personal nuts, I want to know what is happening.
 
epepke said:
I never liked the idea of being rendered unconscious. That's partially why I opted for conscious sedation when I had my spermatocele removed. The other part is that when someone has a knife near my personal nuts, I want to know what is happening.
Click to expand...

It requires a lot of trust, I'll admit that. You are basically putting your life in other's hands. However...

Many people think that somehow they "aren't going to come out of it" because of the anesthetic drugs, or a surgical error. For routine cases in otherwise healthy patients, this is extremely rare. Currently, with the what-could-almost-be-called miraculous monitors we currently use, the chance of something going horribly awry in the hands of a trained anesthesiologist are very small. The patient mortality rate that can be attributed to anesthesia is currently about 3 out of 100,000 cases. Often, the cause of the mortality has to do with an unknown susceptibility to the drugs. But, if you have no family history of bad experiences during anesthesia, even this becomes less likely.

You see, the vapors commonly used will simply diffuse out of your system when they are turned off. Your body breathes them off. You can't store them. The only reason why they stay in your body during the procedure is because you're hooked-up to the anesthesia machine. Likewise, the monitors are just awesome. Simply awesome. In the last 20-30 years, anesthesiology has really come out of the dark ages where the clinician had to use a lot more clinical judgment that made human error a much greater factor. Now, it's pretty hard to make what were once fairly common errors, despite the fact that even then most of those errors didn't result in a negative outcome.

I can understand the apprehensive feeling most patients have. Giving anesthesia, for the anesthesiologist, is very much like flying an airplane, and receiving anesthesia is like being a passenger in that plane. When you (as a patient) are in the back of an airplane for the very first time, you're scared because you putting your trust in the pilot (the doctor) to fly the plane and land you safely - and you really don't know what to expect. You have no control over where that pilot is taking you, and you can only hope that the competence of that pilot (doctor) will get you safely where he told you you were going to go.

But, after you've flown a few times (just like after you've had anesthesia a few times), you know that you don't have that much to fear. And, each successive flight allays those fears even more. It really is a great analogy in so many different ways.

-TT
 
Re: Re: Surgery Nightmare -- Yikes!

Vikram said:
Yes. And considering that most of these awakenings happen during Caesarian sections (since the anaesthesia levels need to be kept low in order to minimise damage to the foetus), maybe it's best to just let an obstructed delivery continue till the uterus ruptures.

Of course, the other option is to encourage widespread use of the BIS monitor which allows evaluation of the depth of anaesthesia, but why bother, when you can just do away with the Temple of Doom altogether and simply let people suffer the agonies of their illness itself?
Click to expand...

And the most over prescribed, mostly unneeded surgery is????

I dunno, but C-sections surely must be near the top of the list.
Hey, gotta train those interns/residents somehow.
 
Re: Re: Re: Surgery Nightmare -- Yikes!

Rouser2 said:
And the most over prescribed, mostly unneeded surgery is????

I dunno, but C-sections surely must be near the top of the list.
Hey, gotta train those interns/residents somehow.
Click to expand...

proof please?
 
Re: Re: Surgery Nightmare -- Yikes!

]Originally posted by ThirdTwin [/i]


>>I don't believe this at all. These data are extrapolated from limited experience, and fails to take into account differing practices at different hospitals.

Ah, well it all comes down to the numbers, doesn't it? Dr. Third Twin has his numbers, and the Joint Commissions have theirs. But Dr. Third Twin's hospital is only one. And perhaps they don't even do any C sections.
 
Re: Re: Re: Surgery Nightmare -- Yikes!

Rouser2 said:
And the most over prescribed, mostly unneeded surgery is????

I dunno, but C-sections surely must be near the top of the list.
Hey, gotta train those interns/residents somehow.
Click to expand...

Rouser, are you sure you mean C-sections? Perhaps you are confusing it with hysterectomy? Regardless, do you have any data about this?
 
Rouser2 said:

Hmmm. Another reason to think twice before entering Modern Medicine's Temple of Doom.
Click to expand...

On one hand, I think that will eventually qualify you for a Darwin Award.

On the other, I kinda wish that more people like you lived in Canada, as it would result in shorter wait times at the hospital.
 
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