Awareness is a known complication of anesthesia. The reported incidence varies but is probably between one in one-thousand and one in ten-thousand. It’s real. For those who experience it it varies from a horrible, terrifying experience to one of nonchalant acceptance.
The recent movie, Awake, highlights some of the effects of awareness under anesthesia in a typical, minimally accurate hollywood stylization.
Recently, I found an entire website dedicated to anesthesia awareness (more properly termed awareness under anesthesia). What struck me most was the following quote from the site:
Until the consistent use of every possible precaution (both human and equipment) to avoid awareness becomes routine, and such precautions are something of which a patient can be absolutely assured, this Campaign will not rest.
The quote is attributed to the organization’s president. I have to confess that it makes good press. It no doubt helps keep the president in public appearances. But, it makes terrible public policy.
First, there is no meaningful evidence that any monitor, except a well-trained anesthesia provider, decreases the incidence of awareness under anesthesia (Sebel P, Bowdle TA, Ghoneim MM, et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004;99:833–9). In fact studies sponsored by the number one maker of “consciousness monitors” have actually shown increases in the incidence of awareness.
Second, by some estimates it would cost as much as $400,000 to prevent a single incident of awareness (Anesthesiology. 2001 Mar;94(3):520-2). At a rate of one in one-thousand cases that adds an extra $400 to every surgical procedure under general anesthesia. Under the best of circumstances the same experts estimates yield an increase of at least $200 per case. How many patients want to pay that amount? At a time when the average American complains about the cost of heath care this seems a frankly frivolous expenditure. If health care expenditure is not increased then those funds must come from somewhere else- what testing or therapy should we eliminate?
Third, it’s great to claim that everyone should get everything, all the time. That leaves us with the “who will pay?” question. More services can be provided in only two ways the first is increasing cost, the second is decreasing other services (hence cost).
Finally, and what I find most appalling, is that physicians, (even anesthesiologists) have bought into this. Responsible physicians have an obligation to patients and an obligation to one is an obligation to all patients. The first step in any cost-effectiveness analysis is demonstrating the effectiveness of the test or monitor in question. The effectiveness of “consciousness monitoring” is far from settled.
I personally don’t want anyone to use a “consciousness monitor” when I have anesthesia. I certainly don’t want a provider to rely on a single monitor that won’t reliably increase longevity or life-enjoyment but may bankrupt our health care system. The extra $2-400 per surgery could do that.
Think about what we ask for. If monitors like this were really good- that is reliable and cost effective then they’d be in use everywhere already.
26 Comments
I’d like to thank the folks over at the Anesthesia Awareness Campaign for linking to our site. Traffic is up enormously. They’re helping Safer Health Care to dispell the emotional and scientifically vacous myths about “consciousness monitoring” as well as allowing readers to effectively take charge of their health care.
It’s your health care dollar. Make providers spend it wisely. Take charge.
Great post. Today I actually had trouble getting to your site. The “Anesthesia Awareness” site must have bumped your views by huge amounts. I’ve never been bumped off a wordpress site before. You owe them big.
We have these monitors. They’ve sat unused for months. No evidence they change anything. Our incidence of awareness is unchanged using the monitors compared to historic controls. But then in our practice we only see awareness in about 1 in 10,000 cases. Once the data started showing up that they may increase awareness use fell off fast. In fact the only incidents of awareness in 2006 were monitored and had “good” values.
I emailed you through the contact link above. If your policy analysis on this is as good as the other stuff you’ve published then I’d like to see it. With a little luck we can get this changed to an “uncovered” service then we can just let patients pay for it. It will be interesting to see who opts for the monitor as an up front, out-of-pocket expense. If it pays and causes no harm (we’re not going back to using them if they increase awareness no matter how much we can charge) then we’ll dust this junk off and use it again.
I’m sure the insurers will be interested- it’s one less thing they have to pay for.
While monitoring is not cheap, your calculations are flawed. You and I know the extra monitoring equipment (depreciated over 8 years) and disposables per case cost about $15 per case (a little less at large places like the Cleveland Clinic that have a large amount of surgical volume). If you reduce the incidence from 2 per 200 to 1 per 10,000 (coservative estimates of what such monitoring does) , then it costs $150,000 (15 dollars times 10,000) top prevent 49 cases or about $4000 to prevent a case.
But the cost increase per individual patient is still only $15.
And I as an anesthesiologist and I as a patient believe that is cost effective (the range for BP pills, vaccines, statins etc to save a year of life that is judges cost effective in this body of literature is anywhere from $5000 to $200,000, but again less expensive for the indiviudal user).
Great to hear from so distinguished a reader as Dr. Roizen. For readers unfamiliar with Dr. Roizen, he has made enormous contributions to anesthesia and perioperative medicine. He is a true pioneer and one of our specialties’ great minds. You can see a sample of his contributions HERE.
That being said, as you will see Dr. Roizen and I have legitimate differences of opinion on some points. Read on.
I need to clarify several points:
1) The estimates are not mine but are from a published source: Anesthesiology. 2001 Mar;94(3):520-2. I happen to agree with their assessment.
2) From a public policy standpoint individual cost increase per case is irrelevant. The issue is the cost to prevent a single incident and hence the overall cost to a healthcare system. Of course in the absence of cost constraint- certainly everyone should get everything all the time.
3) As noted by the cited authors, and alluded to in your comment, monitoring does not eliminate the possibility of recall. Therefore there remains the distinct, and in my opinion strong, possibility that that the monitors have no scientifically provable value. In fact, if the monitors are eventually proven to increase the incidence of awareness then patients are charged for worse care. An outcome I think foolish regardless of the financial aspect. Fundamentally the argument for cost effectiveness hinges on the scientific validity of the monitors effectiveness.
4) From a policy standpoint, as incidence decreases the cost must decrease for a therapy to be valuable. If the monitor actually worked then no one would argue with virtually any reduction from 1:100.
After careful review I find no consistent, statistically valid evidence of effectiveness of these monitors. Therefore from a policy standpoint no amount of funds are justified. Manufacturers have fed on emotion, fear-mongering, and hysteria. Clinicians have fallen victim to pressure from the plaintiffs’ bar. None of these are valid reasons to make health care policy.
We need only look as far as statins to realize that not all therapy that seems like a good idea has demonstrable benefit- meaning: will it make me live longer, will it let me live better, is it effective, is it cost effective. We may well be able to add consciousness monitoring to the long line of failed “presumed effective” medical therapy such as indiscriminate use of PA catheters, non-invasive precordial doppler cardiac output, continuous blood pressure with the finapress (the cool little cuff that necrosed fingers and still gave the wrong pressure), laetril, or blood letting. Or how about raplon- the sux killer- now gone due to safety concerns by the FDA. The FDA had to take it away- we weren’t smart enough collectively to realize the danger! All of these were embraced without sufficient evidence of effectiveness or safety. We, clinicians, were bullied, badgered, or cajoled into using the new and trendy. Until consciousness monitors are proven we need to continue to consider them experimental and accept the possibility that they have no effect or even that they increase awareness.
Finally, I personally have a philosphical problem with allowing patients to believe that these monitors offer “protection.” The reduction in the incidence of awareness, if any, is disputed. I realize that the same can be said about any monitor- reduction in hypoxemia with oxymetry, myocardial ischemia with ECG, and hypoventilation with capnometry. The difference in the case of each of these latter technologies is that oxymetry is unassociated with the possibility of increased incidence of hypoxemia, ECG monitoring unassociated with increased myocardial ischemia, and capnometry unassociated with possibility of increased incidence of hypoventilation. Therein lies the fundamental problem- consciousness monitoring remains unproven technology desperately searching for buyers and a purpose.
I am grateful for your thoughful comments. We must simply disagree on the value of this monitor at this time. As I’m sure you would, I’ll gladly acquiesce when the monitor proves its effectiveness. I’ll even advocate it. We can easily agree that awareness under anesthesia is an issue. We differ only on solutions and policy matters. I demand that my monitors have proven benefit.
I still don’t want someone using one of these pieces of junk on me. I’ve learned that skilled anesthesia is better than unproven technology. If my provider doesn’t know his/her incidence of awareness under anesthesia for the past 5 years- I’ll move on. If it’s too high I’ll move on. If I have no choice- emergency for instance- I’m out of luck.
Thanks again for stopping by.
I am speechless to see economic arguments taking over our moral and ethical obligations to our patients, especially when there is nothing to lose but a lot to gain by implementing every available tool to safeguard patients against awareness under anesthesia.
Dr. Taimoorazy’s speechlessness is not an uncommon reaction. Unfortunately it reveals more about the individual physician’s lack of understanding regarding heathcare cost, healthcare policy, or effectiveness analysis than it does about the technology in question. This is a common failing of modern medical education. In fact I didn’t learn healthcare policy analysis until I went to law school. Speechlessness is simply another vacuous emotional ploy devoid of scientific validity. It fails to address the issue of effective care irrespective of cost. It makes great sensational press but does not add to quality of care.
The idea that there is no loss from using these monitors is wrong. At a nominal one million anesthetics per year (and there are way more) and average cost of $15 per case that’s fifteen million dollars that cannot be used elsewhere in healthcare. I don’t know how Dr. Taimoorazy practices but fifteen million dollars is a lot of money to me.
Dr. Taimoorazy also neglects the fact that these monitors have no consistently proven effectiveness. For the fifteen million dollars he wants to spend he may actually get no value. In essence he wants to waste money on unproven technology thereby creating the possibility of denial of valuable therapy. Additionally, the monitor, at best reduces awareness from about 1:1000 to 1:10,000. Therefore there would still be 100 cases of awareness even with the monitor. The cost per case for the 900 prevented cases is $1600 per case. I don’t call that cheap either. It’s certainly not “nothing to lose.” If the original incidence is lower than 1:1000 (such as 1:10,000), even with a similar per cent reduction, then the cose per prevention goes up.
If these monitors were proven effective then I’d advocate them. In fact if they were effective and cost effective then governments and payers would demand them. No such proof exists. Until they’re proven these monitors are little more than experiments. I’m unwilling to treat my patients as lab rats. If I have a patient that requests this monitoring then I have them sign a separate consent acknowledging the lack of proven benefit.
Perhaps I’ve been jaded after ten years of working in healthcare. but, whenever I hear the humm of practioners talking about whats good for the patient; I know that all you have to do is look for whos making money off the “whats good for the patient” argument. I am a CRNA. I used the monitor religously for about a year. One day after comming under attack for the way I percieved the numbers and the way I treated/charted the value I decided it wasn’t worth the effort.
This technology is to young, no-one can agree really on what vaules are good or bad or how they should really be treated. You may have your ideals about it but the next guy doesn’t; and in a court of law all it takes is one professional witness that doesn’t see things your way.
Matt
My comments may be meaningless here; I’m certianly and old-fart (54) who just retired from the navy after 30 years service as a pilot…..Unfortunately, I now require multiple surgical procedures to correct longstanding orthopedic/neuro problems and I have had numerous surgeries. Awareness under general anesthesia has been a HUGE problem…….The last time that I was injured on a carrier landing, I spent some time in the Bethesda Medical Center (they treat the president) and learned more about anesthesia that any patient should ever know. Every time that I had surgery, the nurses, CRNA’s, anesthesia docs were the best and the brightest (my doc was from UNiv of Pennsylvania and my anesthesia doc was from an IV league school)…so I guess that I got great care…despite the best efforts of the best docs; I remember EVERYTHING…every cut, intubation, every discussion during surgery, and begging for them to stop, but unable to speak………I just retired and have no reason to bitch; the surgery fixed my back, ubt I still have flashbacks of the “awareness” under general anesthesia and it was horrible..I’m not too stoic, but I have seen death “up close and personal” in war, but I must admit that that the “anesthesia awareness” is the worst experience of my life…….I blame nobody for this; my doctors and nurses (CRNA’s) did their collective best to avoid this…..not to whine, but I’m a pretty tough guy and still have constant nightmares about this……PLEASE-continue your research into awareness under general anesthesia……or just tell the patient: it’s going to hurt like hell, you won’t be able to react, and it’s going to be a horrible experience……….
gman,
First let me say thank you for your years of dedication and sacrifice in the service of our country.
Second let me apologize on behalf of anesthesia providers everywhere for the prblems you’ve had. I absolutely agree that awareness is a serious problem that demands further attention and study.
I do find your experiences bothersome. Many federal facilities use consciousness monitors. Since these monitors are associated with an increase in the incidence of awareness I would speculate that one of these was used for your cases.
I hope that someday we have a reliable monitor that actually reduces the incidence of this complication. What we have now if woefully inadequate and probably, as your case demonstrates, increases the incidence of awareness and injury to patients.
Thanks for stopping by. Please join us again.
I had anesthesia awareness during a C-section delivery of my baby. I think most people would be glad to fork over an extra $400 to guarantee they would not suffer anesthesia awareness. I know I would! I’ll never forget the burning/searing pain of the scalpel and hearing the doctor talking. I thought it was a normal experience of C-secions until I later read about anesthesia awareness.
Dear All-
I hope to join this discussion long-term, as a heathcare provider, a lawyer, and a survivor of 100% anesthesia awareness during general anesthesia surgery.
In contrast to gman’s deferential comments, and in contrast to the comments by aegis1, I yield the validity and comprehensiveness of my individual perspective to no one.
I have been a practicing attorney for over 20 years. While it was not my area of specialty, I am functionally familiar with the legal principles of public health, and the legislative underpinnings of current healthcare policy and funding in the US.
I am currently in the final year of training in my second career as a respiratory therapist, having completed my first year of clinicals. I have not yet lost my student idealism, despite being in my 50’s, and despite a long career in senior corporate management as in-house legal counsel to large (very large) corporations. I feel strongly that the lynch-pin of our practice is to relieve suffering, and not to inflict it.
Like gman, I am able to describe every detail of my surgery; the number, depth, and orientation of my incisions and retractions, which ones were just brutally painful and which ones were excurciating beyond all description, the word-for word discussions amongst the surgeon, nurses, and anesthesiologist, the exact difficulties encountered, the terminology I could repeat but not understand, the decisions made while surgery was in progress, the observations made aloud of my heartrate, ventilation and blood pressure. I made herculian efforts to move, speak, open my eyes, to make any indication to the OR staff that I was fully aware, and without any pain relief whatsoever – all without any result, of course.
Unlike many others, I was believed by my surgeon and doctors when I described what had happened. Although I experienced disabling PTSD symptoms in the months after surgery, I received good aftercare and I no longer suffer these symptoms. I have had subsequent major abdominal surgery with spinal anesthesia, which I requested as a result of my prior experience with anesthesia awareness. Despite the horrific pain of my past surgery, the ultimate outcome of my surgeries has been good, and I am in excellent health.
I realise that, as I grow older, it is likely I will eventually require heathcare that can be provided only under general anesthesia. I am prepared to undergo general anesthesia in the future. Despite significant advances in anesthetic drugs and protocols since my unanesthetized surgery, and despite the availability of brain monitoring and other technologies, I realise there are still no guarantees against a repeat experience. Therefore I will do everything possible to avoid a repeat experience, and I advise *anyone* anticipating general anesthesia surgery to do the same.
No one should have to experience the suffering that I experienced. There is NO general good to be achieved in healthcare cost or quality, or in public health policy, that is worth the intentional or even careless vivisectional torture of *any* individual. I strongly encourage every person about to undergo general anesthesia to consult personally with their anesthesiologist, to inform them of *any* past difficulties, to request *the* most advanced monitoring available, to insist that anesthesia be provided by personnel trained on the latest equipment and procedures — and to be prepared to argue til doomsday with insurers or pay out of pocket for the necessary care. There is no ethical or medical support, with the technology currently available, for surgery without pain relief and anesthesia. None. None at all. No policymaker, no insurance executive, no healthcare provider would agree to undergo such a procedure for the general good, nor agree to have anyone in their family subjected to such a procedure in order to make healthcare more generally affordable. Discussions about the insupportable expense of guarding against such inhumane procedures are discussions conducted in the air by people who have no genuine point of reference when weighing individual suffering against the general good.
For myself, I am willing to take an informed risk in general anesthesia — with every possible precaution — because I am in a position to decide that I, personally, prefer the likelihood of a long life over a guarantee against unspeakable suffering. But this is NOT a choice that should be forced on anyone, willy-nilly, for a public good. And it is a choice I might reverse when I have lived another 50 years, when my day-to-day suffering is not likely to be relieved by surgery. This should be *my* informed and ‘live’ choice, always, from one medical treatment to the next. And it should be everyone’s choice, each and every time.
I welcome any contact, comment, or reply, onlist or off, from anyone on this topic. Please find my personal email below.
Linda Vining
elviepearl@yahoo.com
I’m 90, been there, done that. Age 30: appendectomy, spinal block, VA Hosp. Pain awareness returned about half-way thru procedure. I yelled, screamed; anesthetist asked me questions, I begged to be “put under” – a mask was clamped over my nose/mouth and I blissfully lost consciousness. My memory of the experience is still quite clear.
Re mentions by many of memories of docs talking and such during anesthesia — may I suggest a read of the very controversial book, “Dianetics: The Modern Science of Mental Health,” from the 1950’s. It’s been known for a long time, but never validated to the satisfaction of science. Also, related but even more controversial are many stories and books about “Near-Death Experiences.” Perhaps we are all in need of some deeper studies in what constitutes “reality.”
–Old but slightly wiser.
I’ve always wanted to tell someone, anyone of my experience with Awareness. It was back in late 1992 or early 1993 when I had an operation at Audey Murphy Hospital at Lackland Air Force Base in San Antonio, Texas. I had an emergency operation for a Fistula. I remember only that after going in to the operating room, I awoke during surgery and remember the feelings of tugging and pain near my mower torso. I looked at the female nurse near my head and told her “I can feel the pain!” I remember her telling the surgeon that the patient is awake and I also remember the surgeon telling the female nurse, “that’s okay, we’re almost finished.” Was it okay to me? Heck no! It is something I’ll never forget.
In 1983 I had gastric bypass surgery I awoke in this process
my stomach was clamped in to a square device about 1 foot or more above me with my intestines going to it. I could hear the doctors and nurses talking. I did not feel any pain.
Infact I felt as if it was some one else on the table.One of the nurses stated I think he is awake. My doctor said impossible.
The next morning during doctors rounds I told my doctor what I had heard and seen. He called a meeting with his surgical team and had me tell them this.He then told me I must have saw the procedure done on me on tv. I had not.This still bothers me and I have relived this several times in my dreams.
I also experienced surgical awareness in May 1986 when I had my third child by caesarean section. I woke up just as they were making the incision and I felt like I was being butchered alive. I was screaming in my head that I was dying but was unable to communicate with anyone because I was paralyzed. I can still remember it like it was yesterday,very traumatic. When I told the doctor that I felt them cut he said that was impossible, until I told him that I heard them talking about baseball.Then he quickly said that they don’t like to give too much anesthesia because the baby will be groggy.I had 2 c-sections before that and 1 after and never experienced anything like that.No one can really know the excruciating pain unless you have been through it.
One of the things that nobody is addressing is the use of a drug called VERSED, which is supposed to cause amnesia. From a patients perspective VERSED is identical to a GA. However there are lots of people, including me, that have suffered horrible trauma because of VERSED. There is no way of knowing whether the patient actually has the desired (by the medical staff, but not necessarily the patient) and proceed with painful procedures while the aptient is trapped in a flaccid body. I know it’s not true anesthesia awareness, this sedating of patients until they can’t move and (hopefully) can’t remember, but the experience was so far beyond anything I expected from people who were to “care” for me, that I have PTSD now. FYI I don’t use recreational drugs or alcohol. I have no problems dealing with whatever life throws at me, broken bones, etc. but I cannot seem to recover my former mental stability after this living nightmare. It’s just awful and a CRNA is responsible for this. He thinks it’s highly amusing by the way and says he knows what’s best, regardless of patient instructions or bad outcome. I would rather be dead than go through this again.
I have never suffered from anesthesia awareness and hope never to. I am trying to find out as much as possible. I will say that I would gladly pay an extra $200-$400 each time my children or I had surgery if it would eliminate the possibility of anesthesia awareness occurring, as rare as that possibility is. What troubles me is that there is a great debate as to whether brainwave monitoring would even improve the odds against it, and it seems that it doesn’t eliminate it.
When I had Norplant implants removed, I was asked to count the sticks and sign a form indicating how many I saw after removal. Is there some way for patients to visually inspect containers that might “run dry” as I’ve read about in some articles?
If one has never suffered from this phenomenon before does that lessen future risks to them as well?
How is anyone sure that remembrances of awareness are accurate? It seems it would be easier to study this phenomenon if EVERY patient (or at least as many as feasible) were given headphones prior to any incision and these headphones said a particular random number such as “97″ every 20 seconds or so until the final stitches were made. This would at least give people a starting point for studying factual awareness vs. dreams, confusion, or outright lies. How can one judge what procedures or equipment will reduce these occurances if a patient has no way to prove that they really did occur?
What do patients use as proof right now? Couldn’t some drug adversely react with them and cause them to have delusions of pain or sound? That would be a totally different phenomenon, albeit horrific. Studying a particular event like this would be a waste of time as far as anesthetic awareness goes.
Is it possible that the current brainwave machines,when used properly, actually eliminate ALL anesthetic awareness and it is just random, incorrect, recollections that are NOT being prevented?
I am not a doctor, but I am an intelligent person, and a mother, and would like to learn as much as possible. I have a child who will have general anethesia next Thursday. What CAN be prevented by the anesthesiologist? What should I make sure that he is paying close attention to?
I recently attended an international symposium on Memory, Awareness and Anaesthesia at which there was an excellent presentation on the use of the Isolated Forearm Technique as a failsafe way of offering patients the chance to communicate with their anaesthetist if they become aware during surgery. It costs very little to administer, other than some minor additional preparation and vigilance on behalf of the staff, and can be adapted for use in a wide range of surgeries. The possibility to use the IFT to improve patients’ experience under anaesthesia has been around for years. Perhaps the solution to awareness under anesthesia is not so unattainable as you insist it is.
Ms Pearson makes a great point. But the isolated forearm technique has only limited usefulness and only for limited time periods.
It’s never OK for a physician to simply dismiss claims of awareness. Each and everyone needs to be carefully explored and if found real the patient needs to be frerred properly for aftercare.
This post has generated enourmous amounts of comments. Many were vacuous, vitriolic complaints from zealots that add nothing to the Safer Health Care mission of providing useful information. They were summarily deleted. Similarly the endless comments wishing me ill will were deleted.
As I stated the problem with the current consciousness monitors is not cost-effectiveness but simple effectiveness. They simply do not measure consciousness. Yet another recent article in New England Journal, 3/13/2008, confirms that for most patients there is no benefit to the monitor. In fact one patient had awareness despite the monitor revealing adequate anesthesia. I continue to maintain that the monitor may lead to an increase in awareness.
For those patients who have concerns there are high-risk situations and patients:
1) Emergency procedures
2) The very old, very young, and very sick
3) Trauma patients or others with large-volume blood loss
4) Cesarian sections under general (this is actually so common that when I was in training we told women they should expect to remember something).
In each of these cases a consciousness monitor would not be of value since the anesthesiologist would turn all of the anesthetics down to avoid injuring or killing the patient- regardless of what the monitor shows.
I appreciate all of the constructive comments. There remains only one way to manage this. Interview your anesthesiologist. Know his/her incidence of awareness. If he/she doesn’t know, get someone else.
Next, a word about versed. It is not an anesthetic. Recent evidence indicates that it may not even be as good an amnestic as once thought.
Finally, if you experience awareness under anesthesia:
1) Tell your surgeon and anesthesiologist.
2) Ask to speak to the hospital administrator on call and file a formal complaint.
3) Notify the state medical and or bursing board (depending on whether it was a physician or CRNA).
4) Demand that the responsible person(s) fully fund appropriate aftercare.
5) Awareness may not be malpractice but it might be. It depends on state statutes but you should probably contact an attorney.
6) You deserve an apology.
It’s your health, take care of it.
Thank you aegis1 – you have a deep and proper concern that all possible precautions are taken to:
1)Improve the experience of patients who are undergoing anaesthesia during surgery
2)Provide the appropriate after-care for those who have undergone awareness
As an awareness survivor myself, I share your concern.
Please therefore also help to dispel the myth that
using the IFT during surgery is ‘time limited’. It has been used successfully for operations lasting up to 5.5 hours. It is the only procedure, at this point in time, that gives the patient the power to communicate awareness, even when given a muscle relaxant.
Please encourage your colleagues to look again at its potential.
I underwent spinal fusion with rods, due to severe juvenile idiopathic scoliosis, when I was 12. Becaue I was so young and had never had any prior surgeries the anesthesiologist did not know how to ‘correctly dose’ me (those are his words, not mine) and at about the 13th hour of the 16 hour procedure I awoke. At first I did not know what was going on or where I was at… I was just completely disoriented. For a split second I though I was at home, safe in my bed and that my mother must be trying to get me up and ready for school. However, this was not the case. I quickly came to the horrifying realization that I was awake and that my doctors were still operating on my spine. I could hear the drill and, most importantly, I could feel EVERYTHING that was being done. In my head I screamed over and over again, “Please!! Stop! I’m awake! I can feel it!” but nothing happened. I just lay there, face down on the operating table hearing all the medical equipment beeping and buzzing and feeling the most excruciating pain I have ever, and most likely will ever, experience. The last conscious thought that I had was that I just wanted someone to kill me. I know that sounds awful, seeing as how I was only 12 years old, but I just wanted the pain to end. I was later informed that an OR nurse noticed that my brain waves were too active for someone who is supposed to be completely out. She informed the anesthesiologist and he gave me a whopping dose of hypnotics, paralytics, and analgesics… so much so that I had a very hard time waking up after I was closed up and in the intensive care unit. At first I was so haunted by the images and sounds from my awareness experience that I kept it to myself and for a long time I convinced myself that it had not happened. But then I started exhibiting signs of post traumatic stress disorder and after seeing a therapist, I recalled most of my repressed memories regarding my ordeal. After years of therapy, I am happy to say that I am no longer ‘haunted’ by past memories but I still remain ever cautious of going under and am beyond thorough with the anesthesiologists who will be working on me. I have found that Versed given to me before I am even wheeled to the operating room greatly reduces my anxiety and I keep a copy of my anesthesia record at all times… just in case. After several surgeries with no anesthesia awareness, my doctors are pretty sure of what works for me and keeping a record of what works helps me feel more in control when it come to any procedure, no matter how big or small. Sometimes I have ‘flash backs’ or nightmares but I can usually calm myself down and talk myself out of any panic I might be feeling. It has taken me nearly 13 years to get to this point. My heart goes out to anyone experiencing the after affects of this horrible mistake that is made far too often.
As a victim of anesthesia awareness during open heart surgery I am here to say that it is a life changing nightmare that never totally goes away. I agree with other blogs in that the monitors may not totally prevent this from happening and that nothing is foolproof. I guess my sense in bringing awareness to the public eye is that it DOES HAPPEN and I think the key to some prevention would be in the discussion you have with your anesthesioligist prior to surgery and knowing that you need to be accurate with your answers as it may have an affect on the anesthesia choice and I think there needs to be a followup after surgery just in case there were some sort of problme that needs to be addressed. I know in this day and time everyone is looking for a lawsuit and your certainly dont want to open the doors to suggestion as some people are just waiting to jump on the lawsuit wagon. But for the ones that have a serious awareness event and get tossed away with the mental health problems that occur after and are ignored by the healthcare providers it is a nightmare that never ends. As far as the movie AWAKE I thought it was ridiculous and was not even close to what a person goes through I wanted to see it to see how closely it depicted the event. I was disappointed in the movie. I am not sure what the answer is, I am thankful for the Anesthesia Awareness Campaign and all the hard work that Carol does to bring public awareness. Before my surgery I never knew anything like this could happen or even existed. I have spent the last three years researching and trying to understand why it happened and how it happened and deal with the after effects of the traumatic event of being awake, sawed, repaired and stapled back together. Knowing some of the questions to ask prior to surgery are very important. Any one person that the campaigns efforts can prevent from this experience is worth all her efforts.
I can tell you waking up is a BIG HUGE DEAL! I woke up during a proceedure and my surgeon told me and MY family, there was no way! Way! I am not the person I used to be and I suffer every single day! You nay sayers about the monitors WTH are ya thinking? Afraid you might actually get caught NOT doing your job? Why not use them in conjunction with your “incrediable skills”. Does your oath not say something about “no Harm”? Abide by it and give the machine a chance. We all know the cost right? One pt’s ruined life is worth . . . ????? I am preparing for the battle of my life, just to hear someone say, yes, we believe this is a problem and yes we are doing everything we can to make sure it does not happen to one more person because even one is one too many.
Tif,
I am truly sorry for your bad outcome. There were several issues related to your anesthesia and surgical care that were clearly suboptimal- specifically related to physician skill and knowledge.
Your experience highlights the fact that monitors don’t improve outcomes. You seem to have been monitored.
I’m glad you’re getting help and doing better.
Kathy,
Your story is not terribly uncommon. Open heart surgery is one of the high-risk procedures and complete loss of consciousness is less reliable.
In such cases the best that some monitors can do is warn the physician that awareness is likely but the patient’s safety or survival may be compromised by more anesthesia. Every case is literally different.
Here at Safer Health Care, we also appreciate the Anesthesia awreness Campaign. They help keep the focus on after care. Prevention is much more difficult. We are concerned by any program that promotes specific monitoring for prevention. There is every possibility that current monitors increase the risk of awareness. If the current monitors actually worked reliably every anesthesia provider would be using them, it’s that simple.
No Name,
I guess you didn’t read the posts. The monitors don’t work. All of us acknowledge that awareness is a problem. I am truly sorry that the surgeon you chose for your operation was an idiot.
In spite of this, I use the monitor anytime a patient requests. I make the patient sign a separate consent indicating that the patient understand that consciousness monitors may actually increase the risk of awareness.
The currently available “consciousness monitors” have had many chances. There is no statistically valid study that indicates that you are any less likely to have awareness with one of these monitors used.
My personal dislike of the monitor relates not to any “oath” but to the simple fact that I cannot justify any cost for monitoring that serves no medical purpose. You have fallen under the fear-mongering spell of the corporate world and those who make their living promoting fear rather than science and fact.
I anxiously await the day that there is a class-action suit against the makers of these monitors once they are definitively found to increase awareness. These monitors have a greater chance for harm than for help. Notice Tif’s story above. She was monitored. Bad anesthesia is still bad anesthesia.