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.

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.

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.

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.

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.