ANESTHETIC AWARENESS Waking up during surgery
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- Date: Tue, 07 Aug 2007 21:39:08 -0000
http://www.thestar.com/living/Health/article/243641
ANESTHETIC AWARENESS
TheStar.com - Health - Waking up during surgery
Waking up during surgery
LUCAS OLENIUK / TORONTO STAR
Patients who regain consciousness during surgery, but who cannot move
to alert doctors that they're awake, remember pain and doctors'
instructions such as "cut deeper, pull harder." Email story
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Anesthetics a double-edged knife
In Scientific American magazine, UofT professor Beverley Orser writes
"scientific understanding of how anesthetic drugs actually work, and
how to make them better, has lagged behind most other areas of drug
development."
Her article Lifting the Fog Around Anesthesia, in the magazine's June
issue, reports that, "both the desirable and unwanted effects of
anesthetic drugs stem from their power to suppress neuronal activity
throughout the central nervous system, which encompasses the brain and
spinal cord and controls heart rate and breathing." Her story adds
"the state produced by most modern general anesthetics is more of
pharmacological coma."
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Kids more at risk
Children seem more susceptible to intraoperative awareness.
An Australian study, in the journal Anesthesia & Analgesia, surveyed
850 children between 2002 and 2004 and found almost 1 per cent had
experienced periods of wakefulness during their surgery. Studies of
adults have shown 0.1 to 0.2 per cent experienced anesthetic
awareness.
The findings generated great concern, commented research leader Dr.
Andrew Davidson, of the Royal Children's Hospital, in Melbourne.
One child heard the noise of an orthopedic saw. Another described
having a tube inserted into his eardrum.
But Davidson reported he was relieved that only a few of the children
remembered pain.
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David Graham
Coming to during major surgery is a rare horror for patients whose
trauma is the focus of a new movie
Aug 07, 2007 04:30 AM
David Graham
Living Reporter
Sometimes the nightmare starts when you wake up.
Eight years ago Yvonne Coleman drifted off to sleep on a New York
operating table as a team of surgeons prepared her for a two-hour
surgery to remove an abdominal hernia.
"I remember the surgeon asking, `Are you ready kiddo?'
"`Ready for what?' I thought to myself," says Coleman who, at that
point, wondered if her surgery was over and she was being awakened.
Then she felt a knife cut her open. "I felt every tug and pull. I
heard them making fun of my weight. I heard them making plans for the
Christmas party. But I was completely paralyzed," she says.
"In my head I was screaming. I wanted to die."
Any patient who's lived through the horror of regaining consciousness
in the middle of a surgical procedure will never forget the surgeon's
scalpel slicing their skin, the sight of their own blood, the smell of
cauterized flesh and the business-as-usual conversations going on
above them. Meanwhile, they lay still, unable to wiggle a finger,
blink, cry out, or in any way indicate they're awake.
Now, the victims of this rare and traumatic experience are the subject
of a Hollywood thriller about their painful ordeal.
Awake features Hayden Christensen as a young husband who comes to
during open-heart surgery, but who is also unable to move or talk.
Like other patients who've experienced intraoperative or anesthesia
awareness, Christensen wakes up just as his complicated surgery is
about to begin. Jessica Alba stars as his wife, and Terrence Howard
plays a doctor in the film, which is set for release this fall.
He is being operated upon without benefit of pain-blocking anesthesia
but, because he's paralyzed, he can't do a thing about it.
The movie's premise is not so far-fetched, writes Dr. Beverley Orser,
a professor with the University of Toronto's physiology department, in
the June issue of Scientific American magazine. Her article, Lifting
the Fog Around Anesthesia, clears the air on the complicated subject
of modern anesthetics.
"Anesthesiologists are not looking forward to (Awake) coming out at
all," says Scott Beattie, director of pre-operative assessment and
clinical research for the University Health Network, and a professor
at UofT.
"The public has become more aware of the possibility," he says.
"People are plugged in and they worry about it," and some patients
fear it's unsafe to go under the knife.
Beattie is mainly speaking of the subgroup of patients who are most at
risk: those who must receive limited amounts of anesthesia, such as
high-risk cardiac patients, women having caesarean sections and
patients whose doctors want them to awaken immediately after surgery.
Those who are regular users of narcotics or sedatives are also at
risk. And trauma victims set for emergency operations also must
receive a lighter than normal dose of anesthesia.
Carol Weihrer recalls waking up during eye surgery nine years ago.
Weihrer, speaking from her home in Reston, Va., says her life was
destroyed by the experience. She's been anticipating the release of
the film Awake since first hearing it was in production almost two
years ago.
"Anyone who has experienced this personal horror is anxious for the
movie to come out."
Weihrer says she has spoken with people who have already seen the film
in trial showings: "People in the audience absolutely scream." Weihrer
is convinced the film will bring international attention to her
organization, the Anaesthesia Awareness Campaign, and her role as
advocate for others who have woken up mid-surgery.
She is furious that nearly a decade after her ordeal, and despite
years of campaigning, the problem has not been addressed.
Back in 1998 during an operation on her right eye, Weihrer regained
consciousness but could not move. She heard the surgeon say to the
resident, "Cut deeper, pull harder." She was awake, paralyzed, and the
surgery was far from over.
Weihrer says the trauma has left her unable to sleep lying down and
she spends every night in a chair - sleeping for 90-minute intervals -
terrified to let her brain relax into a deep, REM sleep.
Most studies suggest that, in adult patients, the possibility of
waking up from a general anesthetic happens in one or two of every
1,000 surgical candidates. In North America, there are approximately
40 million surgeries conducted each year, says Weihrer.
Of those, 80 per cent require general anesthetic. According to those
stats, between 100 and 200 patients wake up during surgery every day.
Sometimes they're only conscious for a few seconds. But in rare cases,
where the patient is awake throughout the procedure, the post-
traumatic stress can include a range of effects from sleeplessness to
depression and even suicide.
Last April, the family of coal miner and Baptist minister Sherman
Sizemore of Charleston, W. Va., filed a complaint after their father
killed himself in the wake of his ordeal with anesthetic awareness.
The Sizemore suit is the first of its kind - in which the family sues
over the death of a loved one. Their case states Sizemore fell into a
deep depression after his ordeal, despite having no history of
psychological distress before his surgery.
Insult is added to injury when medical professionals, including
anesthesiologists, dismiss patients' claims that they were awake
during surgery. As well, many victims don't speak out, fearing doctors
and nurses will think they're crazy.
Advocates, including Weihrer, support the use of a monitoring device
that measures brain waves and ultimately alerts the anesthesiologist
when a patient is not completely under. A recent report on CNN
estimated they're found in only one in five U.S. operating rooms.
Few of the devices, which cost between $4,000 and $5,000, are
available in Canadian operating rooms. But, says Beattie, "Patients
are starting to ask for them. And I support them."
Weihrer insists they are an important line of defence. "The technology
has been proven in double-blind studies to be 82 per cent effective,"
she says. "It's not good enough to ask the hospital if they have it
and if they use it. You have to ask, `Will you use it on me?'"
And Coleman, who has had other surgeries since the hernia operation,
now insists on first meeting with her anesthesiologist. I make them
promise never to cover my eyes. I want them to look at me."
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