News | December 02, 2007

Experts Agree One Case of Anesthesia Awareness Is Too Many

December 3, 2007 - A panel of researchers, anesthesia professionals and a patient/advocate assembled last week at a forum for healthcare journalists to tackle the complex issue of anesthesia awareness, the rare but devastating condition that is of heightened public concern due to Nov. 30 release of the movie “Awake.”

The forum, “A Wake-Up Call About Anesthesia Awareness: Striking a Balance in Public Perceptions,” was convened to address the range of related challenges, controversies and concerns in order to forge a positive path ahead to reduce anesthesia awareness and improve patient safety.

“While ‘Awake’ may send shockwaves through the systems of those about to have surgery, and those who have suffered this rare event, it also serves as a wake-up call to health professionals to do all we possibly can to reduce the occurrence of anesthesia awareness,” said Orin F. Guidry, M.D., professor, anesthesia and perioperative medicine, Medical University of South Carolina.

Anesthesia awareness occurs when a patient under general anesthesia stays or becomes conscious during surgery but can’t move or talk because paralytics are in effect. While the incidence of anesthesia awareness is rare, it can have devastating effects. The incidence, based on several studies, is reported to be 0.1%, which translates to about 21,000 of the 21 million people in the U.S. who receive anesthesia each year.

Dr. Guidry emphasized the dispute over the number of cases should not distract from the shared sense of urgency to address the issue. “Let’s get out of this box of how often it occurs. Really, one case is too many,” he said. “As anesthesiologists, we are not going to stop until we can get that risk down to zero.”

Carol Weihrer, president and founder of the Anesthesia Awareness Campaign Inc., provided her unique perspective as a patient/advocate whose experience with awareness propelled her to become an advocate for patient safety and support. She suggested patients become more proactive both in preparation for and in follow up after their surgery.

“I encourage people to empower themselves with research and education about their surgery, including the anesthesia,” she said. “They should have a very frank discussion with their anesthesia professional in advance. Always ask about monitoring, ask about paralytics, and be very forthcoming about any drugs that you are taking.”

The use of brain function monitors during surgery can reduce the likelihood of an individual experiencing anesthesia awareness, according to the panelists, who emphasized these monitors are an important strategy, not a solution.

“These monitors provide additional information that nothing else in anesthesia monitoring does,” said Daniel J. Cole, M.D., professor and chair of anesthesiology, College of Medicine, Mayo Clinic, member of the American Society of Anesthesiologists Task Force on Intraoperative Awareness. “I would like to see consciousness monitors in every operating room and available for every surgery at the discretion of the patient and the anesthesiologist.”

He said a 2005 American Society of Anesthesiology survey showed 64 percent of anesthesiologists reported not using a brain function monitor. In a 2007 Stryker National Attitudes and Perceptions (SNAP) survey, 22 percent of those surveyed reported not using monitors. While the surveys used two different methodologies and therefore are not absolutely equivalent, Dr. Cole said this indicates significant improvements have been made in addressing awareness.

Marc Bloom, M.D., Ph.D, director of neuroanesthesia at the New York University Medical Center sees promise in new technologies. “As more options become available to provide level of consciousness monitoring, patients can be reassured that they have an opportunity to have the best possible anesthetic care,” he said.

Tom McKibban, CRNA, MS, with Butler County Anesthesia Services LLC, provided key questions that should be asked of patients recovering from surgery following general anesthesia:

- What is the last thing you remember before going to sleep?
- What is the first thing you remember waking up?
- Do you remember anything between going to sleep and waking up?
- Did you dream during the procedure?

He said in the first few weeks after general anesthesia, patients should also be asked what the worst thing was about the operation.

“If they say the nightmares or recurring dreams, or other disturbing experiences apart from post surgery pain, we need to follow up with that,” McKibban said.

That follow-up may include referrals for counseling to help patients cope with what Weihrer calls the “life-changing experience” of anesthesia awareness.

“I see four primary drivers (to reduce awareness),” Dr. Cole said. “One is medical science, always the basis for the best patient care. Second is the patient/physician relationship. I believe it’s essential for patients to come in engaged and empowered; to ask tough questions and get honest answers. Next is industry, which plays an important role, and will continue to in the future. And finally, patient advocates have a substantial role in bringing this issue forward.”

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