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Anesthesia

Anesthesia awareness??

03/28/2006

Question:

Hi, I`m scheduled to undergo a surgery to remove my galbladder. I am extremely nervous about the articles I`ve read and news reports ive heard about patients experiencing anesthesia awareness where they`re not fully unconscious, and experience pain and awareness of whats going on, but are unable to make the surgeons aware. I know this isnt overly common but it terrifies me, and what makes it even scarier is the fact that ive had to have alot of dental work done recently and everytime ive gone in, it has taken the maximum safe amount of novicane to numb me, and then sometimes I still was not numb. I do not seem to respond to drugs as many people do (novicane, painkillers that knock many people out, ect). They just dont have much of an effect on me. I don`t know if this would have anything to do with the type of anesthesia i will be receiving but I am very worried about this and any feedback you have would be really really helpful in putting my mind at ease.

Answer:

Thanks for your question. You are not alone in this, as more and more patients seem to be concerned about this problem of awareness during general anesthesia. The good news is:

1. It’s quite rare – about 1-2 cases in every 1,000.

2. The great majority of patients who experience awareness during general anesthesia do not have any pain with it.

3. We have some idea of those who are most at risk. This includes patients who are to undergo emergency surgery, those having heart operations, and women having cesarean sections under general anesthesia. Patients having routine elective gall bladder surgery are definitely not in this category.

4. We have brain monitoring equipment that can help the anesthesiologist adjust the level of anesthesia. This equipment monitors brain waves and calculates a number that is supposed to represent how deeply asleep or unconscious the patient is. However, it is not yet proven that this technology can prevent awareness.

5. In the unlikely event that a person experiences this type of unfortunate event, most do not have any long term psychological or physical problems as a result.

What I would do is mention your concern directly to your anesthesiologist. In some hospitals it is possible to meet with the anesthesiologist, or at least talk with that individual, well ahead of the surgery. The level of anesthesia that is given is to some extent a “clinical” judgement. With the concerns you are describing, your anesthesiologist has the option to adjust dosages to the high end, to add drugs that have amnestic (memory suppression) properties, and also to use one of the brain monitoring technologies I have mentioned.

With these precautions, and a competent, experienced anesthesiologist I think the risk of you experiencing awareness during your gall bladder surgery is very low, probably much lower than the average statistic I quoted above.

For more information:

Go to the Anesthesia health topic, where you can:

Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University