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Anesthesia

Extreme Nervousness before Sedation

11/21/2006

Question:

I have heard several stories of people "waking up" during surgery under General Anesthesia. These people say they can feel everything, painfully so, but are unable to speak or move to let the doctor know. In most cases, the patient has a tall sheet in front of their face so they can`t see what is going on, but at the same time nor can the doctors see the patients face and in these particular stories that was one of the major problems, the only thing the person could do is blink, but the doctors were doing their thing and not even looking at him/her. From reading the other comments, I`m guessing this person couldn`t talk or move most likely because of a muscle relaxer drug.

I am VERY nervous about going under, I feel totally vulnerable, I don`t like not having control, and it scares me half to death to hear stories like this, that once I`m under the doctors may never pay attention to my consciousness at all. So how much attention is actually given to the patients consciousness level? And isn`t there some way to monitor a level of consciousness so that the anesthesiologist can detect if the person is awake and feeling pain?

Answer:

I understand and appreciate your concern about being awake during surgery under general anesthesia. It is perhaps a bit reassuring that awareneness under anesthesia is quite rare - about 1-2 per 1000 cases. When it does occur it is often associated with particular high risk cases, including obstetrics, cardiac surgery and trauma. In run of the mill surgeries in healthy people the incidence is less. Finally, in the large majority of documented cases of awareness under anesthesia the patient did not experience physical pain.

It is true that a barrier - a sterile surgical drape - is placed between the patient and the surgeon. This is to isolate the surgical field, which must remain sterile during the operation. Very often, additional drapes are placed around or on top of the patient's head to maintain warmth and normal body temperature - important for the prevention of infection. Depending on the type of surgery, the patient's face can be seen by the anesthesiologist who is normally stationed at that end of the operating table. The face can be checked by lifting the drapes or through the use of transparent drapes. The anesthesiologist then has the opportunity to periodically check the patient for movement, tearing of the eyes, sweating or grimacing, all of which may be signs that not enough anesthesia is being given. Having the patient's face, or at least part of the face, exposed is therefore good anesthetic practice.

Finally, there are indeed monitors available which measure electrical activity of the brain which does correlate with whether the patient is deeply unconscious, lightly sedated, or awake. Such monitors have not become the standard of practice in the United States as there is debate on how effective they are in the prevention of awareness. There is unfortunately still no completely reliable and inexpensive way of measuring consciousness which reflects our relative ignorance about the way the brain works.

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Response by:

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