MEDICATIONS: PATIENT AWARENESS UNDER
GENERAL ANESTHESIA — WHAT IS IT?
What Is Patient Awareness Under General Anesthesia?
Awareness under general anesthesia is a rare condition that occurs when
surgical patients can recall their surroundings or an event — sometimes even
pain — related to their surgery while they were under general anesthesia.
When using other kinds of anesthesia, such as local, sedation or regional
anesthesia, it is expected that patients will have some recollection of the
procedure.
Studies are not conclusive on the frequency of awareness under general
anesthesia, but even one case is important to anesthesia professionals
(anesthesiologists and certified registered nurse anesthetists), who recognize
that this can be a distressing or traumatic experience for the patient.
When awareness during general anesthesia does occur, it is usually just prior
to the anesthetic completely taking effect or as the patient is emerging from
anesthesia. In very few instances, it may occur during the surgery itself.
Despite the rarity of awareness, members of the American Society of
Anesthesiologists (ASA) and the American Association of Nurse Anesthetists
(AANA) want you to know about this possibility. These organizations have been
studying this issue and are in the process of evaluating the effectiveness of
various technologies and techniques to decrease the likelihood of this
occurring.
Why Does It Happen?
In some high-risk surgeries such as trauma, cardiac surgery and emergency
cesarean delivery, or in situations involving patients whose condition is
unstable, using a deep anesthetic may not be in the best interest of the
patient. In these and other critical or emergency situations, awareness may not
be completely avoidable.
While the safety of anesthesia has increased markedly over the last 20 years,
people may react differently to the same level or type of anesthesia. Sometimes
different medications can mask important signs that anesthesia professionals
monitor to help determine the depth of anesthesia. In other rare instances,
technical failure or human error may contribute to unexpected episodes of
awareness. The ultimate goal is always to protect the life of the patient and to
make the patient as comfortable as possible. That is why it is important to have
highly trained anesthesia professionals involved in your surgery.
How Can It Be Avoided?
Before surgery, patients should meet with their anesthesia professional to
discuss anesthesia options. Should there be concerns regarding awareness, this
is an ideal time to express them and to ask questions. Patients should share
with their anesthesia professional any problems they may have experienced with
previous anesthetics and also discuss any prescription medications or
over-the-counter medications they are taking.
As always, your anesthesia professional will guide you safely through your
surgery by relying on his or her clinical experience, training and judgment
combined with proven technology.
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The 10 Things You Should Know About Patient Awareness Under General
Anesthesia
1. It is quite rare. When it
does occur, it is often fleeting and not traumatic to the patient.
2. Patients experiencing
awareness usually do not feel any pain. Some patients may experience a
feeling of pressure.
3. Awareness can range from
brief, hazy recollections to some specific awareness of your surroundings
during surgery. Patients who dream during surgery, or who have some
perception of their surroundings before or after surgery, may think they
have experienced awareness. Such a sensation or memory does not
necessarily represent actual awareness during surgery.
4. Experts in the field of
anesthesiology are actively studying this condition and are seeking the
most effective ways to prevent it.
5. Awareness can occur in
high-risk surgeries such as trauma and cardiac surgery in which the
patient's condition may not allow for a deep anesthetic to be given. In
those instances, the anesthesia professional will weigh the potential for
awareness against the need to guard the patient's life or safety. The same
is true during a cesarean section, particularly if it is an emergency and
a deep anesthetic is not best for the mother or child.
6. It has been shown that
early counseling after an episode of awareness can help to lessen feelings
of confusion, stress or trauma associated with the experience.
7. Researchers in
anesthesiology have spearheaded developments in technology that have
dramatically improved patient safety and comfort during surgery over the
last 20 years.
8. A highly trained
anesthesia professional should be involved in your surgery. No technology
can replace this expertise.
9. New brain-wave monitoring
devices currently being tested may prove to be helpful in reducing the
risk of awareness, but they need to undergo the same rigorous scientific
review process that has led to wide adoption of other medical
technologies.
10. Patients should talk
with their anesthesia professional before surgery to discuss all of their
concerns, including the remote possibility of awareness. These
professionals work to ensure the best possible care of patients in the
operating room.
Patient awareness happens very infrequently. This remote possibility
should not deter you from having needed surgery.
Your anesthesia professional can help you to feel comfortable and
informed about your upcoming experience with anesthesia.
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What Does the Future Hold?
As patient advocates, anesthesia professionals are working hard to reduce the
likelihood of awareness under general anesthesia. Depending upon the type of
surgery, these experts have an array of proven technologies that can be used to
monitor various vital signs of the surgical patient.
Extensive research is under way to develop and study new technologies, such
as brain-wave monitoring, that may lessen the risk of awareness. At the present
time, none of these new technologies has been perfected.
Remember — no monitoring device can replace the judgment and skill of an
anesthesia professional who has years of training and clinical experience.
Working together, you and your anesthesia professional can make your anesthetic
experience as safe and comfortable as possible.
What Should I Do If I Think I Have Experienced Awareness?
ASA and AANA urge you to talk with your anesthesia professional, who can
explain to you the events that took place in the operating room at any stage of
your surgery and why you might have been aware at certain times.
It is important to note that a variety of anesthetic agents is often used,
some of which may create false memories or no memory at all of the various
events surrounding surgery. If you have distinct recollections of your surgery
and want to discuss them, your anesthesia professional can help you or refer you
to a counselor or to other appropriate resources.
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