What is anesthesia awareness?

Anesthesia Awareness is probably the most helpless and terrifying feeling in the world.  It occurs when one is supposed to be completely asleep under full general anesthesia, but the brain is not asleep at all.  Your body is almost always fully paralyzed; you have a tube down your throat; and you can't speak, breathe, or move or do anything to alert the doctors that you are awake.  If you do manage to move, as I did, a disastrously common response from the anesthesia provider is to simply administer one or more doses of paralytic drug; not considering the possibility that the patient is awake; i.e. experiencing Anesthesia Awareness.  A paralytic drug administered while the patient is conscious feels like ignited jet fuel coursing through your veins.  

Technology is available to monitor brain activity that has been proven in multiple scientific clinical studies to reduce the current incidence of anesthesia awareness, commonly calculated to be a minimum 100-200 reported cases per day in the US alone, by at least 82%!  Yet we know that under-reportage may be as much as a third.  Pediatric cases may occur 4-6 times as often.  Those figures work out to a minimum 28,000 - 56,000 reported times per year in the US alone!

This Campaign will not rest until the use of brain activity monitors is routine in all general anesthesia surgeries or a better alternative is found.

I've never or only vaguely heard about anesthesia awareness. Why not?

Anesthesia Awareness has been one of the best-kept secrets in anesthesia, and was, at one time, one of the least-known phenomena in the medical or legal fields in general.  As a result of the work of this Campaign, much media attention has been given to this problem, and slowly, the public is learning to be "aware of awareness."  

From my own experience and the feedback of over 4,000 phone contacts with awareness victims, it seems the anesthesia community sometimes remains in deep denial of the number of times awareness occurs, frequently denies patient reports of the problem, many times fails to make the incidents known to the surgeon or other hospital caretakers, and certainly grossly underestimates the depth and the duration of the devastating psychological aftereffects of anesthesia awareness — most often Post-Traumatic Stress Disorder (PTSD)

However, positive progress is being made by the ASA in recognizing anesthesia awareness.  Congratulations to us all — especially the ASA, for whom this recognition is such a huge step!  Now that the problem is being recognized and acknowledged, perhaps meaningful forward action can take place.

What causes anesthesia awareness?

In my opinion, the most prevalent cause of anesthesia awareness is lack of care and attention on the part of the anesthesiologist along with a resistance to use proven brain activity monitors.  In a 1999 syndicated radio interview, the President of the American Society of Anesthesiologists admitted that "drugs are sometimes mislabeled or administered in the wrong order, and tanks do run dry."  [National Public Radio, Radio Health Network, double feature on Awareness, 1999] 

At present, patients seldom get to meet their anesthesiologist more than five minutes before surgery; they have no choice of doctors or any chance to check out credentials or even know whether the person administering anesthesia is an M.D. or nurse anesthetist; or whether he/she will be monitoring only your surgery or several other surgeries at the same time. In other words, the person who actually sees to it that your vital body functions continue, the one who truly holds your life in his/her hands, is less familiar to you than your hair dresser!  Patients are rarely told they may be paralyzed during the surgery, of the possibility of anesthesia awareness, or if and what type of monitors will be used to determine the level of consciousness of the patient.

Who is warning me about anesthesia awareness?

I was as awake, alert, and aware during the removal of an eye as I am now, as I write this, but I could do nothing to communicate my awareness. Neither anesthesiologist nor nursing staff acknowledged my (loud) reports of the incident upon being awakened in the OR — screaming at the top of my lungs that "I was awake; I was awake while they took my eye out!;" no counseling was offered by the hospital; access to my records was denied for an unreasonable amount of time; my account of the incident was questioned; and I now suffer from Post-Traumatic Stress Disorder (PTSD) that has severe consequences on my daily life and has destroyed my sleep patterns for over ten years now.  Many months later, when I finally obtained my medical records, there was absolutely NO charting of any vital signs or medications for 2½ hours of a 5½ hour surgery!

Who needs to learn about anesthesia awareness?

Potential General Anesthesia Patients
Anesthesia Awareness Victims 
General Practitioners
Hospital Administrators
The Anesthesia Community
Psychiatrists and Psychologists
Judges and Jurors

What can I do to protect myself and my family from experiencing anesthesia awareness?

Be absolutely unrelenting in letting each and every one of the medical personnel you deal with know that you are aware of anesthesia awareness.

I suggest you insist on having time with your anesthesiologist well before surgery.  The European model of meeting the anaesthetist up to a week before surgery, in an office setting, is a great model.  BUT, it takes time and costs money; and that is something the US health care system avoids.

  • Think twice about using a surgical facility or hospital that does not use brain activity monitoring!  Patients are consumers!!  It is important to ask three questions:  Do you have BIS monitors? and Do you use BIS monitors? and will one be used in my surgery?
  • Ask your surgeon who will be administering anesthesia and whether he/she has ever worked with this provider before.
  • Insist on knowing whether you will be paralyzed, to what extent, and if it is absolutely necessary
  • Find out what kind of monitors will be used.
  • Find out whether the anesthesia provider will be with you and only you the whole time.
  • Learn about what emergency backup equipment is available, particularly in non-hospital ambulatory surgical centers or doctors' offices.
  • Ask when the anesthesia machine, monitors, and tanks were last checked and by whom.
  • Find out what the hospital's policies are regarding patients who report anesthesia awareness.  Ask if this facility follows the guidelines in the JCAHO Sentinel Event Alert #32.
  • Be sure to ask if you will maintained the whole time of surgery by amnesic drugs, like Versed.  It is important that these be administered before any intrusive measures (like intubation, administration of paralytics) are taken.

To Whom Can Anesthesia Awareness Happen?

Anyone!  You!  Your loved ones!

Does My Doctor Know about Anesthesia Awareness?

Hopefully more so than 11 years ago when this Campaign started its work. But there are still many doctors I have talked to who are amazed awareness occurs, and are unaware of the extent of the problem, the tremendous post-operative effects on mind and body, or the attitude of the professionals in the anesthesia field.  This Campaign is working very, very hard to change "Awareness of Awareness."

What Are The Effects of Anesthesia Awareness?

In my case, I came out of the operating room screaming at the top of my lungs that I was awake while they took my eye out.  The anesthesiologist never came to visit the recovery room; the nurses would not answer my questions about whether my awareness was recorded.  The anesthesiologist, forced to visit two days later because of the surgeon's complaint, callously informed me I had had local anesthetic in addition to the (supposedly) full general anesthesia; so I could not feel pain; and therefore no harm could possibly have been done!      Such denial and mistreatment are all too common when awareness occurs.  The account of the victim is frequently put into question. Friends and family try to calm the patient by down-playing the reality of the event.  Nightmares, flashbacks, and PTSD are common; psychiatric care is usually needed, sleep patterns change, personality changes occur, startle response is greatly exaggerated, crowds are avoided, noises become troublesome, and control becomes an over-riding life concern—and frequently, the memory never goes away.