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.
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.
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.
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!
Potential General Anesthesia Patients
Anesthesia Awareness Victims
Families
General Practitioners
Surgeons
Nurses
Hospital Administrators
The Anesthesia Community
Lawyers
Ministers
Psychiatrists and Psychologists
Judges and Jurors
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.
Anyone! You! Your loved ones!
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."
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.