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Large Study Reveals How Frequently Patients Wake up During Surgery


Image credit: uchar/iStockphoto

“Accidental awareness” is something horrific occurring during the surgical operation when patients could be able to hear and feel surgeons who were cutting into them, but those patients could not say a word, even if they remained conscious. To experience such thing could be definitely terrifying and it  could easily cause post-traumatic stress disorder as well.

The largest study targeted on the prevalence of this phenomenon so far demonstrated that it was not usual, and the scientists had found that the risk factors could be completely prevented if efforts were made in this respect.

As the focus of the 5th National Audit Project, such study was intended to have a better understanding of anesthesia-related conditions which was somehow unusual. Jaideep Pandit and his team from Oxford University Hospitals have made their finding public in the journal of Anaesthesia.

Although based on the previous studies, accidental awareness happened in one out of 1,000 patients, this latest study showed that the entire odds of waking up during surgical operation were one in 19,600, or nearly 0.005% of the time.

Take the United States for example, every year more than 21 million surgeries with general anesthesia have been operated, as a result, there are nearly 1,050 patients who confront with accidental awareness during the operation.

It has to be admitted that accidental awareness in most cases would last within five minutes, and generally speaking, it only happened when the patient was either being put under or being brought out of anesthesia; and seldom occurred when the surgery was being implemented. But, whether or not the awareness really occurred when the patients were awake, they actually felt asphyxiation, hallucinations and pain as being reported.

It is clear that half the patients waking up under anesthesia would experience such psychological trauma in this circumstance. General anesthesia is intently given for temporary paralysis and relaxing the muscles so as to make it possible for surgeons to do their operations in a much easier way. If the patient woke up and failed to move, and at the same time they would not capable of making surgeons know that they were actually awake. It should be an extremely painful and terrifying experience for patients. Although doctors would be aware of increased blood pressure or heart rate of patients, they would give medications as part of the surgical procedure in regard to muting such physiological cues.

As far as this occurrence is concerned, there are some obvious risk factors related to waking up during surgical operation, such as gender (it is more likely for females to wake up compared with males), age (in most cases, it goes to young adults instead of children or teens), obesity, emergency surgeries and C-sections, in which less anesthetic is generally applied and those inexperienced anesthesiologists.

According to the previous practice, brain monitors was believed to help address the issue of accidental awareness; if surgeons noticed the spikes in patient’s brain activity, they would be aware that patient was awake. But mixed results from the previous studies had doubted whether or not this really worked.

Another suggested approach is linked with the application of nerve stimulators, which could be able to watch closely the body’s state of paralysis. To this end, the necessary amount of medication would be reduced so as to endow patients with the freedom to move if they wake up. In addition, it could minimize odds of accidental awareness during surgery.

As suggested by the researchers, when a patient wakes up during surgical operation, surgeons should know how to deal with the psychological needs and offer necessary services to patients in order to avoid their long-time suffering from depression or PTSD.

Source: CNN

Journal reference: Pandit, J. J., et al. “The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors.” Anaesthesia 69.10 (2014): 1089-1101.