Paralyzed and Awake During Surgery

Nov. 30, 2007— -- Opening in theaters today, the thriller "Awake" is about a man who wakes up during surgery -- paralyzed and unable to communicate the pain he feels.

Though no official comprehensive studies have determined its frequency, the movie estimates that 30,000 Americans will experience some form of this condition this year. What is it and how can you prevent it from happening to you?

Below is information from the American Society of Anesthesiologists and American Association of Nurse Anesthetists.

What Does Patient Awareness Under a General Anesthetic Mean?

Awareness under general anesthetic is a rare condition that occurs when surgical patients can recall their surroundings or an event -- sometimes even pain -- related to their surgery while anesthetized. When using other kinds of anesthetic, such as local, sedation or a regional anesthetic, it is expected that patients will have some recollection of the procedure.

How Common Is This Condition?

Though the movie "Awake" claims that 30,000 Americans will experience patient awareness this year, there are no conclusive studies on its frequency, but even one case is important to anesthesiologists and certified registered nurse anesthetists, who recognize that this can be a distressing or traumatic experience for the patient.

When Does Patient Awareness Happen?

When awareness does occur, it usually happens just before the anesthetic takes complete effect or as the patient emerges from the anesthetic. In very few instances, it may occur during the surgery itself.

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 weighs the potential for awareness against the need to guard the patient's life or safety. The same is true during a Caesarean section, particularly if it is an emergency and a deep anesthetic is not best for the mother or child.

Does the Patient Feel Pain?

Patients experiencing awareness do not usually feel any pain. Some patients may experience a feeling of pressure.

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.

Despite the rarity of awareness, members of the American Society of Anesthesiologists and the American Association of Nurse Anesthetists 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 Patient Awareness Happen?

In some high-risk surgeries such as trauma, cardiac surgery and emergency Caesarean 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 I reduce the risk of patient awareness?

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.

What should I do if I think I've 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 are 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.

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.

What are doctors doing to prevent patient awareness in the future?

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.

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.

However, at the present time, no new technologies have 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.