The Nightmare Of Waking During Surgery

Study: Brain Monitors No Better Than Old Method For Keeping Surgical Patients From Waking

(AP)  Patients say it feels like being trapped in a corpse: They awake during surgery, unable to move or scream. Some remember hearing their surgeons talk, and a few recall feeling intense pain.

Some experts have said special brain-wave monitors were the best way to prevent anesthesia awareness. Now, in a big setback for efforts to prevent it, the first large, independent test of the monitors shows they are no better than older technology.

Researchers at Washington University School of Medicine in St. Louis compared two groups of about 1,000 patients each, all deemed at high risk of waking up during surgery because of health conditions, medication or other factors.

One group used the leading brain-monitoring system, which uses electrodes on the forehead to measure brain waves and software to calculate likelihood of consciousness. The other used an older device that analyzes exhaled anesthetic gas.

Anesthesiologists watched for movement and changes in vital signs and followed protocols to maintain patients' depth of sleep, adjusting anesthesia levels as needed. Patients were interviewed after their surgeries about what they remembered.

Two people in each group had experienced awareness - and the two monitored with the newer system reported having felt pain as well.

Lead researcher Dr. Michael Avidan said that in two of those cases - one with each system - the monitors indicated no problems with the anesthesia. In the other two cases, the monitors signaled problems.

The study analyzed groups of people who had surgery at the university's partner hospital, Barnes-Jewish in St. Louis, in 2005 and 2006.

Anesthesia awareness occurs in 1 or 2 of every 1,000 surgical patients - possibly more often in children - and is thought to happen to roughly 30,000 Americans each year.

Some just have fleeting memories of things they heard, but others describe "white-hot pain" and terror, triggering long-term emotional problems.

Carol Weihrer of Reston, Va., said that 11 years after awakening during surgery to remove a diseased eye that caused severe pain, she still has post-traumatic stress disorder, can sleep for just short periods and suffers mood swings and panic attacks.

Weihrer, who founded the group Anesthesia Awareness Campaign Inc., said she heard the doctor give instructions: "Cut deeper, pull harder." "I actually saw them cut the optic nerve when everything went black," she said.

"While you're laying there on the table," she recalled, "you are thinking, praying, cursing, plotting, pleading, trying to crawl off the gurney, trying to kick, scream, move any part of your body to let them know you're awake. In effect, you are entombed in a corpse."

Kathy LaBrie of Nashua, N.H., also suffered awareness during surgery for a deviated septum. She said she heard "the sound of pushing and grinding and the surgeon talking to the nurses about the kind of car he had. ... I tried moving my arms and legs - I couldn't do anything. I thought I was dying."

Dr. Jeffrey Apfelbaum, president of the American Society of Anesthesiologists, who was not involved in the study, said there is "tremendous pressure" from industry and patient advocates to use the brain-wave technology, despite the lack of solid evidence that it works better.

The position of the anesthesiologists group has been that brain-wave monitoring should not be done routinely, but may be helpful for certain patients at high risk of awareness. But widespread use would be very costly.

The dominant maker of brain-wave systems, Aspect Medical Systems, says its monitor, called a bispectral index or BIS, is used in about 17 percent of the roughly 20 million U.S. surgeries each year in which anesthesia gas is used.

The device can cost as little as $5,000. But the researchers estimated that if it were used on all U.S. patients getting general anesthesia, the disposable electrodes alone would cost more than $360 million a year.

The device, on sale since 1998, "can prevent both too little anesthesia, which could cause awareness, and too much anesthesia, which could cause prolonged recovery and anesthetic side effects" such as grogginess and nausea, said Aspect's medical director, Boston anesthesiologist Dr. Scott Kelley.

He said the new results show the system can help anesthesiologists "achieve a very low incidence of awareness in high-risk patients."

But Avidan's fellow researcher, anesthesiology professor Dr. Alex Evers, said he thinks having doctors closely follow a protocol to maintain the patients' depth of sleep was the key to reducing anesthesia awareness in both groups.

The Food and Drug Administration has stated only that the BIS device "may be associated" with reducing awareness during surgery.

About 10 percent of U.S. surgical patients receive intravenous anesthesia, without any gas. The study findings do not apply to them.

Dr. Douglas Jackson, assistant anesthesiology professor at University of Medicine and Dentistry of New Jersey in Newark, said the study shows the BIS system "is not a magic bullet."

"We still don't have a monitor that can tell us about depth of anesthesia (and) awareness," he said, adding that controlling that is still an art.

[rosapreiss]

Mark Rosen, a senior anesthesiologist and vice chairman of anesthesiology at the University of California San Francisco Children''s Hospital, who had himself suffered the rare experience of anesthesia awareness, states that he applauds the Avidan study for "convincingly revealing the BIS monitor for what it is %u201Cunreliable for clinical practice". Avidan himself states objectively, and clearly with no subjective agenda or personal axe to grind "larger, follow-up studies need to be done to replicate or refute these findings".
Surely, the least the manufacturers and promoters of the BIS equipment should do is to offer the Avidan team the same professional courtesy with which their own (Be Aware) study was treated by the Avidan team. They should refrain from emotive and judgemental responses, pending conclusions from the promised larger follow-up studies. These, we hope will ultimately arrive at the scientifically and statistically most valid conclusion for the good of those who ultimately count - the patients!

[docpeter-2009]

I woke up during hand surgery. I was looking around the room when the radiology tech noticed and started shouting "He''s awakw, He''s awake." I smiled and told him "Shhhh that is my hand they are working on & I would like to use it again." The anesthesiologist asked If I was alright and I told her that my arm was hurting. It really felt like someone had the heel of their shoe on the inside of my arm. I even talked to the doctor and asked how is it going, not so good the joint they were trying to repair was damaged more thant the x-rays revealed. Finally after about 5 minutes or so I told the anesthesiologist "It''s time to sat goodnight Grace." and she put me back under.

[bobnjersey]

[He said the new results show the system can help anesthesiologists "achieve a very low incidence of awareness in high-risk patients." ]

so what criteria defines a high risk patient for conscious awareness?

[kittyres-q-r]

I awoke during sinus surgery back in the early ''80''s. Fortunately, I did not feel any pain, but I did hear the doctor''s instructions to the surgical assistants while he was operating. When I mentioned to him at my follow-up visit that I had heard him, he was astounded. Since then, I''ve awoken only one other time while under anesthesia (for a minor procedure). Fortunately, the doctor must have realized that I was trying to tell him to stop what he was doing, because I went back "under" almost immediately. I''m concerned about possible future surgeries, because I would think that since I''ve already experienced two "awareness" episodes while under anesthesia, there is a really great likelihood that it will happen again. I certainly hope that SOMETHING will help the doctors monitor my level of consciousness!!!

[coppertales]

When I was around 6 years old I had my tonsels removed. I awoke on the table and I remember two doctors standing over me and the big light above. Then I went back to sleep.

My wife was awake during a historectmey around 20 years ago and felt all the pain....chris3

[rf35]

This brain wave monitor sounds like another example of a company trying to push a product that doctors don''t want and patients neither need nor get any benifit from. Kind of like many prescription drugs. It''s just another useless add-on to raise your insurance rates.

[jetlizhan]

i''m glad i didn''t read this article before i had surgery this past october (breast reduction)- because this was the most painful recovery i''ve ever experienced (but so worth it!)- heaven forbid had i awakened DURING the procedure!

[mike71067]

"I actually saw them cut the optic nerve when everything went black," she said.

Oh come on. Be a man and deal with it.

[juwboy]

Floydypoo aka Callow_Youth:

Both of us attended a university, but, unlike you, I BENEFITED from my university education.

[juwboy]

bobbyfunn asked:

"Am I supposed to believe a lie detector actually works?"

If a lie detector is 90% accurate and 90% of people tell the truth when tested, then, in every group of 100 people:

81 honest persons will be correctly identified as honest

9 liars will be correctly identified as liars

1 liar will be incorrectly identified as honest

9 honest persons will be incorrectly identified as liars

So, if lie detector evidence was admissible in the courts, one guilty person would be set free for every 9 people who are falsely accused.

bobbyfunn, the answer to your question is "NO!!!"

Even if the lie detector was 99% accurate and 99% of people were honest, it wouldn''t get better, it would get worse.

In a group of 10,000 people the numbers would be 9801, 99, 1 and 99, respectively.

Now there would 99 times as many false accusations against innocent parties compared with the number of criminals who would be set free.

[shanev137]

Reminds me of the movie The Island, when Starkweather wakes up on the operating table as they are sawing open his chest.

[randynason]

Not only did I wake up during surgery, but I contacted a meningitis infection as a result of the spinal anesthesia. These things happen all the time, all too often.

[vancouverboo]

I woke during my knee surgery. No big deal. I asked them a question, they said "he''s awake, increase the dose." So I went out again. I felt them scraping and pulling and some pain before getting their attention. It''s hardly worth writing an article for the internet. Well, you have to write something to fill the blank spaces between the advertisements.

[bobbyfunn]

And I am supposed to believe a lie detector actually works?!

[rational_1]

Very interesting article. Volatile anesthetics have a number of diverse effects on patients, producing immobility, loss of consciousness as well as amnesia. So the patients who displayed awareness during anesthesia were also at least somewhat resistant to the amnestic effects as well. At least in lab animals amnestic effects occur at lower doses than the doses of anesthetics required to produce loss of consciousness or movement. The patients clearly had enough anesthetic on board to maintain immobility yet they did not display amnesia. Wonder why that was. I wouldn''t be surprised if some rare genetic mutation is involved. These rare individuals might give us some ideas about what molecular sites anesthetics are targeting to produce amnesia and loss of consciousness.