Prevention: What You Can Do To Prevent Intraoperative Awareness
Talk to your anesthesia doctor and provide accurate information. This is your best defense against intraoperative awareness.
So, be honest with your doctor about:
- Your fears. Usually, this will help calm you. While no absolute guarantees can ever be made, your doctor can help pinpoint whether or not you have higher risk than average for this complication and let you know how he or she will address the risk.
- Alcohol consumption. Chronic, excessive alcohol intake results in a higher need for anesthetic medications.
- Illegal drugs use. Your anesthesiologist needs to know this to figure out which and how much anesthesia it will take to get you to sleep and keep you there. They are not there to judge you, but cannot keep you safe if they don’t have all relevant information.
- All of your prescriptions and supplements. Different medications affect the metabolism of anesthesia differently. And just because supplements are “natural” or “alternative” doesn’t mean they don’t have side-effects or don’t interfere with anesthetic medicines.
Waking Up Under The Surgeon’s Knife
Canadian Donna Penner was relaxed at the prospect of abdominal surgery – until she woke up just before the surgeon made his first incision. She describes how she survived the excruciating pain of being operated on while awake.
In 2008, I was booked in for an exploratory laparoscopy at a hospital in my home province of Manitoba in Canada. I was 44 and I had been experiencing heavy bleeding during my periods.
I’d had a general anaesthetic before and I knew I was supposed to have one for this procedure. I’d never had a problem with them, but when we got to the hospital I found myself feeling quite anxious.
During a laparoscopy, the surgeon makes incisions into your abdomen through which they will push instruments so they can take a look around. You have three or four small incisions instead of one big one.
The operation started off well. They moved me on to the operating table and started to do all the normal things that they do – hooking me up to all the monitors and prepping me.
The anaesthesiologist gave me something in an intravenous drip and then he put a mask on my face and said, “Take a deep breath.” So I did, and drifted off to sleep like I was supposed to.
When I woke up I could still hear the sounds in the operating room. I could hear the staff banging and clanging and the machines going – the monitors and that kind of thing. I thought, “Oh good, it’s over, it’s done.”
That changed a few seconds later when I heard the surgeon speak.
Want To Know More About The Inside Of The Or
The OR often seems like an exclusive setting to those not privy to the daily ins and outs of surgical procedures. Patients who remain awake during surgery are given a front-row seat to the handiwork of some of our most talented medical professionals.
But thats not the only way to get an in to the OR! Working as a surgical technician can put you on the frontlines of leading medical procedures while aiding in the lifesaving process of surgery. Learn more about the perks of the position in our article: 4 Reasons Becoming a Surgical Tech is Worth it.
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Who Is Suitable For This Type Of Surgery
- Anyone who is concerned about feeling out of control because of being put to sleep
- Those who are older, or whove had medical problems, heart trouble in particular and the risk of an anaesthetic worries them
- Those who have previously had an operation under general anaesthetic and just felt awful afterwards nauseous, lethargic, not sleeping properly, in lots of pain
In all these cases it wasnt the operation, but the general anaesthetic which made them seek alternative options, more suitable for them as individuals.
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Open Heart Surgery: What To Expect On The Day Of Surgery
There are several surgeries that are classified as open heart surgeries. While this form of surgery entails opening up a person’s chest with a large incision to expose and operate on their heart, what a specific operation entails from start to finish differs.
Coronary artery bypass graft is the most common type of open heart surgery. This operation involves going around a blocked coronary artery in order to restore blood flow to the heart. Open heart surgery may also be performed to repair or replace a diseased heart valve, transplant a donor heart, fix a congenital heart defect, or implant a life-saving medical device.
Here, the basic steps of open heart surgery are reviewed. While this gives you a good sense of what lies ahead, be sure to speak with your healthcare provider about what your procedure will look like.
How The Anesthesiologist Monitors During Surgery
The anesthesiologist, using intraoperative monitoring, will be watching your heart rate, blood pressure, and breathing rate . Increases in these seen on the intraop monitors indicates that the anesthesia is too “light.” These parameters generally increase before any awareness occurs. The anesthesiologist is constantly adjusting the delivery of the anesthesia gas and giving other medication in the IV to keep the anesthesia level where it needs to be. The anesthesia is increased to ensure adequate depth of anesthesia if it’s too light. Likewise, even though you are unconscious, your body will reflexively move to stimulation if the anesthetic depth needs to be increased. This also occurs before awareness.
The various brain monitors on the market have not been shown to reduce anesthesia awareness, despite what the makers of these expensive devices say. They do provide other useful information and may or may not be used if your hospital has them, at the discretion of the anesthesiologist.
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Anesthesia Awareness: Awake Under Anesthesia
Fear of being awake under anesthesia, called anesthesia awareness or intraoperative awareness, causes a lot of anxiety for patients facing surgery.
Having anesthesia is scary for most people. As an anesthesiologist, I usually meet patients right before their surgeries. People facing surgery have many apprehensions and fears. More and more are concerned about anesthesia awareness.
I repeatedly hear that patients are often more apprehensive about the anesthesia than the surgery itself. And of all the fears that people have about the anesthetic side effects and anesthetic complications, the one I hear most often is, “I’m afraid of waking up during the surgery.”
Anesthesia awareness has received a great deal of attention in the press over the last few years and even a full-length movie, called “Awake,” capitalized on this fearful concept . But what is it really? Why and to whom does it occur? Keep reading to find out why it most likely won’t happen to you.
Are You Sitting Or Lying Down During Cataract Surgery
A full GA is only very rarely required for cataract surgery. Some patients have difficulty in lying still, and some are simply so nervous that they request sedation to the level that is effectively a general anaesthetic. So long as you have a healthy throat, heart and lungs a modern anaesthetic is very safe.
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What Is Not True Anesthesia Awareness
There are many situations that are confused with anesthesia awareness.
Sedation anesthesia. I often have patients tell me they had anesthesia awareness during their colonoscopy or other procedure. These procedures are commonly done under intravenous sedation anesthesia. While the intravenous sedation drugs do cause sleepiness and often amnesia- you don’t remember the procedure, they do not cause unconsciousness. It is not at all abnormal to be awake and remember these procedures. With the sedation, pain medications are either injected at the surgical site or given in the IV or both. You should still not be uncomfortable, even if you are awake, during surgeries or procedures under sedation.
Sedation plus spinal or epidural. Neither sedation or spinal/epidural anesthesia makes you unconscious during your operation. If you have spinal or epidural anesthesia to block the pain of surgery, you are usually also given sedation. The same is true for local anesthesia as well. In this case, it is not unusual or abnormal to have memories of being in the operating room. This is not anesthetic awareness.
Dreaming. Some people actually dream during their anesthetic, or more likely, when transitioning from unconsciousness back to wakefulness at the end of surgery. These dreams are often interpreted as actual wakefulness, but are not.
Statistics On Awareness Under Anesthesia
The American Society of Anesthesiologists estimates that some degree of anesthesia awareness occurs in about 1 in 1000 general anesthetics. It is believed that the majority of these cases are during the induction of the anesthetic when the drugs haven’t fully taken effect. Likewise, a great many cases are at the end of surgery, during anesthetic emergence, when the anesthetic is wearing off but isn’t completely gone. These are not intraoperative awareness as the surgery is not occurring. Because the memories are fuzzy and confusing, patients often don’t know that this wasn’t during the surgery itself.
There are no exact statistics on true intraoperative awareness cases that occur during the surgery and cause distress and lasting trauma to the patient. It is, however, an area of active study and research.
Again, talk to your doctors and ask questions if you are remotely concerned that this has happened to you.
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Man Awake During Heart Surgery
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A PATIENT has received pounds 9,000 in compensation because he was awake during a seven-hour heart bypass operation.
Norman Dalton, 55, an electrician from Leeds, remembers many details of his surgery at Leeds General Infirmary. ‘I felt my chest being cut open and blood being mopped away. I heard and felt the saw cutting through my chest bone.
‘I could feel every cut and saw the doctors made. I couldn’t scream out to tell. I think I was trying, but I just couldn’t move. It was like a living nightmare – I was asleep but at the same time awake,’ he said yesterday. ‘All the time I could hear voices and I tried somehow to signal that I was not properly sedated – but I was quite powerless and absolutely terrified.’
It took him 10 months to recover from the trauma and the hospital assigned a psychiatric nurse to help him through the stress.
Mr Dalton said: ‘I couldn’t go back to work. I couldn’t concentrate. I couldn’t work with power tools. If it made the sound or the sort of sensation and vibration of being operated on it made me feel petrified.
‘That’s quite difficult when you’re an electrician.’
‘People have said to me that I should be grateful that the operation saved my life. I am grateful, but I should not have had to go through that terrible nightmare.’
Anaesthetic problems, page 2
What Is Anesthesia Awareness
Anesthesia awareness, also called intraoperative awareness refers to a specific situation where a person is under general anesthesia for surgery and regains consciousness during the surgical procedure.
The definition of general anesthesia includes induction and maintenance of loss of consciousness. This means that you should not be able to wake up until the surgery is over. You do not respond to voice or painful stimuli.
For various reasons, some people do regain consciousness when they are under general anesthesia. For most people, this involves a very brief, hazy memory. Some people are aware of what is being said, but cannot move or indicate that they are awake. Still, there is usually no sensation of pain or awareness of the operation. The very rare, unfortunate few are awake, cannot move and do feel the surgery being done.
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Postoperative Arm Or Hand Symptoms
Though relatively rare, some patients complain of pain, numbness, or tingling in their hands or of arm and hand weakness after heart surgery. It can occur in one or both arms. This usually is the result of injury to the brachial plexus, which is the main nerve trunk that provides both sensation and muscle function to the arms and hands. It tends to happen most in patients with preexisting neurologic issues, including those associated with diabetes. It occurs because the nerves of the brachial plexus can sometimes be stretched or pinched during heart surgery that has been performed via the median sternotomy incision . Patient position on the operating table during the operation also can contribute, which is why the operating room personnel go to great lengths to both position patients carefully and to pad their arms and elbows to prevent nerve injury.
Brachial plexus injury after heart surgery is rare, but can be seen in a couple of different forms. The most common form causes numbness in the hands, usually in the third, fourth, and fifth fingers. The outlook for this type of injury is usually quite good, with symptoms resolving over 3-6 months. If you experience pain, numbness, or weakness in your hands or arms after heart surgery, it important to let your surgeon know. Though most symptoms usually resolve, it may be that referral to a pain specialist or for physical therapy and more extensive evaluation may be necessary.
Going Back To Work And Diet
Angioplasty And Stent Placement
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries.
A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it that helps prevent the artery from closing in the long term.
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Can A Person Have Open Heart Surgery While They Are Awake
The patients are given a mild sedative rather than being knocked out this drops their heart rate but means they can respond to commands. The patients are drowsy so they can be aroused but are also able to drift into sleep, Dr Jawali said. If we need them to cough or breathe more deeply to clear air from their heart they can respond.
What Happens After Open
When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart. You may have intravenous lines in your arm to supply you with fluids, as well as a catheter in your bladder to remove urine.
You will also be attached to machines that monitor your heart. Nurses will be nearby to help you if something should arise.
You will usually spend your first night in the intensive care unit . You will then be moved to a regular care room for the next three to seven days.
Taking care of yourself at home immediately after the surgery is an essential part of your recovery.
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How Does The Or Change When The Patient Is Awake On The Table
For those who arent familiar with the environment or the procedures, the OR can be a fear-inducing place. This is why, as mentioned above, some form of sedation is often used even when patients arent put to sleep with general anesthesia. This helps calm nerves that commonly come with the tension of knowing youre being operated on and potentially hearing the sounds of surgical saws or drills, Angelis explains.
But there are other things surgical teams do to make their patients more comfortable when theyre awake on the table, beyond sedation. Much of this falls to the role of the anesthesiologist and/or nurse anesthetists. These professionals are tasked with keeping the patients comfortable, awake and alert. They not only monitor vitals throughout, but also coach the patients throughout the procedures, keep them informed on the progress and often assist in transporting the patients to the intensive care unit following surgery.
There are some general dos and donts, Angelis explains, noting that any music being played in the background will not be as loud if the patient is awake. He adds that the surgeons will also be less likely to slip up by swearing, yelling or saying Oops throughout the procedure.
Staff avoid using terms like blood or pain, Chaboki adds. Sudden noises, such as instruments on the tray, are avoided, too.