Hundreds awake during surgical procedures

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A report has stated that hundreds of people are ‘aware’ during surgical procedures and state that they felt stitching, pain, tugging and heard conversations. The report added that many of these cases could be prevented.

An audit undertaken by the Royal College of Anaesthetists assessed all the reports of awareness while under general anaesthetic and discovered that 80% of the cases could have been prevented.

The most distressing part of the event, according to patients, is their inability to move.

In the UK, about 2.8 million general anaesthesias are administered annually and the audit discovered that patients’ reports of being aware occurs in 1 in 19000 cases. This increased to one in 8000 patients when muscle relaxant drugs had been administered.

The highest incidences occurred during emergency caesarean operations where the rate is one in 670. According to the leader of the project, Professor Jaideep Pandit, this extremely high rate can be attributed to a combination of the urgency of the procedure and the fact that this type of procedure is only done under general anaesthetic in dire circumstances. The operations are often done out of normal operating hours, by junior staff, and at times the drugs may be problematic.

He added that there were some reassuring views of the study. He was under the impression that when starting the study, all patients would experience extreme distress as this could be classified as a nightmare event, however, only 50% stated that they were distressed by the event. He added that this may be because most of the awareness cases only continued for a few seconds.

He said that many patients were distressed by paralysis, rather than pain. Since we are all aware of what pain is, it is easier to recognise and accept it, but paralysis is unfamiliar to most people. He stated that those who experienced paralysis gave descriptions of being buried alive and entombment.

Pandit stated that when a surgeon suspects that a patient is aware and starts to reassure them by talking and confirming that staff are aware of the situation and are in the process of rectifying it, it can help to prevent the situation from causing long-term psychological issues.

The report has stated many recommendations to reduce incidences of awareness, including the reduction of muscle relaxant dosages, the use of monitors, ensuring the relaxant has worn off before the anaesthetic agents are reduced and ensuring that the transfer into the theatre is done as quickly as possible.

This particular audit only assessed cases where patients had specified spontaneous awareness. The incidence of awareness is much higher, about one in 600 operations, where patients were proactively asked about awareness levels.

Prof Pandit stated that it is necessary to do further research to understand the variance. He said that many patients may have found it too trivial to report, however, some may not have reported it because they did not want to relive the experience.

He stated that if the number of incidences was as high as one in every 600 operations and all the patients were traumatised by the event, thousands of people would be traumatised and this is not the case at all.

Image Credit: Lars Plougmann

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