Undergoing surgery can be a daunting experience, but most people trust that they will be under general anesthesia, ensuring they will not feel any pain or remember the procedure.
However, in rare cases, patients can become aware of their surroundings during surgery, a phenomenon known as anesthesia awareness, or unintended intraoperative awareness.
Awareness and Responsiveness
Assessing awareness and responsiveness during general anesthesia is a difficult task. There are different ways of measuring consciousness, including the use of monitoring equipment, behavioral tests, and patient self-reports.
Monitoring equipment such as the electroencephalogram (EEG) can help assess brain activity and detect changes in anesthesia levels. However, the interpretation of EEG data can be challenging, and there is no consensus on how to define different levels of anesthesia. Additionally, monitoring equipment can be costly and may not be available in all medical facilities.
Behavioral tests, such as the isolated forearm technique, have been used to identify cases of awareness by assessing the patient’s responsiveness to verbal commands. However, these tests can be difficult to perform, and there is a risk of false positives and negatives. Moreover, not all patients are able to respond to verbal commands, especially if they have been given neuromuscular blocking agents.
Patient self-reports can also be used to detect cases of awareness. However, this method relies on the patient’s ability to remember the event and report it accurately.
How Often Does Accidental Awareness Occur?
The incidence rates of accidental awareness during general anesthesia vary widely.
For example, studies using the isolated forearm technique have shown higher incidences of awareness, with some reporting rates as high as 1 in 25 patients. But that doesn’t mean that the person was fully awake and conscious. Just because they showed some slight degree of responsiveness doesn’t mean they were actually awake and conscious.
Studies that rely on patient self-reports have reported much lower incidence rates, with some as low as 1 in 19,600 patients. This number would probably be a more accurate representation of how many people actually had a real experience of wakefulness, enough to remember it afterward.
Why Does Accidental Awareness Occur?
There are several factors that can contribute to accidental awareness during general anesthesia. Some of these include equipment malfunction, errors in drug dosing, and patient factors such as obesity or drug use.
It is also possible that the anesthesia team may not have properly assessed the patient’s level of consciousness during the procedure.
However, it is important to note that accidental awareness is a rare occurrence, and most patients will remain completely unaware during surgery.
What Can I Do To Prevent Waking Up During Surgery?
While you cannot control all the risk factors for anesthesia awareness, there are steps you can take to reduce your chances of experiencing it during surgery. Here are some tips:
- Follow instructions: Your anesthesiologist will give you instructions on how to prepare for surgery. It is important to follow these instructions carefully, as they can affect the absorption and effectiveness of anesthesia.
- Answer your anesthesiologist’s questions: The anesthesia team will ask you important questions about your medical history, allergies, and medication or supplement usage.
- Be open and honest with your anesthesiologist: Your anesthesiologist needs to know the truth about your drug and alcohol use, as this can significantly impact the choice and dosage of anesthesia required.
- Ask questions: Don’t be afraid to ask questions about the anesthesia process, the type of anesthesia that will be used, and the monitoring equipment that will be in place. Make sure you understand the risks and benefits of your procedure and the anesthesia used.
- Speak up: If you feel any discomfort or awareness during the surgery, it is crucial to inform your anesthesia team immediately. This can help prevent the experience from continuing and allow the team to adjust the anesthesia accordingly.
If you are still concerned about the possibility of waking up during surgery, you can discuss your concerns with your anesthesiologist and surgical team.
They can provide you with more information about the specific anesthesia techniques and monitoring equipment that will be used, and can address any questions or concerns you may have.