By: Ray S. Magill
What is anesthesia awareness or intra-operative awareness?
Anesthesia awareness is a common phrase used to describe the phenomenon
of being aware, alert, conscious during surgery or recalling events
that happen during a surgical procedure. However, the connotation
inherent in the phrase "anesthesia awareness" suggests that
a person is aware despite being under the influence of anesthesia.
This is somewhat of an oxymoron since anesthesia is defined as the
loss of sensation, such that although a person may be aware mentally
they still may not have sensation physiologically due to the anesthesia.
Thus the term intra-operative awareness may be more fitting to the
phenomenon. Specifically, the goal of anesthesia is not always unconsciousness
so that in some procedures awareness is completely acceptable and/or
even desired. For example, during epidural and other regional anesthetic
techniques an individual is aware albeit they may be given sedatives
to ease the anxiety of the experience.
Whatever one chooses to call it, intra-operative awareness can be
a significant concern for individuals facing surgery, and rightfully
so. The prospect of being "awake" while a surgeon performs
his work is not an inviting proposition. However, the incidence of
intra-operative awareness during general anesthesia is very rare.
Recent studies and data released by the American Society of Anesthesiologist's
(ASA) indicates that the reported incidences are between 0.1 to 0.2%.
Furthermore, these numbers are likely to include benign experiences
of awareness such as having brief recollection with no pain whatsoever
or even false memories, and dreams, that can be induced by anesthetic
and peri-anesthetic drugs. This, and the inherent difficulty in confirming
intra-operative awareness presents difficulties in producing exacting
figures. Thus, the incidence of traumatic intra-operative awareness
may be significantly less. Yet, for the individual requiring surgery
and the anesthesia professional providing care, even a small risk
is a concern.
The incidences of intra-operative awareness during general anesthesia
are very unlikely, however, the rate of incidence is higher in certain
types of surgery, such as trauma surgery, cardiothoracic surgery,
and obstetrics (labor and delivery). During emergent life saving procedures
the anesthesia professional must balance the patient's comfort level
with the risks involved with the administration of certain anesthetic
drugs. For example, some of the drugs associated with anesthesia have
the effect of decreasing or affecting the heart rate which could be
life threatening if administered to someone who is already in a state
of cardiac distress. Another concern may be the effect certain anesthetic
drugs may have on an unborn child due to the drug's ability to cross
the placenta, again, the anesthesia professional must balance patient
comfort with known risks and the preservation of life. Furthermore,
in all surgical procedures there is an individual aspect to each operation.
Thus, there are potential risks involving the specific physiology
and reactivity to anesthetics that each patient may display. Therefore,
each case is weighed individually according to a patient's medical
history and physiological condition. Minimizing the risks involved
is thus the goal in every situation, but risks are inherent and cannot
be absolutely eliminated. This said however, anesthesiology professionals
are committed to delivering the safest and most comfortable operative
experience feasible. In addition, this is why It is important to discuss
all the concerns and review a complete medical history in detail with
an anesthesiology professional prior to surgery.
An individual can guard against experiencing intra-operative awareness
by being proactive in his/her medical care. Patient's have rights
concerning anesthesia care and a patient can request specific anesthesia
professional for their case if they so desire and arrangements can
be made to try and accommodate those requests. The number one defense
against experiencing intra-operative awareness is a skilled and knowledgeable
anesthesia professional whose experience and clinical training provide
the necessary know how to minimize the risks to their clients.