Perfusion Glitches: Waking Patient

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Event Description:

While on bypass my patient began to wake up approximately 13 mins,. into the pump run.

Anesthesiologist had left the room for his extended break.

Forane had to be maxed out at 5% because the patient was now trying to sit up and due to the fact the anesthesiologist had not responded to his beeper or phone calls.

Upon finally re-entering room, he blamed perfusion for the waking up of the patient initially stating not enough Forane had been on.

This particular Dr. does not put a BISS on the patient either. Says they are useless.

How Was The Problem Identified?

Patient was trying to get up.

What Steps Were Taken ?

  1. Anesthesia administered additional agents:   Issue Resolved

What Clues Were Missed?

No BISS, Anesthesia not present

Discussion:

The question is raised on whether or not Anesthesia should leave the room once bypass is initiated.

(Click Image above to view source of article below …)

Awake: Waking up during surgery

“My toes wouldn’t move. My whole body was completely paralyzed. I had no way to let them know I was awake…I felt the doctor take my hand and I thought oh dear god, they’re getting ready to cut my hand.”

That’s Jodie Stanley describing being awake during surgery. It’s a phenomenon called anesthesia awareness. Jodie, a registered nurse, says she had never heard of it until it happened to her. Victims have called it their worst nightmare. “They may remember sounds or conversations in the operating room or they may have excruciating pain or wake up feeling paralyzed, not being able to respond. It’s like being alive, but inside a corpse,” according to Dr. Peter Sebel of Emory University School of Medicine.

A new movie called “Awake” just came in at No. 4 in the weekend’s box office tally. The thriller stars Hayden Christensen as a patient who is fully conscious but physically paralyzed during surgery. The movie’s promoters have said, “It will do for anesthesia what ‘Jaws’ did for swimming in the ocean.”

To be clear, anesthesia is very safe, and awareness incidents are rare. Out of the 30 million cases in which anesthesia is used, anesthetic awareness happens in about 1 or 2 cases out of every 1,000 according to the American Society of Anesthesiologists.

Researchers believe that anesthesia awareness is under-reported by 50 percent to 100 percent of the official numbers, says Carol Weihrer, president and founder of the advocacy group Anesthesia Awareness. She bases her numbers on her own experience as an advocate and information she has pulled together from other organizations.

She emphasizes that whenever it does occur, the impact can be traumatic. According to her organization, approximately 50 percent of awareness victims suffer from post-traumatic stress disorder.

It’s definitely a scary risk however remote, but there are certain things that can help reduce your risk of experiencing anesthesia awareness. Brain monitors can help reduce the risk by more than 80 percent, but they are available in only half of operating rooms according to Sebel.


Outcome:

  • No issues.

Some Shared Experiences

Waking up during surgery can be quite disturbing and has happened to me on a few occassions. Listening to the doctor/nurse conversations is to me the most disturbing part. Outside the operating room you view these progessionals as exactly that and their conversations are always very proper.

 

Under the knife and when the think you are under the rules change dramatically. You hear about the bad night partying they had, chatter about all types of things not associated with what they are doing and even “flirt” with each other. Kinda scary when you hear them talk like any other person you know and think that they are not concentrating on the surgery or matter at hand priority. I have experienced it a few times. The doctors usually don’t believe me until I tell them what they did last weekend partying. Then they are embarrassed. Whenever I now have to be put out, I explain what has happened and my resistance to the anesthesia they are using. That usually works and they make sure I am “out”. The conversations are quite funny sometimes but unsettling most of the time.

Posted By Anonymous Jerry : 1:34 AM ET 

you have to keep in mind that many, many surgeries are now performed as “mac” anesthesia. this means that although sedation is given patients are indeed awake. the area that surgery is being performed on is given local anesthetic rendering the area numb. the patient is comfortable during the procedure but aware. this is not the same as “anesthesia awareness” since general anesthesia was not the intended endpoint. patients are told what to expect before hand and should expect to be awake/ aware. don’t do these doctors who work very hard to correctly and safely perform their job a disservice by assuming all procedures require genreral anesthesia.

Posted By Anonymous Anonymous : 11:02 AM ET 

Not every doctor goes out for “bad partying” on the weekend. As an anesthesiologist I can tell you we are well trained and take the nature of our profession very seriously. When you are in my OR you are not “just a Patient”. You are MY PATIENT and my responsibility. The fact is we do not yet know the full extent of how general anesthesia affects the body, nor do we fully understand the inner working of the brain. Until we can explain all of this, general anesthesia is a complex area of medicine and will continue to be such. This is one of the reasons we undergo extensive training, with over 12 years of post secondary education.

 

The risk of awareness is extremely low. ANY awareness though is not something we strive for and is currently an area of great interest in anesthesia societies. There is definitely a difference between MAC, or Monitored Anesthesia Care, and General Anesthesia. During a MAC you are sedated, and the surgical site numbed with local anesthetic but you are breathing on your own. You may recall words spoken, or things in the operating room but due to the local should not have pain.

 

During General anesthesia you are rendered completely unconscious and your breathing is either assited or completely taken over by the anesthesiologist. Your vital signs are montiored either way. You are never left unattended.

 

The point is, anesthesia and surgery are a serious undertaking. They have inherent risks. The fact that some people remember doesn’t necessarily mean they were under a GA. MAC cases are more and more prevalent as surgical techniques have advanced. This is a good thing as patients generally awaken much faster from MACs and feel much better sooner. For a relatively small procedure like a carpal tunnel, there is absolutely no reason to have a general anesthesia. In fact, many would consider it malpractice to do so.

 

Unfortunately, the NIH grants extremely low amounts of research $$ to the field of anesthesia. Until these dollars are increased, the ability to study those with anesthesia awareness and hopefully decrease the incidence is limited. The monitor alluded to in this article- the BIS monitor_ is not the perfect answer. The BIS is still controversial and has not been proven to decrease anesthesia awreness. This certainly may change as new positions are adopted by the American Society of Anesthesiologists.

 

As a concerned physician and a scientist, however, I will continue to be vigilant and base my views on science and evidence, not on Hollywood movies.

Posted By Anonymous A Concerned M.D. : 5:03 PM ET 

I was having a hernia operation, and also under general sedation. I remember going under, but then midway during the procedure felt a lot of tugging on my peritinium. I woke up hearing the doctors talking, and I was thinking to myself I should say something because its really starting to hurt. But,I found that I couldn’t move, and in the same moment I felt intense pain. Then everything went blank. I woke up in the recovery room. The surgeon later explained that during the procedure while working on the peritinium, my vitals dropped unexpectedly, forcing him to stabilize me first before continuing. He explained that I must have experience an acute vasovagal response which caused my vitals to drop, and then essentially faint while under anestesia. Although my experience was short lived it was very real.

 

Posted By Anonymous Anonymous : 5:37 PM ET 

I have had awake episodes in 2 different surgeries. The first one the anestesiologist asked me later if I could explain it. I remember seeing my stomach cut open, but that one didn’t hurt. I just shut my eyes quick and was out. The second was a brain surgery and when they cut through a muscle in front of my ear it hurt bad, and it still seems to hurt at times. I thought I was the only one.

Posted By Anonymous Anonymous : 10:28 PM ET 

Surgery is one of the most valorous things a person can do. It takes a great deal of strength to understand that your injury or disease may need surgery and once the decision is made to have the surgery, there should a way to insure the patients somberness throughout the surgery. Waking up during surgery can cause one to experience post-traumatic stress disorder after the surgery and can also cause many complications during the surgery. For example, if one has a heart condition and he/she wakes up during a leg surgery; this person can lose control and have a heart attack. With all the advances we have in technology nowadays we should be able to insure that anesthesia will not wear off. In addition we should also find a way to help people more prone to these awareness cases by effectively administering more anesthesia to a patient.

Posted By Anonymous Jay’ner : 10:13 AM ET 

I woke up when having my wisdom teeth pulled. I have been put under many times and this is the first time I experienced anesthesia awareness. I think the doctor/dentist didn’t give me enough of the good stuff, so I woke up during the procedure just enough to be aware, to hear talking, to see things (my eyes had medical tape over them), and to feel pressure (but not pain). It freaked me out and I passed out. I have talked to other people and it is apparently fairly common during dental surgery, as the person administering the anesthetic is usually not an anesthesiologist!

Posted By Anonymous Anonymous : 11:49 AM ET 

I had my gall bladder removed earlier this year. When I was in recovery I asked my mom if anyone mentioned fybroids to her (she had talked with the surgeon after that surgery) and she said no. I thought it was weird that my first memory was fybroids. I remember hearing discussion of it and remember thinking “I have fybroids? What?” The surgeon had left me a photo which I assumed was an picture of my gall bladder. I brought it with me for my follow up and it turned out the photo was a fybroid, not my gall bladder. He was pretty freaked out that I heard conversations during surgery. I don’t remember any pain though.

Posted By Blogger Olive’s mommy : 2:23 PM ET 

It was a number of years ago but I had surgery to reconstruct and repair a broken jaw after a motorcycle accident. I remember every excruciating minute. The incisions, the moving of bone fragments, the hardware being put it…I can still remember it like it was yesterday. When I brought this to the attention of the care providers they basically told me I was making it up.

Posted By Anonymous Palmer : 4:33 PM ET 

It happened to me during oral surgery while I was unconscious— I was able to tap the dental assistant’s hand with my finger — she said ” doctor, our patient is with us” and he said ” can’t be, and then I tapped again” and everyone laughed —I then went “back to sleep”…..

Posted By Anonymous E : 8:47 AM ET 

I once faced this and have told many people about it, but few would agree with me. Most laughed:)

This was 15 years ago when I was a teenager and I had to undergo appendicitis surgery. First, when I was given the anathesia, I had weird feeling as if I was breaking up into tiny particles like atoms. not being a chemistry major, I ccant explan more than that.

 

Then, during the surgery I woke up during the middle of the surgery . I felt immense pressure and weird pain. I heard the docs instructing for the instruments and saying thats theres lot of water, do suction. I wanted to say something, open eyes, move but couldnt do anything. I dont remember anything few minutes after that.

 

Later I told the nurse about it and she didnt beleive me. Then I mentioned the conversation that I had heard and that they did suction. And she was SHOCKED. I even remembered the OT nurse’s name.

 

Later it was found that I had severe infection in the intestine and there was watery substance that needed removal.

I releived that I am not the only one facing this. Question for dccs here…..Is it possible that the same can happen to me when I go in for some other surgery. Should I make the docs aware of it. Remember this was 15 years ago.

Posted By Blogger Anuraag : 6:55 PM ET 

Being an RN, it was not as bad as if I had no medical training. I woke up during surgery to correct bleeding after breast cancer surgery. I knew that I was intubated, could not breathe or move. I tried to relax so the machine could breathe for me and dozed off a couple of times. Once awake again, hearing the OR staff laughing and talking, I decided to try and move and eventually moved my foot. Someone noticed and told Anesthesia and they checked me and put me under. The next morning I asked the doctor if I had dreamed it or was I actually awake. He shook his head and said,”I’m afraid so”. I would not want to experience this again. It is a little scary, knowing that you have a plug in your throat, keeping you from breathing.

Posted By Anonymous Ginny : 8:56 AM ET 

About 20 years ago, I was scheduled to have a partial hysterectomy, vaginally, with a spinal as anesthesia. During the surgery I was also given something to relax me, intravenously. I was brought into the OR and relaxed and given a spinal. Unfortunately for me the spinal did not “take” and I could feel everything. I could feel tugging and pain. I was trying to verbalize that I was in pain. The medical student who was in the room heard me and said “Mrs. — can you feel that.” And it took every effort for me to (sounded to me like) loudly say “YES”. Next thing I knew, something was put over my face and I was asleep. The surgery was performed under general anesthesia. The anethesiologist was nowhere to be found when I was in recovery and my mother and husband had to track someone down to get scripts for morphine because I was there with nothing. Spinal wasn’t in effect and absolutely no meds. I was in so much pain I was shaking enough to almost fall off the gurney. I got nothing until I got to my regular room hours later. Then I was given morphine in each butt cheek. The relief was so much that I cried and the tears were running down my face while the nurses were bathing me to put me into my bed. I have never forgotten this. My doctor was totally unsympathetic and did not even want to hear about it. He said “are you still talking about that.” when I mentioned it a couple days later while I was still in the hospital. I was disgusted and found another doctor immediately.

Posted By Anonymous Leticia : 2:47 PM ET 

I woke up during surgery and, in fact, sat up. I was undergoing laser surgery and sat up on the table to see the doctor. I looked up at the anethesiologist who said “Good morning! Are we awake?” and I replied “Of course I am”. The doctor at that point said “Why isn’t she out? Give her more, make sure she’s out.”

I passed out after that but woke up when they were taking me out of the operating room. I was even having a very coherent conversation with the doctor.

It was a strange and disturbing experience, but now I must say that that I can laugh about it. But I feel very fortunate that I felt no pain as others have reported.

Posted By Anonymous Anonymous : 3:46 PM ET 

It happened to my wife. She was having surgery in her intestines, and woke up and was watching on the monitor. She suffered no pain, but was fastinated by the images. She finally asked if that was her on the monitor, and very quickly was put back to sleep.

Posted By Blogger Dan : 8:20 AM ET 

I woke up during a test procedure where they ran a tube down my throat to scope out the area. When I woke up, I raised my head up off the table and began to gag because of the tube. A nurse noticed my head raise up and pushed it gently back down and said “we aren’t done yet”. They gave me more anesthetic and I went back to sleep. It was a horrible but luckily short time period.

Posted By Anonymous Anonymous : 3:12 PM ET 

15 years ago, during reconstructive surgery from breast cancer, I experienced what you are calling ‘anesthesia awareness’. I became aware and realized I couldn’t move or breathe, then began to panic. I kept thinking ‘I have to move! I have to move and let them know I am awake!!!’ I ultimatley starting moving my head back and forth, then I heard someone say something about giving me more anesthetic. I could hear the surgeon and others talking during all of this but I did not feel any pain. I had to have two more surgeries after that and told my physician and anesthesiologist about what I experienced with hopes that it would not happen again.

Posted By Anonymous Anonymous : 2:29 AM ET 

I have had 3 foot surgeries (both feet each time) where bone has been cut and reset with screws, etc. and 2 out of 3 times I woke up when I heard the saw start up and also when doctors (1 for each foot) were discussing my toe nail polish color (I forgot to remove it). I could feel them moving my feet around and my arm on the long thin table but never had pain and didn’t realize it was possible, it didn’t traumatize me or anything, I am lucky.

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