Anesthesia Awareness
Recently the movie “Awake” came out in theatres and sparked much controversy throughout the country about the condition also known as anesthesia awareness. Following the release of the movie, Larry King Live did a special about this issue, in which King interviewed physicians and patients who have suffered from awareness. In response to the recent influx in publicity over the issue, the DREAM Campaign has taken the initiative to interview Dr. Tong Joo (TJ) Gan, who sheds light on many concerns that patients have when considering a surgical procedure as well as the misconceptions about anesthesiology in general. With so much focus on awareness and the negative impacts of anesthesia, it is important that the public be properly informed. Awareness can be a highly unpleasant experience, but most times the alternative is a surgery with negative outcomes or even worse, death.
There are about 100 to 150 reported cases of anesthesia awareness per year in the United States. It is very difficult to get an exact figure because it is underreported. Dr. Gan shared with us a case in which a patient of his experienced anesthesia awareness. The patient had come to the Emergency Room with a gunshot wound to the abdomen. He was suffering from massive blood loss and had very faint blood pressure so the anesthesiologist had to administer a safe dosage of anesthesia that would not hinder the overall wellbeing of the patient as well as the blood pressure. When questioned post-operatively, the patient reported that he could hear voices during a brief period in surgery.
Hearing is said to be the last sense to go and the first to return under general anesthesia. As in the case of Dr. Gan’s patient, the modifications that had to be made because of low blood pressure caused the patient to become slightly aware and that is why he was able to hear briefly during his operation. “He did not suffer from any consequences after that and in fact, he thought that it was part of the operation,” said Dr. Gan.
When asked the common question, how can a person feel pain when they are paralyzed, Dr. Gan discussed the three areas of anesthesia; paralysis which paralyzes the muscles, analgesic which block pain signals to the brain, and anesthetic which puts the person to sleep so that they do not remember anything. For this reason, a person can be physically paralyzed but they may still feel pain. The human body does have natural responses to pain such as sweating, increased blood pressure and movement which may indicate to the anesthesia care provider that they are not fully anesthetized.
New technology allows anesthesiologists to measure the brain waves of a patient even while they are under anesthesia. “By using specific monitors, one can tell how deep a person is in anesthesia,” says Dr. Gan, “It is a bit like an iceberg; if it is below the water, it is very difficult to know how deep the iceberg is, and the monitor tells you what the depth of anesthesia is even when the patient is asleep.” The Bi-spectral Index Monitor, or BIS monitor is an example of such a device. Brainwaves are measured on a range of numbers from 0 to 100 in which 0 equates no brain activity and 100 is the mental state of a person when fully awake. During general anesthesia, brainwaves are measured between 40 and 60. If the BIS monitor measures activity above 70, there is a very good chance that the patient may not be fully anesthetized.
Dr. Gan mentions several fascinating facts throughout the interview one being that genetic factors can influence the way a patient reacts to anesthesia. Studies have shown that women tend to wake up about 10 minutes sooner than men when the anesthesia is cut off. This means that women need more anesthesia in order to produce the same effect. Redheads are also said to need more as well.
The revolutionary research that is being done by researchers like Dr. Gan is vital to prevent cases of unpleasant experiences and side effects. “One of the most effective ways to try and prevent this problem is to raise awareness of this problem, no pun intended,” Dr. Gan explains, “So we educate our staff, anesthesiologists and anesthesia care providers to let them know that this problem does exist and therefore it is important to take steps as well as understand the patient to try and prevent it.” He also mentions that there are mandatory educational modules that every anesthesia care provider must take. These modules go through various aspects of educational awareness such as the incidents of awareness, the scenarios where awareness may happen, the drugs or drug combinations that would reduce the incidents of awareness as well as monitoring the inter-operative awareness.
The Department of Anesthesiology is committed to find as many ways possible to provide the best patient care. Dr. Gan’s research in particular focuses on steps that could alleviate patients from the common unpleasant side effects of anesthesia and surgery by improving patient outcomes during the perioperative (before, during and after surgery) period including anesthesia awareness, pain, nausea and vomiting, and bowel dysfunction through the use of drug and non-drug method, such as acupuncture.
Our hope is that through listening to this interview, people will become educated about the issue and in turn they will be relieved of any anxiety they may face about being under anesthesia.
Dr. Gan is a professor and devoted researcher here at Duke, whose interests include Anesthetic-related Clinical Pharmacology, Inter-operative Awareness and Post-Operative Pain, Nausea and Vomiting, and using Acupuncture. He came to Duke as a visiting associate and fellow in 1993 is now serving as both professor and Vice Chairman of Clinical Research. Dr. Gan is also known for his research on the Bi-spectral Index (BIS) Monitor.
Click here to listen to the full interview on the DREAM Campaign iTunes U podcast >
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