Is Anesthesia Awareness a Real Thing?
Anesthesia Awareness In Hollywood
The movie “Awake” is fictional entertainment that exploits anesthetic awareness as a plot device. Viewers should remember that while anesthesia awareness under general anesthesia can occur, severe cases such as the one depicted in this movie are highly unusual. Anesthesia Awareness can be anything from remembering a few voices to major events during the surgery. Most documented cases are from patients who remember hearing a few voices from the OR staff. During induction or emergence is the most likely time for this to occur, which is expected, since the auditory sense is the first thing to return during emergence. When pain is remembered, it ranges from a sore throat due to the endotracheal tube, to traumatic pain at the incision site. The truth is, the amount of cases where a patient is able to recall significant painful events from the actual surgery is VERY rare. Hollywood has come out with a few movies where a patient is fully awake through the entire surgery. These story lines are very exaggerated, and are for entertainment purposes only. The Best CRNA Programs have extensive training to their students to ensure that this is not likely to happen.
How Common is Anesthesia Awareness?
Approximately 21 million surgeries are performed under general anesthetics each year. The frequency of anesthesia awareness is 1 or 2 per 1000 anesthetics delivered annually. This averages out at 40 to 70 cases per day and 20,000 to 40,000 cases each year across the United States. Again, it is important to remember that the vast majority of these cases are simply a patient recalling a few voices or sounds that they heard either while going to sleep or waking up.
Who or What is to Blame?
Anesthesia awareness can happen for a variety of reasons. The biggest risk factor is anesthesia performed by unsupervised trainees. Awareness may be related to the depth of anesthesia that can be tolerated. Procedures at risk for awareness: cardiac, obstetric, and major trauma surgeries. Machine malfunction or misuse may result in an inadequate delivery of anesthetic to the patient allowing them to get “light” and wake up. Patients with a high drug tolerance require a lot higher drug dose than may be expected by the anesthesia provider. This is why an accurate and honest drug history must be obtained by the CRNA or anesthesiologist. Patients that have “difficult airways” may require repeated attempts at intubation which can allow time for the short-acting anesthetic to ware off.
Anesthesia Awareness Can Have Lasting Consequences
The experience is traumatic for those patients who go though this type of event. Cases where a patient has full awareness with explicit recall can have lasting effects. These effects can range from mild anxiety all the way to a post-traumatic stress disorder. Additional effects that have been seen in patients include: nightmares, flashbacks, insomnia, daytime anxiety, irritability, and even suicide.
Objectives for Today’s Nurse Anesthetists
Our goal as a CRNA is to achieve and maintain a balance of agents or adequate physiologic environment for the patient. The more we learn about our anesthesia drugs, and continue to educate our health care professionals, the safer our patients will be. Anesthesia providers are finding more ways to ID high risk patients, and make any appropriate changes to the anesthesia plan. The risk can be reduced by careful checking of drugs, dosage, and equipment and strong vigilance by the CRNA during a case. It is always important to discuss all available monitoring techniques. Monitors such as the “BIS” monitor are great tools and should be utilized. If a patient does experience “Anesthesia Awareness” we need to make sure that the appropriate support for our patients is provided. Ultimately all of these objectives lead to one main idea and that is to reduce the risk of these types of events. You can start your training in this field by preparing for Nurse Anesthesia School, admission to CRNA Program, and successfully completing the courses to become a Nurse Anesthetist.
How Should CRNAs Deal With Awareness
Anesthesia awareness cannot always be prevented. It is important that Nurse Anesthetist do not deny that awareness did occur. If a patient claims to remember specific events during the surgery the CRNA must apologize to patient if they don’t think it happened. All CRNAs should acknowledge and manage the occurrence of awareness with compassion. During post-op visit, the anesthetist should obtain a detailed account of what the patient claims to remember. From there you should answer any questions the patient may have, and refer them for psychological counseling if appropriate. The most important learning point here is that all health care practitioners must manage anesthesia awareness with compassion and diligence. The best CRNA Schools have extensive training in managing anesthesia awareness.
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