'Anesthesia Awareness': When Patients Wake Up During Surgery

Facing surgery to remove her right eye, Carol Weihrer was taking it in stride. "I 1 went into this with a very good frame of mind," says Weihrer, of Reston, Virginia, of the operation performed more than eight years ago.

She had been struggling with a serious condition called corneal erosion syndrome—a severe and painful abrasion that causes cells from the cornea to detach and fall from the eye, often affecting vision. Weihrer decided the surgery was the best solution.

Little did she know the nightmarish experience would alter her life. And it began on the operating table. "I remember hearing disco music, and then I heard the surgeon say to the resident, Cut deeper,' Weihrer recalls. "I realized I was awake and the surgery had just started."

She tried frantically-and futilely to blink her eyes and move her head to alert the surgeons. "I was screaming at the top of my lungs but no noise was coming out."

Weihrer was experiencing what doctors call "awareness with recall" or "anesthesia awareness," when patients aren't fully anesthetized and are alert during surgery.

Underrecognized Problem

The Joint Commission on Accreditation of Healthcare Organizations, the group that accredits 16,000 US hospitals and other healthcare facilities, calls this phenomenon an "underrecognized and undertreated" problem.

It suggests that facilities that perform surgery using general anesthesia develop a policy that includes the education of staff, better identification of patients at particularly high risk and post-operative follow-up to detect any problems. The group also recommended that hospitals ensure that patients who experience mental distress after experiencing anesthesia awareness be given access to counseling or other support programs.

While the exact number is unknown, one study estimates that one to two patients per 1,000 experience anesthesia awareness. That translates to 20,000 to 40,000 patients each year in the US.

Resulting Problems

For some, the experience is so terrifying that they develop post-traumatic stress disorder (PTSD), says Dr. Peter S. Sebel, a professor of anesthesia at Emory University School of Medicine in Atlanta, who co-authored the study.

Weihrer says she has had PTSD since her ordeal. "I have all the classic symptoms. I have not slept in a bed for six-and-a-half years; I can't lie down in a bed," says Weihrer, who sleeps in a chair. She also sees a psychiatrist regularly, she adds.

The Preventive Solution?

Because of her horrifying experience, Weihrer founded The Anesthesia Awareness Campaign, a nonprofit advocacy group that seeks to make people aware of the problem.

She and others say the solution is for hospitals to install monitoring technology that can alert anesthesiologists if a patient is on the verge of waking up.

This monitoring technology, already available, "measures brain waves and gives a readout" that alerts anesthesiologists to increase the anesthetics to reduce the chance of a patient awakening, says Sebel.

Two recent studies indicate the value of such monitoring. In one, Sebel notes, researchers assigned approximately half of 2,463 patients to a monitored group; the others received standard care. Only two reports of anesthesia awareness occurred in the monitored group, compared with 11 in the standard care group.

In the other study, only 0.04% of 4,945 monitored patients had anesthesia awareness, compared with 0.18% of 7,826 patients in a standard care group.

"I think the data are sufficiently convincing to make a case for using the monitoring technology," says Sebel, who works as a consultant for a company that produces monitoring equipment.

Risks Vary

But Dr. Roger W. Litwiller, president of the American Society of Anesthesiologists, says the solution is not that simple.

"Each person's body reacts differently to anesthesia," he says. "And there are many different types of anesthesia. We take everything we know about the patients and the surgery, and based on that information, we must determine the types and amounts of drugs to use and how to administer them."

Anesthesia awareness is more likely to occur during cardiac surgeries, traumas and emergency C-sections, Litwiller explains, because "it isn't safe for the patient (or the baby) to have the deepest level of anesthesia."

He says that while brain-wave monitoring technology may help, it's too soon to say that for sure, and his organization has assembled a task force to study the issue.

In the meantime, both sides agree that patients facing surgery can reduce their risk of anesthesia awareness by giving surgeons and anesthesiologists the most accurate medical history possible—and always inform health-care providers about any previous problems with anesthesia.