Anesthesia Awareness: Consciousness During Surgery

Awareness under Anesthesia Transcript: Guest: Dr. Orin Guidry – Anesthesia & Perioperative Medicine Host: Dr. Linda Austin – Psychiatry Dr. Linda Austin: Dr. Guidry, the movie Awake is about the phenomenon of awareness under anesthesia. Does this actually happen? Dr. Guidry: Yes, it does occur, but its incidence is really quite rare. Most published studies have it as being about .1%, though in other studies it’s even less common than that. Dr. Linda Austin: What’s going on when this occurs? Dr. Guidry: It is a variety of sensations, all the way from a fleeting recall of something that might have happened in the beginning or the end of the operation, progressing in severity all the way to the horrible experience that’s portrayed in the movie. Dr. Linda Austin: What can doctors do to prevent this from happening? Dr. Guidry: I don’t think we can absolutely prevent it, but we can decrease its incidence. The things that we can do to decrease it incidence are, first of all, to take a good history from the patient, to look for factors that may increase the likelihood of awareness. Secondly, we very often give amnestic drugs before the procedure to block peoples’ memory. Thirdly, it’s incumbent on us, as anesthesiologists, to thoroughly check our equipment to make sure everything is functioning well. And, finally, there are now monitors available, some use the term level of consciousness monitors, that give us a guide to the depth of anesthesia. Dr. Linda Austin: What can patients do to maximize the chance that they’ll have a good experience under anesthesia? Dr. Guidry: I think they should start with a very frank visit with whoever the person is that’s going to administer their anesthetic. They need to be prepared to discuss all the medicines they’re taking and, particularly, they need to be frank if they’re using recreational drugs or alcohol. Dr. Linda Austin: Because? Dr. Guidry: Because it’s a possibility that these things may change the way their body metabolizes their drugs, make them more likely to have awareness and, plus, they cause a lot of other unrelated problems during an anesthetic. Dr. Linda Austin: Can you ask your doctor to have a monitor? Dr. Guidry: That’s certainly a very reasonable request. There are certain technical situations in which it’s very difficult to use a monitor. The electrodes are placed across the forehead such that if a patient were having a cosmetic procedure, like a brow lift, where the electrodes would be in the incision, it would obviously be impossible to use it. And there are other technical problems associated with it from time to time, but in general it’s a very reasonable request. Dr. Linda Austin: Thank you very much. Dr. Guidry: You’re welcome.