Research Paper Example on Intraoperative Awareness

There are over 230 million surgeries performed every year. Most people going into surgery would never think something like waking up on the table could happen to them, that’s so rare it only happens in the movies, right? Well actually, it’s a lot more common than most people realize. According to an article written by Dr. Joshua Lang titled “Awakening”, 1-2 out of every 1,000 patients undergoing surgery experience some level of intraoperative awareness (a.k.a anesthesia awareness or intraoperative recall). That’s over 230 thousand people a year experiencing this phenomenon, potentially hundreds of lives ruined every year. So what exactly is intraoperative awareness, why does it happen, what does it do to a person, and what is currently being done to prevent this from happening? There are many questions regarding this occurrence, but one thing is for sure, intraoperative awareness should never happen.

This abnormal experience is something that should never occur, so why is it so common? For starters, the brain is the most complex organ in the human body, and the truth is, scientists still don’t fully understand how it works. Even though anesthesiologists and other scientists and doctors have been studying this concept for over a hundred years it is still unclear exactly what consciousness is or how it works. In fact, one of the most commonly used drugs in general anesthesia, sevoflurane, is still not understood in its effects of creating unconsciousness (Lang 2013). This is where most of the problems start. If scientists and doctors who are putting people under, essentially taking lives into their own hands, don’t even understand how the drug they are using operates or how the concept of consciousness works, they should not be doing it at all. To fully understand why it happens, what it is exactly must first be understood. The American Society of Anesthesiology states, “The condition, called anesthesia awareness (waking up) during surgery, means the patient can recall their surroundings, or an event related to the surgery, while under general anesthesia” (American Society of Anesthesiology 2021). Anesthesia awareness, or intraoperative awareness is essentially when general anesthesia (meaning the entire body is affected and the patient is unconscious) doesn’t quite work the way it is supposed to and the patient wakes up enough to remember a specific event that occured, sometimes even claiming to have experienced pain, during their surgery. Though this seems like a relatively simple occurrence, it is actually a lot more complicated and problemsome than it may appear.

Many cases where intraoperative awareness occurs involve small, hazy flashbacks that never really lead to anything, but when it does, it can ruin lives. When awareness occurs, the patient does not usually experience any physical pain and is quickly put back under (American Society of Anesthesiology 2021), but since patients eyes are generally taped shut and oftentimes their bodies temporarily paralyzed, they are unable to alert anyone that they are awake (Lang 2013). Since they can’t alert the doctors that they’re awake, some patients may lay awake on the table for minutes or more before anyone realizes what has happened. This is a lot of time especially if the patient becomes fully conscious. Normally doctors can tell pretty quickly that the patient is becoming conscious and fix the problem, but not always. Sherman Sizemore Jr. was a Baptist minister and a former coal miner. He underwent an exploratory laparotomy at the age of 73 to determine the cause of a recurring pain in his abdomen. Although there never were any official accounts of Sizemore awakening, his family continued to argue through a lawsuit that he was awake, and feeling pain, throughout the surgery. Sizemore reportedly started acting strangely immediately after his surgery. He complained of not being able to breathe, he refused to be around his grandchildren, he was afraid to be alone, and he suffered from insomnia and severe, vivid nightmares. Having no past record of psychiatric illness, two weeks after his surgery, on February 2, 2006, Sizemore shot himself (Lang 2013). Sherman Sizemore is not the only case where something similar has happened. There have been hundreds if not thousands of very similar cases. Because these doctors had failed to keep their patient unconscious or recognize that he wasn’t fully unconscious during his surgery, not only was he affected, but his entire family’s lives have been forever changed. In 2006-2007 a study was performed on awareness patients with about a 5 year follow up time. In that time, 6 of 13 original confirmed awareness patients had died, 5 of 7 confirmed awareness patients as well as 3 out of 25 control patients had developed PTSD at the time of the interview. The median onset time for symptoms was 14 (ranging from 7-243 ) days after surgery (Leslie, Chan, Myles, Forbes, McCulloch 2010). 71% of confirmed awareness patients were proven to have developed symptoms of PTSD or other psychological distress, that rate is five times higher than the soldiers that were returning from Iraq and Afghanistan. Based on these statistics, that would be around 161,000 patients a year who develop PTSD, and 46%, around 100,000 who may die, all because of a mishap in the operating room.

It is clear how out of control this situation has become, with over 200,000 people affected each year, scientists need to step up and find better ways to greatly reduce the chances of experiencing awareness. There are new studies and machines that can help anesthesiologists better monitor their patients' consciousness. For example, a new machine has been developed using a combined electroencephalographic (EEG) and auditory evoked potentials (AEP) anesthesia index to enhance the ability to detect awareness while under anesthesia. As EEG and AEP signals in the brain reflect contrasting neuronal pathways, the combination of parameters from the signals can help provide a better idea about the brain’s status during anesthesia (Tacke, Kochs, Mueller, Kramer, Jordan, Schneider 2020). Although scientists and doctors still don’t fully understand the brain and consciousness, they are able to use new technology to better detect when awareness is about to occur and hopefully help reduce the probability of it occurring. In 2009 a 5 year case study was started, this study used ETGA and TIVA injections as well as laryngeal masks to induce general anesthesia. It was found during the study that “patients who received ETGA and TIVA had significantly higher incidence of developing awareness compared to those who were anesthetized using laryngeal masks” (Kuo, Lee, Wang, Hseih, Huang, Lam 2017). Doctors and scientists have discovered better methods of inducing general anesthesia to help reduce the risk of awareness. Using the laryngeal mask has shown to greatly reduce the risk of patients experiencing awareness during surgery. Although there are new ways and technology to help detect awareness, the best way to prevent it is through patients honestly telling their anesthesiologists everything they possibly know about their health, conditions, and medications they are currently on. “Before surgery, patients should meet with their anesthesiologist to discuss any past problems with anesthetics, including a history of awareness. Patients should also list all prescription and over-the-counter medications they are taking, so an anesthetic plan can be tailored to best meet their needs” (Zerwas 2013). It is very important that patients are 100% honest with their doctors about any medications or past complications in order to have the best chances in the operating room.

While it is true that intraoperative awareness only occurs in every 1-2 patients for every 1000, and that rate is decreasing more and more as time goes on, it is still a very serious problem in the US. Many doctors will tell you that awareness is very rare and uncommon, but it actually occurs much more often than it seems. Sure 1 in 1000 sounds like pretty good odds at first, but when the whole picture is in view (there are over 230 million surgeries every year), suddenly 1 in 1000 seems like a lot more. Intraoperative awareness is a very significant problem and doctors and scientists still have a very long way to come before surgical patients truly don’t have to worry. 

It is evident that intraoperative awareness is a serious issue in the US and it needs to be under greater control. There are complex issues revolving around awareness and monitoring consciousness in anesthesia patients, thousands of lives are robbed due to lack of knowledge or recognition, and even though there are new ways and amazing new technology, there is still a long way to go before this problem will be something of the past.