The truth about accidental awareness during general anesthesia
Accidental awareness during general anesthesia (AAGA) is the phrase used to describe when a patient becomes alert during a surgical procedure when he or she…
Accidental awareness happens during surgery when the patient is supposed to be unconscious. (Shutterstock)
Accidental awareness during general anesthesia (AAGA) is the phrase used to describe when a patient becomes alert during a surgical procedure when he or she should be unconscious.
Considered the most feared complication during surgery for both doctors and patients, accidental awareness can mean a patient suddenly gains perception of pain and awareness of surroundings but has an inability to move, speak, or otherwise alert those around to what is going on.
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Though once thought to be a more frequent occurrence, a new study–the largest study on AAGA to date–has revealed approximately 1 in every 19,000 anesthetic procedures results in a level of accidental awareness. This number is much lower than previous estimates, which suggested as many as 1 in 600 cases had AAGA occur.
“Suddenly, I knew something had gone wrong, said Sandra, who experienced AAGA as a 12-year-old patient, in the opening chapters of the report. I could hear voices around me, and I realized with horror that I had woken up in the middle of the operation, but couldnt move a muscle? while they fiddled, I frantically tried to decide whether I was about to die.
Sandra’s paralysis was the result of muscle control medication administered during a surgical procedure. These drugs are necessary to prevent the body from moving unexpectedly while the surgeon is operating, but if the actual anesthetic that control consciousness doesn’t work, it means someone may end up “awake” yet unable to move.
“Systematically I went through each body part again, muscle by muscle, nerve by nerve, sinew by sinew, willing something, anything to react. At first, it felt like nothing would ever work again,” Sandra explained.
Though she did not recall feeling any pain, the experience left her with violent nightmares for more than a decade, and it wasn’t until she made the realization between the nightmares and her experience that she was able to recover.
Sandra’s experience is not unique, and hundreds of people have reported AAGA. According to the study, the majority of episodes of awareness are short-lived and occur before surgery starts or after it finishes; however, in 51 percent of cases patients felt distress, and 41 percent of patients reported long-term consequences. In a press release from the The Association of Anesthetists, experts noted “sensations experienced included tugging, stitching, pain, paralysis and choking. Patients described feelings of dissociation, panic, extreme fear, suffocation and even dying. Longer-term psychological harm often included features of post-traumatic stress disorder.”
Accidental awareness occurs approximately in 1 of every 19,000 procedures. (Shutterstock)
Despite the frequency of accidental awareness, researchers aren’t entirely sure what causes, and indicate that a complex mixture of factors is likely at play. Professor Jaideep Pandit, Consultant Anesthetist in Oxford and Project Lead, stated, “Risk factors were complex and varied, and included those related to drug type, patient characteristics and organizational variables. We found that patients are at higher risk of experiencing AAGA during caesarean section and cardiothoracic surgery, if they are obese or when there is difficulty managing the airway at the start of anesthesia. The use of some emergency drugs heightens risk, as does the use of certain anesthetic techniques.
However, the most compelling risk factor is the use of muscle relaxants, which prevent the patient moving. Significantly, the study data also suggest that although brain monitors designed to reduce the risk of awareness have a role with certain types of anesthetic, the study provides little support for their widespread use.
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Thankfully, medical science is making significant advancements when it comes to improving human anesthesia. Last year, a study published in Science Translational Medicine indicated researchers had identified specific brain waves that signaled the point when consciousness was lost. At the time, they suggested the discovery might eventually be used to better monitor a person’s level of unconsciousness during surgery.
