Happy Holidays!

With the recent release of the movie “Awake” - a movie that portrays a patient who is anesthetized without proper levels of anesthesia resulting in a paralyzed yet awake patient there has been a recent media frenzy surrounding this topic. I have received numerous questions about the possibility and frequency of this rare and unfortunate event, and having seen many of these sensationalized portrayals, I feel it is extremely important for people to understand the truths about awareness under general anesthesia. So this month, I invite one of my esteemed colleagues in the field of anesthesia at the Massachusetts General Hospital – Dr. Shahzad Shaefi, M.D., to discuss the topic in detail…

Dr. Shaefi is a clinical fellow in Anesthesiology at the Massachusetts General Hospital and the recipient of many honorable distinctions including the National Royal Society of Medicine Anaesthesia Prize, the National MSSVD research prize and the GlaxoSmithKline 14th International AIDS Conference Scholarship. We are very honored that Dr. Shaefi has taken the opportunity to share his thoughts on the topic of awareness under general anesthesia with visitors to the Bumble Collection’s website and thank him for his efforts.
I hope you enjoy this month’s topic as I feel it is current and an especially relevant concern for women who undergo caesarean sections, which carries an increased risk of awareness (0.4% of cases), where light anesthesia is purposefully used to minimize the risk to newborns and their mothers.

For more information on the topic of awareness please visit the American Society of Anesthesiologists at http://www.asahq.org/
Keep your questions coming… and again Happy Holidays and a Wonderful New Year to everyone!
Sincerely,
Dr. Sal Maya

Hello, my name is Dr. Shaefi and I am pleased that Dr. Maya has asked me to discuss a very important topic that is on the mind of many patients before general anesthesia – awareness under general anesthesia. The issue of awareness has received significant attention in recent months and I feel it is important that patients understand the issues from a healthcare professional. If you have been affected by intra-operative awareness under general anesthesia, I urge you to contact your healthcare professional for additional treatment and resources.
Awareness under anesthesia is a rare complication of general anesthesia that occurs when surgical patients can recall their surroundings or an event— sometimes even pain—related to their surgery. This should not be mistaken with other forms of anesthesia such as local, sedation (MAC – monitored anesthesia care) or regional anesthesia, where it is expected that patients have some recollection of their procedure.

Awareness is quite rare. Studies are not conclusive on the frequency of awareness under general anesthesia, but it is estimated to occur in anywhere from 0.05% - 0.13%, or in 1 out of 2,000 cases. This risk is increased for cardiac surgery (1-1.5% awareness), trauma surgery (11-43% awareness) and Caesarean section under general anesthesia (0.4% awareness). When it does occur, it is often fleeting and not traumatic to the patient. Awareness can range from brief, hazy recollections to some specific awareness of your surroundings during surgery. When awareness during general anesthesia does occur, it is usually just prior to the anesthetic completely taking effect or as the patient is emerging (or “awaking”) from anesthesia. In very few instances, it may occur during the surgery itself.

In order to help prevent awareness, patients should meet with their anesthesia professional to discuss anesthesia options. Should there be concerns regarding awareness, this is an ideal time to express them and to ask questions. Patients should share with their anesthesia professional any problems they may have experienced with previous anesthetics, and also discuss any prescription medications or over-the-counter medications they are taking.

While the safety of anesthesia has increased markedly over the last 20 years, people may react differently to the same level or type of anesthesia. Sometimes different medications can mask important signs that anesthesia professionals monitor to help determine the depth of anesthesia. In other rare instances, technical failure or human error may contribute to unexpected episodes
of awareness.

In some high-risk surgeries or in situations involving patients whose condition is unstable, using a deep anesthetic may not be in the best interest of the patient as it can lower the blood pressure and cause hemodynamic instability in a patient who is already unstable. In emergency caesarean sections, where general anesthesia is used due to the urgency of the situation, the focus is directed on the newborn. In these cases, lower levels of anesthesia are used to protect the baby and mother in these emergency situations, and unfortunately, awareness may not be completely avoidable.

Many physicians and researchers have been studying the issue of awareness under general anesthesia and are in the process of evaluating the effectiveness of various technologies and techniques to decrease the likelihood of this unfortunate event. At the present time, none of these new technologies has been perfected.

If you have experienced awareness under general anesthesia I urge you to talk with your
anesthesia professional, who can explain to you the events that took place in the operating
room at any stage of your surgery and why you might have been aware at certain times. Research has shown that early counseling after an episode of awareness can help to lessen feelings of confusion, stress or trauma associated with the experience. If you have distinct recollections of your surgery and want to discuss them, your anesthesia professional can help you or refer you to a counselor or to other appropriate resources for treatment.