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Waking Up During Surgery Uncommon But Happens


What would happen if you were having your gallbladder removed and you woke up during surgery? Waking up during surgery, called unintended awareness, is uncommon but happens in about 2 of every 1,000 patients.

Patients may remember what happened during surgery

In 2005, the American Association of Nurse Anesthetists (AANA) issued considerations for policy development regarding anesthesia awareness, also referred to as unintended intraoperative awareness or in layman’s terms, waking up during surgery.

During such events, patients may be aware of some or all of the activities related to the surgery and have direct recall of the events later. The AANA statement noted that “this may be distressing to some patients and may progress to posttraumatic stress syndrome in a subset of these patients.”

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A new report by Petra Bischoff of the Ruhr University in Bochum and Ingrid Rundshagen of the Charite Berlin, addresses ways to avoid unintended awareness and discusses treatments that are available for patients who do wake up during surgery. In addition to administering an inadequate amount of anesthesia, there are other risk factors medical personnel need to consider.

For example, children are 8 to 10 times more likely to wake up under anesthesia. People who have been taking pain killers for a long time or who abuse medications are also at greater risk of unintended awareness. Types of surgeries that are more likely to be involved in such events include cesarean sections, emergency operations, and surgeries performed at night.

Obesity may also be a risk factor, as it can be more difficult to determine the right amount of anesthesia required. Use of muscle relaxants and/or benzodiazepines as anesthetics may also pose a higher risk. Aware surgical patients who have been given muscle relaxants will be unable to let surgeons know they are awake because they cannot move, while failure to administer benzodiazepines properly can result in increased awareness.

To help prevent patients from waking up during surgery, the study’s authors recommend medical personnel consider all the risk factors mentioned. They also suggest measuring the anesthetic gas concentrations regularly, monitoring brain electrical activity, and providing noise protection for patients. Any patient who reports having been aware during surgery should get immediate professional treatment.

American Association of Nurse Anesthetists
Bischoff P, Rundshagen I. Deutsches Aerzteblatt Intl 2011; 108(1-2): 1-7