Tackle Tough Issue Of Anesthesia Awareness
A dynamic panel of researchers, anesthesia professionals and a patient/advocate assembled this week at a forum for healthcare journalists to tackle the complex issue of anesthesia awareness, the rare but devastating condition that is of heightened public concern due to today's release of the movie "AWAKE." The forum, "A Wake-Up Call About Anesthesia Awareness: Striking a Balance in Public Perceptions," was convened to address the range of related challenges, controversies and concerns in order to forge a positive path ahead to reduce anesthesia awareness and improve patient safety.
"While AWAKE may send shockwaves through the systems of those about to have surgery, and those who have suffered this rare event, it also serves as a wake-up call to health professionals to do all we possibly can to reduce the occurrence of anesthesia awareness," said Orin F. Guidry, MD, Professor, Anesthesia and Perioperative Medicine, Medical University of South Carolina.
ONE CASE IS TOO MANY
Anesthesia awareness occurs when a patient under general anesthesia stays or becomes conscious during surgery but can't move or talk because paralytics are in effect. While the incidence of anesthesia awareness is rare, it can have devastating effects. The incidence, based on several studies, is reported to be 0.1%, which translates to about 21,000 of the 21 million people in the United States who receive anesthesia each year.
Dr. Guidry emphasized that that dispute over the number of cases should not distract from the shared sense of urgency to address the issue. "Let's get out of this box of how often it occurs. Really, one case is too many," he said. "As anesthesiologists, we are not going to stop until we can get that risk down to zero."
PATIENTS, ADVOCACY AND IMPATIENCE
Carol Weihrer, President and Founder of the Anesthesia Awareness Campaign, Inc., provided her unique perspective as a patient/advocate whose experience with awareness propelled her effective advocacy for patient safety and support. Describing her work on behalf of those, like herself, who have experienced this life-altering event, Ms. Weihrer said, "I am a patient, I experienced awareness; I am passionate; and I am impatient! It's my life's work to direct my passion toward those who have had their lives changed by this terrible experience."
Carol suggested that patients become more proactive both in preparation for and in follow up after their surgery. "I encourage people to empower themselves with research and education about their surgery, including the anesthesia. They should have a very frank discussion with their anesthesia professional in advance," continued Carol. "Always ask about monitoring, ask about paralytics, and be very forthcoming about any drugs that you are taking."
LEVEL OF CONSCIOUSNESS MONITORS
The use of brain function monitors during surgery can reduce the likelihood of an individual experiencing anesthesia awareness, according to the panelists, who emphasized that these monitors are an important strategy, not a solution. "These monitors provide additional information that nothing else in anesthesia monitoring does. I would like to see consciousness monitors in every operating room and available for every surgery at the discretion of the patient and the anesthesiologist," said Daniel J. Cole, MD, Professor and Chair of Anesthesiology, College of Medicine, Mayo Clinic, member of the American Society of Anesthesiologists Task Force on Intraoperative Awareness.
Dr. Cole pointed to progress: "A 2005 American Society of Anesthesiology survey showed that 64% of anesthesiologists reported not using a brain function monitor. In a 2007 Stryker National Attitudes and Perceptions (SNAP) survey, 22% of those surveyed reported not using monitors. While the surveys used two different methodologies and therefore are not absolutely equivalent, this indicates that we've made significant improvements in addressing awareness. But we're not there yet."
Marc Bloom, MD, PhD, Director of NeuroAnesthesia at the New York University Medical Center sees promise in new technologies. "As more options become available to provide level of consciousness monitoring," Dr. Bloom said, "patients can be reassured that they have an opportunity to have the best possible anesthetic care."
PROMOTING GOOD COMMUNICATIONS
Tom McKibban, CRNA, MS, with Butler County Anesthesia Services, LLC, provided key questions that should be asked of patients recovering from surgery following general anesthesia: