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Thursday, April 4, 2013

Waking up during surgery is a rare event

One of the worst nightmares for anyone contemplating surgery is of waking up during the operation. Unfortunately, this does happen, albeit extremely rarely. Anesthetists make every effort to ensure that people do not wake up when they’re not supposed to, and that includes collecting data on the events. To that end, anesthetists from the UK and Ireland have conducted a huge survey on accidental awareness during general anesthesia.

They found a few interesting things, many of them reassuring. Between the over 7000 anesthetists surveyed, there were only 153 cases of accidental awareness, or one in about 15,000 surgeries. This is considerably lower than the previous reports of one per thousand. This discrepancy could be because complaints about waking up in surgery were not passed on to the anesthetists, who typically do not interact with patients after surgery. More hopefully, the rates have really decreased significantly.

Of these accidental awakenings, nearly half were caught before the surgery actually started. There were only 46 cases of patients waking up on the operating table, or about one in 50,000. 

In the not at all surprising category: people who woke up during surgery experienced more pain and distress than people who woke up before or too soon after the surgery.

What can be done to cut down the incidents of accidental awareness during surgery even more? Two words: training and monitoring. Although two thirds of the UK medical centers in the survey provided depth of anesthesia monitors, less than 2% of anesthetists routinely use them. Only 4.5% of the centers have any kind of policy for preventing or managing awareness during surgery.

By the way, waking up during surgery was not considered the worst surgical complication for either patients or doctors. For patients, nausea and vomiting took first place. For anesthetists, it was death. I’m glad to see that the anesthetists have their priorities right.

Pandit, J., Cook, T., Jonker, W., O'Sullivan, E., & , . (2013). A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK Anaesthesia, 68 (4), 343-353 DOI: 10.1111/anae.12190.

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