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Anesthesiologists Seek New Approach to Phenomenon of Waking During Surgery

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Each year, an unimaginable horror occurs to a number of patients in the midst of surgical procedures.

These unfortunate people wake up only to realize they are still in surgery and, while they are able to feel indescribable pain, they are completely paralyzed and unable to move, cry out, or otherwise let the surgical team know they have regained consciousness.         

In an attempt to prevent this somewhat rare medical phenomenon, the American Society of Anesthesiologists, at a meeting in Atlanta, has instituted new measures to monitor patients under anesthetics.

Significantly, however, the group did not recommend the routine use of brain function monitors which are designed to detect brain-waves and determine the level of consciousness with mathematical accuracy.

According to recent data, in one or two out of 1,000 cases, patients wake up, hear noises, or feel extreme pain during surgery. These reports of consciousness during surgery were more frequent in patients who were in unstable condition or trauma victims.

While one-tenth to one-fifth of 1% is statistically small, it amounts to a great many people when you consider the millions of surgeries done worldwide each year. Even that small percentage, however, amounts to 1,000 to 2,000 cases per million.    

After a 2004 lawsuit brought attention the problem, closer monitoring during surgery and discussion with patients after the procedure was encouraged.

The American Society of Anesthesiologists also proposed a checklist protocol for anesthesia equipment to ensure the correct dose is administered and for the careful examination of the patient’s reflex motion as well as blood pressure and heart rate.

The group rejected the general use of brain function monitors even though one study reviewed the machines favorably since, "there is insufficient evidence to justify a standard, guidelines, or absolute requirement that these devices be used."

The monitoring equipment, manufactured by Aspect Medical Systems Inc. of Massachusetts, was introduced in 1996 and costs $9,500 but can be obtained for $5,000 or less, a company spokeswoman said.

The society concluded that brain function monitors would be used on a “case-by-case basis” especially in procedures such as trauma surgeries and Caesarean sections, which do not allow for deep anesthesia. 

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