Study: 100 patients a day in USA wake up during surgery

[hobbes]

Just saw the following article in USA Today. Has any of the experienced CRNA's ever experienced this?

Study: 100 patients a day in USA wake up during surgery

By Robert Davis, USA TODAY

Anesthesia failure that allows a patient to wake up during surgery, paralyzed and unable to cry for help, occurs 100 times a day in the USA, a study reports Monday.

The rate is similar to those documented by previous international studies, but many doctors have long questioned the prevalence. This is the first time in more than 30 years that the problem has been quantified in U.S. hospitals.

These findings, and the results of two similar trials also to be released today, led the Food and Drug Administration late Friday to broaden its approval of a device it says has reduced the risk of patients waking up during surgery. The BIS monitor, which is used in one-third of U.S. hospitals, turns the brain's EEG waves into a number that can tell anesthesiologists at a glance how deeply a patient is sedated.

Another study of 1,200 patients found that using the BIS monitor reduced the frequency of surgical awareness by 82%.

Such study results are viewed as preliminary. "Awareness is clearly a problem," says Jeffrey Apfelbaum, professor and chairman of anesthesia and critical care medicine at the University of Chicago. "But these studies have not been vetted through the peer-reviewed process. We are all anxious to find a way to minimize the incidence of this problem, but we need to do it through sound science."

The makers of the monitor, Aspect Medical Systems of Newton, Mass., financed the studies, which are being presented at the annual meeting of the American Society of Anesthesiologists in San Francisco. BIS stands for bispectral index technology.

Anesthesiologists have led the medical profession in patient safety efforts. But many of them have resisted the use of BIS monitors, saying they do not need help determining whether their patients were adequately sedated. "They have their head in the sand," says the study's lead investigator, Peter Sebel, a professor of anesthesiology at Emory University School of Medicine. "They say they have never had a case in their career. I think they may have, they just don't know about it."

His study of nearly 20,000 surgical patients found that for every 1,000 who receive general anesthesia, 1 to 2 people become aware of what is happening to them. Half of them feel pain.

"I did not feel cutting, but I felt tremendous pulling," says Carol Weihrer, who awoke during eye-removal surgery. "It takes a lot of torque to get an eye out."

Since her 45-minute ordeal in 1998, during which she felt surgical tools on her chest, listened to the music played in the surgical suite and felt like gagging because of the tube down her throat, she has become a patient advocate.

"It has been described as worse than rape or kidnapping in that you can't squirm or scream," she says. "There is no way to release your fear or your frustration." She and other patient advocates say patients should ask for a BIS monitor.

[2ndCareerRN]

I can believe that.

When my wife had her pacemaker implanted, it took over 3.5 hrs to get a good vetricular lead. While not a general, usually a good conscious sedation will keep a person calm and help them forget. Not my wife, she remembers talking to the cardiologist several times during the procedure. She received a total of 600mcg of fentanyl and 28mg of versed. Suddenly the outpatient procedure turned into an 3 day stay, because of the drugs and the fact the ventricular lead did not stay put.

The next two times they opened her up to play with the pacer or the leads, the cardiologist had anethesia there to use diprivan. Must have worked a lot better, she didn't remember a thing from those two.

I for one would hate to be under a general light enough that I could feel, and hear everything going on around me. And feeling the procedure done.

bob

[Irishcreme]

This happened to my mom once. She told me there was no pain but she did feel tugging. She also remembered them talking about vacation spots. At one point the nurse even said to the doctor that my mom was trying to tell him something with her eyes. Turns out they used a new drug on her.

[nilepoc]

lets see, the hospital I am in does over 100 surgeries a day, and lets say every hospital does around 80 or more. That one hundred suddenly becomes a much smaller number.

Please note that this is research payed for by the BIS company. Fortunately USA pointed that out.

I would like to know if they included emergency surgeries such as c-sections in their study. Recall in emergency C-sections is not uncommon. Not that it is a good thing, but the repid nature of the surgery tends to increase the number of aware patients.

thanks for posting the article.

Craig

[yoga crna]

As far as I am concerned, it is a marketing tool by the Aspect Company to sell BIS monitors. I watch my patients and equipment very closely and in 43 years have never had a patient complain of recall. I know it does happen--I reviewed a malpractice case where the patient was able to give a verbatim report of everything that was said in the OR. If you look for the cause of hypertension/tachycardia and not treat it before determing the cause, you may find the patient is light and needs more anesthesia and not a beta blocker that masks the fact that the patient is awake.

I have no need to increase the cost of surgery by having a monitor I don't need. By the way, I have used a BIS monitor and have seen it used, but I am still not convinced.

I hope all of you students are learning how to read those studies and to determine their reliability. That is an important aspect of professionalism.

YogaCRNA

[Maximus]

I find this subject fascinating, and that is why I wrot an essay about it a few months ago for a scholarship.

The incidence of awareness in noncardiac and nonob cases is 0.2% (Anesthesia, 1991). It is much higher in ob, cardiac, and trauma surgeries. At that rate it amounts to at least 40000 pt's at day. Luckily most of the patients who experience awareness do not also experience recall. So they experienced all the suffering at the time but don't remember it afterwards.

There actually is a lot of research about the bis monitor that is totally independent from Aspect Medical Systems. Research does show that is a good indicator of depth of anesthesia. It can do this even better than blood concentration levels of certain anesthetis (Anesthesiology, 1997). But not perfectly, a case report showed that a child demonstrated awareness at a bis score of 47 - supposed to be deep anesthesia (Anesthesia and Analgesia, 2001). How many of our monitoring systems are perfect though. However there is no research that says BIS monitoring can prevent intraoperative awareness. It may help indicate depth of anesthesia but it is a little bit of a leap to turn that into preventing awareness. The reason there is no research is b/c at an incidence rate of 0.2% a powerful enough study would require a huge sample and thus very expensive.

I would argue that we need this study though. 40,000 people is way to many. Awareness is real and it is a major fear of patients. Anesthesia providers may believe they have a perfect record but some studies show that it is underreported or disregarded by health care professionals.

[gotosleep]

Originally posted by Maximus

I find this subject fascinating, and that is why I wrot an essay about it a few months ago for a scholarship.

The incidence of awareness in noncardiac and nonob cases is 0.2% (Anesthesia, 1991). It is much higher in ob, cardiac, and trauma surgeries. At that rate it amounts to at least 40000 pt's at day. Luckily most of the patients who experience awareness do not also experience recall. So they experienced all the suffering at the time but don't remember it afterwards.

There actually is a lot of research about the bis monitor that is totally independent from Aspect Medical Systems. Research does show that is a good indicator of depth of anesthesia. It can do this even better than blood concentration levels of certain anesthetis (Anesthesiology, 1997). But not perfectly, a case report showed that a child demonstrated awareness at a bis score of 47 - supposed to be deep anesthesia (Anesthesia and Analgesia, 2001). How many of our monitoring systems are perfect though. However there is no research that says BIS monitoring can prevent intraoperative awareness. It may help indicate depth of anesthesia but it is a little bit of a leap to turn that into preventing awareness. The reason there is no research is b/c at an incidence rate of 0.2% a powerful enough study would require a huge sample and thus very expensive.

I would argue that we need this study though. 40,000 people is way to many. Awareness is real and it is a major fear of patients. Anesthesia providers may believe they have a perfect record but some studies show that it is underreported or disregarded by health care professionals.

nice post...and I agree.

[Maximus]

I was just reading my post and I meant to say 40000 patients a YEAR experience awareness.

[alansmith52]

yeah i was gonna say, didn't bis do this research,

I hardley belive any research I read anymore. If its not made up elements for the periodic table its somthing else.

many research groups are admiting to the falsification of their studies.

like I Say i hardley belive any of themanymore

[redshiloh]

I remember I had to have a D&C after my baby died at 16 weeks, I was awake and it hurt, but I couldn't tell them, couldn't move.

When I told them afterwards they acted like they couldn't care less.

[sixes]

My sister experience this while under a general for tubal.

The Doc said no way the anthesistest said no way.

She then told them everything the said and the music that was played including the Doc telling the nurse it was the wrong tape selection.

She now has a medical alert that says what to do if she needs surgery again.

[HeatherB,CST]

My mom woke up like 3 times during her total knee. First time she said "Oh, are you done?" and four masked faces appeared in her line of sight. Someone said "I'll get her" and off she went back to sleep. Second time, she woke up and felt her body being jolted as the surgeon hammered into her femur. She didn't say anything, and thought to herself "oh, they're not done" and closed her eyes again. Third time, I think she said something like they were just finishing up, closing...

She was never scared or in pain, just mostly amused at the whole thing. Does this happen often? Has anyone seen this?