Okay, so I'm all fired up and don't have my ducks in a row, so give me you best shot.
I've posted before - I'm a patient who had anesthesia awarenss. I've just seen the AANA/ASA patient brochure on awarness and I think that it is a shining example of misinformation and a true disservice to patients and patient safety. The brochure is at http://www.aana.com/news/pdfs/awareness_brochure0705.pdf
It is hard for me to pick this thing apart and give specific examples of what my problem with it is. (though I try) It's more the whole tone of the thing, the way the whole thing seems to be designed to placate and present the information in such a skewed way that a patient is discouraged from participating in their anesthesia choices, such as the use of relaxants, BIS or amnesiacs. I know you may be sick of people coming to you scared out of their wits by a sensationalist news article, but this type of skewed wordsmithing exercise is not justified or ethical in my book.
Section on "What is patient awareness?"
"Studies are not conclusive on the frequency of awarenes" Huh? I thought that about .1-.2% is fairly accepted in the community. Sounds like they are hedging to me.
"When awareness does occur, it is usually just prior to the anesthetic taking full effect or when the patient is emerging from anesthesia. In a very few instances it may occur during surgery" I thought that most awareness occurs during maintenance, perhaps intubation. They make it sound like you might be a little aware as you are drifting off or waking up. Not really the definition of awareness in my book. I really dislike the statement that "in a very few instances it may occur during surgery" Very few? Like count on one hand? I'd like to know where that comes from.
Section on "Why does it happen?"
Patient condition mentioned first, pt varied reaction to anesthesia 2nd, "In rare instances, technical failure of human error" Is this so? I've read (I think in closed claims) that technical failure was #1, human error #2, patient condition #3, but since this was closed claims I assume it would be biased. I don't know, but I doubt the validity that technical failure plus human error would be the cause of, say, less than 10%.
Section on "How can awareness be prevented"
Zero JCAHO suggestions. Patients advised to give prior anesthesia history, current meds. I know this board is sick of the JCAHO recommendations, but still as a patient I expect them to mentioned, or at least referenced in an educational document so I can make an informed decision.
Section on "10 Things you should know about awarness" - summary
1. Awareness is rare, ususally fleeting and not traumatic. Speechless at the word crafting of this one. A shining example of cherry picking study data.
2. Patients usually do not feel pain, some feel pressure. Umm, isn't it something like 30% feel pain? "Pressure", if intense, can be severely traumatic to experience as well. Again, made to sound very benign.
3. Awareness can vary from brief, hazy recollections to some specific awareness...Patients may dream, have memories of before or after, [which is not necessarily awareness.] To me, another rendition of "It's all in your head". Read the full text to get the slant.
Sorry about your experience however, I refuse to spend any time debating anesthesia with a non-anesthesia provider. We are all happy to educate you but you obviously are emotional, have taken a stance, and aren't going to budge. Furthermore, you haven't any ground to stand on when trying to debate with us regarding this matter. Given your experience, you certainly have the right to a strong opinion regardless of how inaccurate it may be. Maybe some others will oblige and debate you but most of us do not have the time. Good luck to you and I certainly hope you are getting the necessary counseling, etc.
"You will not be happy with any brochure printed by anyone unless it states that "Awareness is a common problem, usually caused by poor practitioners, and the only way to prevent it is to use a BIS monitor." Correct me if I'm wrong.
My response -
1. I don't think it's a common problem. I think that it probably has an incidence of .1-.2%.
2. I don't think that it's ususally caused by poor practitioners, don't know where you got that one. As I said, I think, in a closed claims analysis, human error may have been #2 after technical problems. Since this database is from people who sued, I assumed it's biased and said so.
3. The only way to prevent it is to use a BIS monitor. It is my personal belief that the BIS, in high risk of awareness cases, can give a provider a tool that helps to reduce the incidence of awareness. I think the numbers that the clinical trials came up with were a 50% reduction in risk, with a p value giving 95% confidence. Personally, I think that with the numbers so low in the trials, that's too optimistic. In the real world maybe what, 25% reduction? For someone trained and comfortable with using it? That's anyone's guess.
If I had my say with the booklet, here are some changes I'd suggest:
Under 10 things you should know
1. It is quite rare and often fleeting. It it does occur, be sure to tell your provider who can help you deal with any psychological consequences, which can be severe if left untreated.
Why I'd make these changes. Awareness is already grossly under-reported. If you don't know you can't help. The original text only gives one side, the experience is fleeting (not always) and not traumatic (how many patients have psychological consequences? A lot)
2. Patients who experience awareness have a wide variety of experiences, from a pleasant, dream type awareness, feelings of pressure, pain, or anxiety.
Why I'd make these changes - pain may not be "usual" but it isn't "unusual" either. What, about 30%? Saying that patients don't usually feel pain, and then transitioning into "maybe" pressure, is MISLEADING.
3. Patients who experience awareness, or other disturbing recollections before, during of after treatment should always feel free to discuss them with their providor.
Why I'd make these changes - I'm sure that there are a lot of patients who think that have inter-operative awareness who are actually remembering before/after the procedure, but there are also those with awareness. The original text only discusses what true awareness is NOT, leaving it up to the patient to figure things out. I also think that the original text misappropriately discourages the patient to admit awareness. To help show why I think it's skewed, I'll flip things around. I'm not suggesting that a pamphlet has this wording.
Awareness can range from an extended, clear recollection of your surgery to a brief awareness of your surroundings. People who have experienced awareness may may think they have had a dream. Such a recollection does not necessariy represent a dream, but may actually be awareness.
5. Awareness can occur for any patient undergoing GA, but is most likely to occur in high risk surgeries.....
Why I'd make these changes - Aren't the highest number (not risk) of cases of awareness in healthy patients, who are not in for cardio, trauma or childbirth? When the original text states that awareness can occur in a, b and c, it misleadingly leads the reader to conclude that it can ONLY occur in a, b and c.
9. New brain wave monitoring devices currently are available and may prove...
Why I'd make these changes - Saying that monitoring devices are "being tested" makes it sound like they have not been FDA approved, which I think is misleading. (I know that a lot of you hate the BIS, but that's not the point, honesty is) If someone tells me a new cancer drug is being tested, I don't think that it's on the market. If a patient is so freaked out about possible awareness to hunt down a facility that has a monitor, maybe they should have one.
And NO - I don't have ANYTHING to do with Aspect.
Please stay polite, I'm trying to. Actually, I'm kind of having fun. I know that I have such a different point of view than almost anyone else on this board. Please take my comments as they are intended, not as an attack on personal beliefs but as a patient perspective.
sandman1
70 Posts
Sorry about your experience however, I refuse to spend any time debating anesthesia with a non-anesthesia provider. We are all happy to educate you but you obviously are emotional, have taken a stance, and aren't going to budge. Furthermore, you haven't any ground to stand on when trying to debate with us regarding this matter. Given your experience, you certainly have the right to a strong opinion regardless of how inaccurate it may be. Maybe some others will oblige and debate you but most of us do not have the time. Good luck to you and I certainly hope you are getting the necessary counseling, etc.
My response -
1. I don't think it's a common problem. I think that it probably has an incidence of .1-.2%.
2. I don't think that it's ususally caused by poor practitioners, don't know where you got that one. As I said, I think, in a closed claims analysis, human error may have been #2 after technical problems. Since this database is from people who sued, I assumed it's biased and said so.
3. The only way to prevent it is to use a BIS monitor. It is my personal belief that the BIS, in high risk of awareness cases, can give a provider a tool that helps to reduce the incidence of awareness. I think the numbers that the clinical trials came up with were a 50% reduction in risk, with a p value giving 95% confidence. Personally, I think that with the numbers so low in the trials, that's too optimistic. In the real world maybe what, 25% reduction? For someone trained and comfortable with using it? That's anyone's guess.
If I had my say with the booklet, here are some changes I'd suggest:
Under 10 things you should know
1. It is quite rare and often fleeting. It it does occur, be sure to tell your provider who can help you deal with any psychological consequences, which can be severe if left untreated.
Why I'd make these changes. Awareness is already grossly under-reported. If you don't know you can't help. The original text only gives one side, the experience is fleeting (not always) and not traumatic (how many patients have psychological consequences? A lot)
2. Patients who experience awareness have a wide variety of experiences, from a pleasant, dream type awareness, feelings of pressure, pain, or anxiety.
Why I'd make these changes - pain may not be "usual" but it isn't "unusual" either. What, about 30%? Saying that patients don't usually feel pain, and then transitioning into "maybe" pressure, is MISLEADING.
3. Patients who experience awareness, or other disturbing recollections before, during of after treatment should always feel free to discuss them with their providor.
Why I'd make these changes - I'm sure that there are a lot of patients who think that have inter-operative awareness who are actually remembering before/after the procedure, but there are also those with awareness. The original text only discusses what true awareness is NOT, leaving it up to the patient to figure things out. I also think that the original text misappropriately discourages the patient to admit awareness. To help show why I think it's skewed, I'll flip things around. I'm not suggesting that a pamphlet has this wording.
Awareness can range from an extended, clear recollection of your surgery to a brief awareness of your surroundings. People who have experienced awareness may may think they have had a dream. Such a recollection does not necessariy represent a dream, but may actually be awareness.
5. Awareness can occur for any patient undergoing GA, but is most likely to occur in high risk surgeries.....
Why I'd make these changes - Aren't the highest number (not risk) of cases of awareness in healthy patients, who are not in for cardio, trauma or childbirth? When the original text states that awareness can occur in a, b and c, it misleadingly leads the reader to conclude that it can ONLY occur in a, b and c.
9. New brain wave monitoring devices currently are available and may prove...
Why I'd make these changes - Saying that monitoring devices are "being tested" makes it sound like they have not been FDA approved, which I think is misleading. (I know that a lot of you hate the BIS, but that's not the point, honesty is) If someone tells me a new cancer drug is being tested, I don't think that it's on the market. If a patient is so freaked out about possible awareness to hunt down a facility that has a monitor, maybe they should have one.
And NO - I don't have ANYTHING to do with Aspect.
Please stay polite, I'm trying to. Actually, I'm kind of having fun. I know that I have such a different point of view than almost anyone else on this board. Please take my comments as they are intended, not as an attack on personal beliefs but as a patient perspective.