Mana_Tangata

Hi, I'd like to know the best way to insure that I don't get a drug or procedure. I know that I can stipulate it on the consent form, but that any restrictions I make can be nullified if I verbally consent later. I'm worried that a provider could claim that I made a verbal consent when I did not. Is there any way to stipulate on the written consent form that a restriction can only be changed in writting, or as witnesses by a patient advocate? It must be very hard for a healthcare provider to let someone die rather than respect their wishes, but it is very important to me. Thanks!

"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.

Hi, I don't think that this forum encourages patients to go into our personal experiences, sorry. I think that my experience was not unusual. My feeling is the point of the brochure is not education but to placate patients. If it was labeled "Why your anesthesia providor thinks you don't need to worry about awareness" I'd be okay with it. I doubt that those that crafted the brochure were unaware of the studies that show how many patients develop PTSD, how many patients are traumatized by the experience, how many patients feel pain during awareness.

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. Thanks for the opportunity to vent.

I don't think that the anesthesia community is unaware - I agree with you that the exact opposite is the case and you have been barraged with the topic. As far as other folks in the medical profession, and getting policies in place, I'm not so sure. I think that the reason I did not get the after care recommended by JCAHO is because the hospital did not have any policies to deal with me. While I am very angry at the anesthesiologist regarding my aftercare, I have to acknowlege that the experience was probably very traumatic for him as well, and he may not have been thinking clearly. (we are all human) If the hospital had some kind of policy it would have helped both him and me.

Hi, I'm sorry if this is not the place, but I think that my experience has a lot to be learned from. There seems to be a war going on around anesthesia awareness, and I feel I have been caught in the middle. Common sense seems to have been lost. Do I think that I was given negligent care, or that a monitor would have prevented what happened? I don't know. Do I think that if my experience did not initiate such a defensive and denial reaction I would be in such bad shape? I don't think so. I was cut lose without any couseling, completely unprepared for the psychological consequenses. If I had experienced some kind of complication that did not elicit such a defensive reaction, I think that I would have been given the care I needed. It seems to me that anesthesia awareness has been touted as being equivalent to inadequate care. I do not agree with this, and think that that type of thinking is detrimental to patient care. I have two friends who also experienced this, both trauma cases. Do I think that they received substandard care? No. I don't think in either case the anesthesia providor knew about the awareness. This was a good ten years ago, so before all the press. I feel like a nail that has stood up and gotten very hammered down. Earlier I posted that i did not know if I would continue to speak up. But you know what, I exist. It seems to me that there are might be some people on this board who would want learn something from me.

Wow, I've obviously hit a nerve here and offended a lot of people. I am so sorry. As far as intentionally misleading people about who I am, you are right, I did not let you know my position up front, but I did not lie about it either. The increadible emotional response I get from people is part of the reason I hide what happended to me. They are either horrified, don't believe me, want to kill my anesthesiologist....I've just stopped telling people. I'm so sorry. As far as not knowing what all of you go through and the stress that you are under to do a good job, you are right I will never really understand it. In looking in to what happended to me, however, I do have a new appreciation for how hard your job is. But I do have a huge amount of anger towards MY anesthesiologist. I think that he was very sloppy. I think that 99.99% of people in the profession are not. I really don't know whether to post here anymore or not. It was so nice to find a safe forum to discuss my experience, but I'm really don't want to piss people off. Also, frankly I'm not up for taking the brunt of the backlash.

Thanks for all of your support on the board. You know, this is the first time anyone would talk to me openly about it (and without a person from risk management in the room).

My anesthesia record shows that the anesthesia "start" was 10 minutes after I entered the department. I don't remember him asking me about previous anesthesia experiences, or current medications, and he did not document anything. I had written a letter to my surgeon about setting off alarms when I was sedated for a minor procedure due to my low heart rate, but she did not inform the anesthesiologist or put it in my chart. It's hard for me to tell if he did a baseline reading or not - the initial BP and HR reading is the same minute as "anesthesia start".

I am not an attorney or a shill for Aspect. I'm not sure that I want to get this discussion, but the first thing my anesthesiologist said regarding the incident was that a BIS monitor would not have helped me. While I've been doing research I've come across an amazing animosity towards Aspect, it seems like they have really pissed people off. As a patient, I have to say that I don't really care. I agree that I probably won't find answers in my anesthesia record. I have to say for all of you out there, though, that it matters. When I looked at mine and saw that my anesthesiologist had converted my weight from lbs to kgs wrong, transcribed my temperature at intake wrong, gotten the medications that I was currently on wrong, as well as the date/time wrong, it was pretty depressing. For all I know he gave me the best of care possible, maybe something he did saved my life, but when I see all the mistakes on my record it makes me feel like I was as important as a hamburger patty at McDonald's.

Hi, I'm the patient, not an attorney. I'm trying to figure out why it happened to me. I didn't want to say that up front because I wanted honest opinions, which I though might be hard for people to give if they knew where I was coming from. I understand that this forum is just folks' individuals opinions. For those of us that have gone through it, it's really hard to get any answers. Everyone is so afraid of being sued.

No Versed or other pre-op meds. She was on sevoflurane, dilaudid, N2O, rocuronium, pretty typical amounts. Her HR at intake was 66, but probably high due to nerves. It doesn't look like the anesthesiologist was aware of her low hemodynamics.

What do you think of a patient who had a resting HR of 43, initial BP of 114/58 (athlete, no cardio probs) who was kept at about 120/60 and a HR of 65-83 for about 2 hours, and had intraoperative recall? The patient informed the surgeon of her low resting HR which caused alarms to go off during a previous procedure, but the surgeon never informed the anesthesiologist. Do you think it was a case of inadequate communication/care, or just bad luck?

Hi, I was wondering how long it takes folks, if you are thorough but moving right along, from receiving a patient to start of GA. Including interview, equipment check, paperwork, etc. Thanks!