Talk:Anesthesia awareness/Archive 1

Archive 1

Talk

thanks to whoever provided this article. it's an important topic!

Things we should add at some time

1. distinction between GA and sedation
2. why only an issue during paralysis and explain that a bit better
3. more common under ga for severe trauma and c/s
4. outdate fentanyl anaestheisa

Erich 01:16, 21 May 2004 (UTC)

and anybody know exactly what this means: It is also highly comorbid with alcoholism? (cause its not clear at all to me) Erich 08:40, 21 May 2004 (UTC)

I thought it meant that many Anesthesia awareness victims become Alcoholics. I don't know if it is true or not. --Michael L. Kaufman 14:37, May 21, 2004 (UTC)

well PTSD is associated with alcoholism and aother forms of substance abuse but unless the association is stronger with awareness then the comment just seems a bit distracting to me. You weren't the original contributor of this page by any chance were you? Erich 23:27, 21 May 2004 (UTC)

Please visit www.anesthesiaawareness.com. I, too, disagree with the comment about alcoholism. However, the symptoms and sequelae of PTSD are life-changing for victims of awareness. The hesitation of the anesthesia community, especially the leadership of the American Society of Anesthesiologists, is abhorrent. Awareness is like "being entombed in a corpse" and the memory NEVER goes away. [Carol Weihrer, President, Anesthesia Awareness Campaign, Inc.]

Awareness is associated with alcoholism because those with a tolerance (think "resistance") to the sedative effects of alcohol also have a tolerance to the sedative effects of most anesthetics. Therefore, usual doses of anesthetics may not be sufficient to assure amnesia for an alcoholic patient. (Peter M. Lucas, MD, Anesthesiologist)

GA (general anesthesia) is the term used for a completely unconscious and unresponsive state. Such as would be required for a major surgery. Sedation refers to a reduced level of consciousness and responsiveness. This is used for mild to moderately uncomfortable procedures like endoscopies for example. Although there has been much effort made to draw firm distinctions between "conscious sedation", "deep sedation", and "anesthetitized", they all exist on a continuum that could best be described by what the patient is or is not reponsive to. That is; responsive to voice, or to gentle stimulation, or only to moderate pain. At the far end of this spectrum, the patient is unresponsive to deep pain and would be considered anesthetized. An important corollary here is that any of the drugs usually used for sedation can, in sufficient doses, create any depth of sedation or anesthesia that you please. Conversely, many drugs that are used for general anesthesia can be used in small doses for sedation. (Peter M. Lucas, MD, Anesthesiologist)

Paralysis is associated with an increased risk of awareness under general anesthesia most likely for these two reasons. 1) A paralyzed patient cannot give the anesthesiologist one of the indicators of a lightening anesthetic; movement. And 2) A lesser reason is that paralysis may be more needed for patients who are not tolerating larger doses of anesthetic. (Peter M. Lucas, MD, Anesthesiologist)

Awareness is more common in trauma patients undergoing general anesthesia for this reason. The drugs used for general anesthesia depress the cardiovascular system. This means that patients who have lost blood (as well as certain other groups of patients) will often have a dangerous decrease in blood pressure when a "full" dose of anesthetic is used. When this happens, the anesthesiologist makes the decision that a risk of awareness is preferable to a risk of organ failure and/or death and therefore reduces the anesthetic. Of course, efforts are made to restore blood volume all the while. But the emergency nature of the surgery often requires that surgery and anesthesia begin before blood volume can be restored. (Peter M. Lucas, MD, Anesthesiologist)

And any coment on BIS monitors and others?

The BIS monitor is controversial. "BIS" is a term for the Bispectral Index which is a proprietary device made and marketed by the company Aspect. It is a 3 or 4 lead EEG (Electroencephalogram) placed on the forehead that is processed via a small machine and gives a number between 0-100 based on that EEG. 100 is fully awake and 0 is no brain activity. The company claims that a number between 40-60 indicates adequate anesthesia to prevent awareness and overdose. The company has not revealed how they process this number but it is presumed to be some form of pattern matching based on controlls. It has been shown to be effective, but the downsides are notable. The monitor is highly subject to electrical interference and muscle movement such that is has been shown to show adequate anesthesia in awake, but paralyzed volunteers. It clearly has the potential to prevent awareness but it has been hypothesized that it may also increase the risk in others. For example, imagine your Anesthesiologist is trying to raise a BIS value from 20 to 50, by lightening the anesthetic. This could, especially with the limitations noted above, result in a patient being lightened to a level of awareness when, if the Anesthesiologist had not used it at all, he or she would never have lighted the anesthetic otherwise. The main source of controversy, though, lies with the marketing of the device. This BIS monitor is marketed not so much to the Anesthesiologist who might use it, but to the general public by sponsoring frequent stories in the media about the horrors of awareness and making sure your Anesthesiologist is using the BIS monitor. These scare stories always seem to occur during the annual American Society of Anesthesiologists conference. Hmmm... It has also not been shown to be cost-effective to use. (Anesthesiologist,MD)

High risk subjects may benefit the most from the use of brain monitors. Dig into Doctor Evidence's Brain Montor web sites, which are dynamic databases built on data from all published studies available. Quick notes: BIS shows best evidence for decreasing the rate of intraoperative awareness in high risk patietns, the BIS monitor has the most scientific evidence backing up its claims, and the incidence of intraoperative awareness is much higher than most anesthesiologists would like you to believe: Doctor Evidence Brain Monitor Database Doctor Evidence Intraoperative Awareness Database —Preceding unsigned comment added by 72.67.175.104 (talk) 05:21, 7 May 2008 (UTC)

I'm removing a number of the bolded sections and scare quotes. They read as advice or commands to anesthesiologists or victim advocacy, and there are much better fora available. —Preceding unsigned comment added by Ggrzw (talk • contribs) 01:28, 31 May 2009 (UTC)

Spelling

I note that there has been some disagreement about the spelling of "an(a)esthetist", ending up with both terms being used in different parts of the article. I have changed them all to the American spelling, for two reasons:

1) The title is "Anesthesia awareness" not "Anaesthesia awareness"

2) The Manual of Style states: "If no such words can be agreed upon, and there is no strong tie to a specific dialect, the dialect of the first significant contributor (not a stub) should be used." We may disagree about who the first significant contributor was, but certainly (IMO) the majority of the article used the American spelling.

All the best.Mmoneypenny 21:47, 4 October 2006 (UTC)

I strongly disagree! I have contributed significant sections of this article (over 50% of the entire text as it stands), and Wikified it considerably. I use British spellings, but I leave American spellings alone because I respect those who use them. I expect that same respect in return. Preacherdoc 21:21, 5 October 2006 (UTC)

From my talk pages, User:Mmoneypenny wrote: "Thanks for your message about the above. I don't know if you saw my comment on the anesthetic awareness talk page, regarding the reasoning behind the changes. They were: a) The article is called anesthetic awareness. b) The first major contributions used "anesthesia" and, finally, before I changed the spelling, there were 39 spellings of anesthetist/anesthesiologist/anesthetic as opposed to 31 spellings of anaesthetist/anaesthetic.

From the manual of style:

Articles should use the same dialect throughout...

If no such words can be agreed upon, and there is no strong tie to a specific dialect, the dialect of the first significant contributor (not a stub) should be used...

IMO the article is confusing switching (between anaesthetist and anesthetist) and I am following the manual of style guidelines by: a)using the same spelling throughout and b)the one used by the first major contributor (and changing the spelling to the one used most commonly)

I am therefore reverting your changes in the interest of consistency but am more than happy to bring this to Wikipedia:Third opinion. Finally, I too am British and prefer anaesthetic/foetus/encyclopaedia (or even anǣsthetic?) and am doing this entirely out of a wish to be consistent. I am also doing my best not to be a dick, so am more than happy to have a discussion.

PS. Can we hold any further discussion on the anesthesia awareness talk page? All the best.Mmoneypenny 21:48, 6 October 2006 (UTC)"

I still don't agree, but life is too short to argue this any further.

I don't think it is confusing to see both "anaesthesia" and "anesthesia" in the same article. I think any reader could easily understand both. It is certainly untidy, but no more than that. Preacherdoc 10:41, 7 October 2006 (UTC)

I think there should be redirects. Anæsthesia awareness, anæsthetic awareness, anaesthetic awareness, anesthetic awareness, unintended intraoperative awareness and unintended intra-operative awareness should all re-direct to this article. 69.140.164.142 05:34, 11 April 2007 (UTC)

Xenon?

How does xenon work as an anæsthetic? 69.140.164.142 05:31, 11 April 2007 (UTC)

Anesthesia awareness and lethal injection

It seems to me that there ought to be some mention here of the controversy over the possibility of anesthesia awareness during executions by lethal injection. Note that there is already a section in that article discussing the issue. I realize some might object to including this topic here because of medical ethics considerations, but it should be possible to talk about the controversy in an NPOV fashion. Comments? Richwales (talk) 01:23, 19 November 2007 (UTC)

In my understanding of judicial execution by lethal injection, as practised in the United States, the dose of thiopental administered, being far higher than would be required to produce general anaesthesia, is sufficient to ensure that the subject has no awareness of their own death. There is no evidence to either support or refute this view. (I do not know which protocols for judicial execution are applied in other countries beside the United States).

In my opinion, those who oppose judicial execution are looking for any potential point of criticism, and anaesthesia awareness is one such point. I wrote a significant portion of the text dealing with anaesthesia awareness in the lethal injection article.

I think it is reasonable to mention that the possibility of awareness has been raised by some critics of lethal injection, although I don't think it warrants more than a line or two in this particular article, since it is so comprehensively dealth with in the lethal injection article.

It is appropriate to point out that I object to the death penalty, and in particular to the use of anaesthetic agents for this purpose. Preacherdoc (talk) 13:03, 19 November 2007 (UTC)

Rate

"The incidence of anesthesia awareness in the United States is believed to be 20,000 to 40,000 cases per year, which represents 0.1 percent and 0.2 percent of all patients undergoing general anesthesia.[2]"

The link just takes me to a toplevel page, so I can't verify this. But is that really true? It seems quite high. If 20,000-40,000 is 0.1%-0.2% of all general anesthesia, then there are (ballpark) 20 million general anesthesia surgeries in the US per year -- that's close to 10% of the population. Do I live a sheltered life, or do people really average one general anesthesia surgery per decade? —Preceding unsigned comment added by 204.16.43.198 (talk) 19:24, 17 December 2007 (UTC)

this needs to be corrected, in my opinion. Twipley (talk) 16:47, 19 April 2009 (UTC)

I removed it as the other rate in the article is all I can find, and the ref is gone so no way to confirm. Fuzbaby (talk) 03:20, 18 June 2009 (UTC)

The given ref info was enough to find the actual article (jcaho was just a reprint). Here's the full cite: "The Incidence of Awareness During Anesthesia: A Multicenter United States Study". Anesth Analg. 99: 833–839. 2004. doi:10.1213/01.ANE.0000130261.90896.6C. PMID 15333419. {{cite journal}}: Cite uses deprecated parameter |authors= (help) Free abstract does support the given percentage and that thre really are that many uses of anesthesia annually. DMacks (talk) 03:31, 18 June 2009 (UTC)

You are right, I accessed the full article from my work subscription and they report a rate of .13%, or .0013. This was defined as memory that was from the operative period, such as recall of music playing or of pieces of conversation, there were no incidences of what most people would worry of like a type of 'locked in syndrome'. I will add this to the article.Fuzbaby (talk) 13:45, 18 June 2009 (UTC)

Looks good! DMacks (talk) 16:34, 18 June 2009 (UTC)

Quibble re wording

QUOTING the article, Outcomes section: "Some patients experience posttraumatic stress disorder (PTSD), leading to long-lasting after-effects such as nightmares, night terrors, flashbacks, insomnia, and in some cases even suicide."

It seems to me that describing suicide as an after-effect downplays its seriousness. Wanderer57 (talk) 17:18, 20 March 2008 (UTC)

Locked-in syndrome?

Does anyone else think a link to the locked-in syndrome article in See Also might be appropriate? It seems like a variation on the same type of situation (physically paralyzed while more or less conscious). I have mentioned this on the locked-in syndrome talk page too. 128.135.121.235 (talk) 21:44, 26 May 2009 (UTC)

Nope. Locked In Syndrome is due to sodium deficiency and rapid replenishment that damages neurons, not desensitizing many, many, many, many, many centers of the brain, which THIS is about. Your supposition is assuming that a splinter in the thumb is the same as a fracture of said thumb's bones.Wzrd1 (talk) 03:52, 1 November 2011 (UTC)

Has not had enough analgesic?

The first paragraph has a part stating that this could be caused by too little analgesic. Analgesic refers to the substance's ability to remove pain. A more appropriate term may be amnesic, as this would have more impact on the patient's ability to percieve what is happening (or remember) during a procedure. Rmosler | ● 13:17, 30 July 2009 (UTC)

Quite accurate. I had surgery and awakened during surgery, whist in a hypnotic state, as I had a spinal block. I had actually asked the surgeon for a mirror to watch, when he reacted and demanded more hypnotics, which he did relate after surgery. My wife was conscious for her C-section, going under with a migraine, relating the discussion accurately, of the personnel in the OR about the current sports game score. The surgeon noticing a differential between her BP/HR and tears being produced (perhaps micro-movements too?) and demanded proper sedation, upon which she coded and recovered. No mention was made until I noticed the electrode burns and ground point burns. My wife produced their conversation, which shocked all personnel concerned.Wzrd1 (talk) 03:57, 1 November 2011 (UTC)

Incidence paragraph

"Anesthesia equipment should always be checked prior to use but because of haste this does not always happen. Prompt inspection of the anesthesia equipment and record after a patient reports awareness must be done immediately and may help prevent future occurrences unless it was caused by human error (as it usually is). All drugs used and empty syringes must be carefully examined and tested because drug errors cause a high percentage of awareness cases. It is also important that a case of suspected awareness be communicated to the patient's healthcare team immediately, and that the event be scrutinized closely by senior anesthetic medical staff." The preceding paragraph seems to have been inserted without reference and sounds more like an instruction manual. "But because of haste" is far too much of a generalisation. Citation needed. —Preceding unsigned comment added by 114.74.194.139 (talk) 14:48, 6 May 2011 (UTC)

In spite of my personal experience and my wife's personal and verified experiences, I fully agree. No reference, it should be deleted, as it is OR or pure opinion, not based upon verifiable sources. Such things belong with flying saucer references that have no verifiable sources. And Marvin the Martian documentation for US citizenship.  ;) Wzrd1 (talk) 04:00, 1 November 2011 (UTC)

I'll disagree with the category

Frankly, this is NOT a low importance article, nor is it "Did you know". Being awake, aware and oriented times three is a REAL big deal for the person who experiences surgery whilst in that condition! One suspects some AMA type of CYA action going on, which is NOT what medicine should be about! Either one CAN trust a medical professional or not. Said persons should choose their battles carefully, as the result could become a disaster. The placement of the article smacks of OR on the part of professionals attempting to limit damage, rather than place a topic of significant concern into its proper place. Perhaps said professionals would like a muscular block whist I hang, draw and quarter them? Didn't think so, neither would I want such a thing. Consider your audience carefully AND consider the harm caused the patient mentally, which is equal to physically.Wzrd1 (talk) 04:10, 1 November 2011 (UTC)

Background

The tone of this seems a little accusative and less than neutral. That is why I have put the neutrality marker on it Martyn Smith (talk) 00:27, 3 February 2012 (UTC)

Infants?

There's no mention of the fact that up until the 1980's babies were only paralysed, without anaesthetic, during major surgery. This became public knowledge in 1985:

Jill Lawson reported that her premature Baby, Jeffrey, had holes cut in both sides of his neck, another in his right chest, an incision from his breastbone around to his backbone, his ribs pried apart, and an extra artery near his heart tied off. Another hole was cut in his left side for a chest tube, all of this while he was awake but paralyzed! The anesthesiologist who presided said, "It has never been shown that premature babies have pain.

Ssscienccce (talk) 12:33, 22 July 2012 (UTC)

Section 3: No citation needed?

Just an opinion from a complete layman: In my opinion the first sentence in section 3, "The experience of anesthesia awareness", which proposes (quote) that "The most traumatic case of anesthesia awareness is full consciousness during surgery with pain and explicit recall of intraoperative events.[citation needed]" does not need a citation. The first and second Wiki entry phrases in "Psychological trauma" read as follows: "Psychological trauma is a type of damage to the psyche that occurs as a result of a severely distressing event. A traumatic event involves a single experience, or an enduring or repeating event or events, that completely overwhelm the individual's ability to cope or integrate the ideas and emotions involved with that experience." Although not explicitly stated that the more subjectively distressing the triggering event is, the more traumatized the patient is likely to become, to my knowledge the assertion is nevertheless true (statistically speaking). Cause/effect between the stress level and the ensuing trauma is such a tacitly accepted fact that I doubt it has been studied (I tried to find bibliography on the subject, to no avail). Therefore, since the sentence is more than likely to be accurate, even if a citation would be welcome it is by no means necessary.
Jordissim (talk) 23:57, 29 May 2013 (UTC)

Opinion or fact, based on what evidence?

In other words who and what can we trust and why? Somebody added this: 'Post operative interview by an anthestist is common practice to elucidate if awareness occurred in the case. If awareness is reported a case review is immediately performed to identify machine, medication, or operator error.' But offered no citation so should it be deleted or can I add my opinion (fact but can't prove it) too? In the UK this has never happened to me or anyone I know - neither interview post-op nor a case review, if this happens elsewhere (always or sometimes?) please send evidence. No point citation because things stated in published documents are not always the truth and we can put p any untrue nonsense online we like, many do. Apparently opinion is not allowed here, what is required for opinion informed by experience (of self and many others) to become fact?Truthdoctorknows (talk) 21:42, 6 September 2013 (UTC)

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