"When I talk to anesthesia providers, they say, 'It's just a bad hour' or 'They didn't feel pain,' " said Wise. "They're not appreciating the potential for long-term psychological damage."
Leaders of the American Association of Nurse Anesthetists (AANA) tend to view the problem differently. In 2002, the group published "Silenced Screams," a graphic account by patient advocate Jeanette M. Liska of her 1990 abdominal surgery.
Jodie Stanley awoke from anesthesia during an operation on her right hand.
(Steve Gates - For The Washington Post)
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_____From The Post_____
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It Knows When You're Awake (The Washington Post, Nov 23, 2004)
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Robert Wise, M.D., vice president at the Joint Commission on Accreditation of Healthcare Organizations, was online to discuss patients who wake up during surgery.
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Tom L. McKibban, immediate past president of the AANA, said he considers intraoperative awareness to be "a patient safety issue." The JCAHO alert "has everyone's attention, and that's a good thing."
Paralyzed, Traumatized
For patients, waking up during surgery can be shattering.
Victims of the worst cases compare it to torture. Sebel's study found that about half of awareness patients report that they cannot breathe, usually because they are intubated. Some people reported that they thought an accident during surgery had left them paralyzed.
Some patients are so traumatized that they avoid doctors entirely and vow never to undergo surgery again, psychiatrists say. Others suffer from flashbacks and panic attacks triggered by the smell of rubbing alcohol, the sound of metal on metal, which reminds them of surgical instruments, or the sight of surgical scrubs on a TV show.
"This struck me as the most virulent form of trauma I have ever seen -- even worse than rape," said Bessel A. van der Kolk, a professor of psychiatry at Boston University School of Medicine and a PTSD expert who co-authored a study of awareness patients.
A chief reason, he said, is "the paralysis and total helplessness, the fact that people are doing things to you in an environment in which you're supposed to be safe . . . and patients overhear nasty comments." In her book, Liska described hearing her surgeon make comments about her breasts while enduring pain that she said felt "like a blowtorch."
Anesthesia awareness has multiple causes, studies have found. Sometimes it is the result of defective equipment or physician error, such as failure to accurately calculate the dose of a drug or to check whether a machine is working properly before surgery starts. Other cases occur when anesthesia is lightened too early at the end of a case "to facilitate operating room turnover," according to JCAHO, or when an intentionally light dose is given to a cardiac or trauma patient for fear that too much anesthetic could be dangerous, even fatal.
Robert J. West, an Austin lawyer who is representing Williams in the malpractice case he filed against his anesthesiologist, said he does not know why his client was under-anesthetized, "but his condition certainly had some role." Williams, who was undergoing surgery for a defective mitral valve, has congestive heart failure. In court papers the anesthesiologist denied Williams's allegations.
General anesthesia typically consists of three kinds of drugs: a paralytic to prevent movement; a hypnotic gas or intravenous drug that renders the patient unconscious and unable to remember what happened or to feel pain signals; and a painkiller.
