Anesthesia awareness is perhaps the most helpless and terrifying
feeling in the world. It occurs when one is supposed to be completely
asleep under general anesthesia, but the brain is not asleep. The body
is usually paralyzed, and movement of any sort is absolutely
impossible. There is a tube down your throat, so you can't speak or
yell; in fact, you can't even breathe without mechanical help. If you
do manage to move, as I did, a common response from the anesthesia
provider is to administer more paralytic drug, never considering the
possibility of awareness. The paralytic drug burns like ignited fuel
flowing though your circulatory system. Anesthesia Awareness is
frequently likened to being "entombed in a corpse" or buried alive.
Inquire about what kinds of monitors will be used, and if any equipment
owned by the hospital is not routinely used (like brain activity
monitors). Specifically, find out about awareness monitors, such as
the BIS monitor or other monitors that measure level of consciousness.
Anesthesia Awareness is
slowly coming out of the closet, and I'm proud to say this Campaign has
played a large part in that! The anesthesia community usually avoids
talking about awareness, seldom includes its possibility in the
preoperative interview (also known as informed consent, where you will
always be told you can die, but are not informed about the possibility
of awareness), will almost always deny any possibility that one of
their patients may have experienced awareness, downplays the terror of
the event, and will always assure you that it can't/never will happen
to you.
Despite the fact that all of the media refer to the phenomonen as
"anesthesia awareness," and that is by far the most frequently used
term, the ASA has decided to rename it "unintended intraoperative
recall."
Your best defense is an active offense.
I am keenly aware that the mere ownership of brain activity monitors does not solve the problem of anesthesia awareness. I tell those with whom I speak that they must ask three questions:
1. Does your facility own brain activity monitors? They can't be used "at the individual practitioner's discretion" if there are none available!
2. Does your facility use brain activity monitors?
Having them doesn't guarantee their use. Many hospitals own them,
largely due to lawsuits, but never use them! I know; it's the case at
the hospital where my awareness occurred.
3. Will you your facility use brain activity monitors in my surgery?
Try to get this in writing, because the person who promises to use a monitor may not end up being your anesthesia provider.