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Awareness (not that kind of Awareness) and Anesthesia

March 20, 2009

Awareness and Anesthesia
To arrive at the ideal anesthetic, we need to understand more
about how anesthesia works and how people consent to have anesthesia.
Some types of surgical procedures can and should be accomplished using a
technique called conscious sedation, with monitored anesthesia care. Some
awareness is intended and expected during conscious sedation, so patients
need to be educated and consent to undergo that type of surgery and
anesthesia if indicated. In my experience, many people do not understand
the difference between conscious sedation and general anesthesia when it is
explained before surgery, nor do they remember the discussion after surgery.
Awareness while under the influence of general anesthesia is very rare. It is a
potential complication of general anesthesia.
The awareness during general anesthesia portrayed in the Hollywood
thriller Awake reveals a frightening medical issue. In reality, this unintended
situation could be due to numerous types of problems resulting from
mechanical failure or human error. It is challenging to accurately analyze
questionnaire and interview data in order to differentiate unconscious
memory formation, dreaming, and drug-induced hallucinations from actual
inappropriate awareness under general anesthesia. Studies determining the
statistical incidence of these events vary significantly. The posttraumatic stress
syndrome (PTSS ) that may develop as a result of a medical sentinel event
such as awareness under general anesthesia requires specialized intervention.
Anyone experiencing an awareness event can obtain help from special interest
groups that can provide support, such as the Anesthesia Awareness Campaign
founded by Carol Weihrer, and obtain appropriate referral to qualified mental
health care professionals.
Theories of anesthesia have been changing over the years to adapt to new
molecular knowledge and understanding, but there is still a gap, especially
relating to anesthetizing the conscious mind and the unconscious mind.
The conscious and unconscious minds have properties yet to be revealed.
Various kinds of learning and memory occur while under general anesthesia.
Until there are pure anesthetic agents whose effective depths can be measured
faithfully with monitors better than bispectral analysis, in order to guarantee
that each and every anesthetized patient does not experience unintended
awareness during surgery, there is no ideal agent or monitor or mechanical
fail-safe. Increasing patients’ overall educational awareness about the events
surrounding surgery pertaining to anesthesia improves patient satisfaction
and surgical outcomes. Providing the satisfactory service of patient safety and
comfort is the goal of every anesthesiologist.

From the book The Sweet Smell of Success, Health and Wealth Secrets by Dr Geiger

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