Accidental Awareness During Surgery: Anaesthesiologist Speaks On The Dreaded, Rare Phenomenon

Can you remember those dreams which paralyse you to the extent of you not being able to open your eyes or move or scream? Accidental awareness feels somewhat like that, says anaesthesiologist Dr Kalra

Most of us would never like to remember what happened to us during major surgery. The attending surgeon also wants us to be as still as possible. Here, general anaesthesia comes into the picture, a drug that can put us in a sleep-like state before surgery. In many ways, the state is more than just asleep as one is not able to respond to pain or touch or move during the medical procedure. While the case stands true for the majority of patients, there are rare instances where the patient will become suddenly conscious in the middle of a surgery and might even remember what exactly happened to them under the knife. The rare and controversial phenomenon has a clinical name, it is called accidental awareness.

The phenomenon is a rare and serious complication of general anaesthesia. It is feared by patients and anaesthesiologists alike. The phenomenon is observed in only one or two out of every thousand medical procedures. While the patients usually don't feel pain, the experience of it can be very distressing. To understand the rare condition, Thehealthsite.com spoke to Dr Vandana Kalra, a senior anesthesiologist and ICU Head at Rainbow Hospital, in Agra.

Anaesthesia: Controlled pain, motion and memory

Anaesthesia is the name of treatment given using drugs called anaesthetics. The drugs are administered to save you from any pain and for smooth execution of the surgical procedure. On basis of types, the drug can be used to numb a part of the body or to make you completely unconscious. The kind of anaesthesia administered to you might be determined by the nature of the surgery to be performed. The expert explained that anaesthesia is often a combination of some drugs including those that kill pain, induce forgetfulness and muscle relaxants to limit motion. Dr Kalra explained that the right proportion of all the elements can never be compromised.

Unconsciousness under general anaesthesia is non-negotiable

When the surgery involves procedures on the head, abdomen, or chest, then, in these cases, you might be administered general anaesthesia that will make you completely unconscious. "As anaesthesiologists, we have to make sure that during a serious surgery, the patient ought to remain unconscious. Awareness can be traumatic for patients and can interfere with the medical procedure. Unconsciousness under general anaesthesia is non-negotiable. For any reason, if the patient remains aware during the procedure, it reflects bad practice on part of the anaesthesiologist," said Dr Kalra.

Awareness during surgery: A fearful scenario

Dr Kalra said that the occurrence of awareness under general awareness is rare but a fearful situation. The expert explained that if, under some condition, the patient remains aware under general anaesthesia, then the most unfortunate part is that they won't be able to do anything with this awareness. As per the expert, the patient won't be able to communicate to the attending surgeon that

they are aware of what is happening to them. The patient might remember something being inserted into their mouth or someone talking. The worst situation would be the inability to move or temporary paralysis under the influence of drugs. The expert explained that if the number of analgesics or painkillers is not adequate, the person might experience some pain. However, studies show that only 1 in 5 patients experience pain in accidental awareness.

Very rare but there might be reasons

Dr Kalra said that with the coming in of sophisticated instruments, the chances of accidental awareness during surgery might become bleaker. "As it is, it is a very rare occurrence and the chances of it occurring in the future are also unlikely. But, it doesn't mean that it doesn't occur," said Dr Kalra. The expert then explained some conditions under which such awareness can occur -

Wrong dosage- As per the expert, the situation is unpardonable if the dose proportion administered is inappropriate and if it results in the patient becoming aware under general anaesthesia. It reflects bad practice.

Compromised patient- Dr Kalra explained that sometimes the patient has co-morbidities and too many organs are at stake during the surgery. Under such circumstances, medical practitioners might have to limit the dose to prevent any complications.

Regular intake of opioids and alcohol- As per Dr Kalra, if the patient consumes narcotic drugs regularly or has been an alcohol addict, then, in some rare situations, the appropriate dosage of anaesthetics might not produce the desired effects on them due to low sensitivity towards the administered drug.

Absence of reviving instruments- Dr Kalra explained that a key component of anaesthetic administration is to revive the patient back to consciousness. The expert said that in regions or hospitals where life-saving instruments like ventilators are not easily available, then the practitioner in rare situations might like to lower the risk of complications by administering a low dosage.

Why patients might not be able to communicate to the surgeon

As per Dr Kalra, if a patient becomes accidentally aware during the surgery, then he or she might not be able to communicate it to the attending surgeon. The expert explained that they might feel completely immobile but aware at the same time. "Some communication is made through fluctuating parameters like changes in blood pressure, breathing rate or saturation but it would be hard for the surgeon to differentiate if the fluctuation is caused by the sudden awareness of the patient or some internal complication. Some sophisticated machines can send a message but these machines are not that easily accessible," said Dr Kalra.

Stories have been written

Some reports in the past have narrated the rare experiences of patients living through rare, distressing situations. As per reports, these patients have suffered through extreme helplessness at that moment with not being able to move or scream. Studies have also shown that not all patients who experienced

awareness during surgery can remember all the details and some might even forget under the influence of drugs that induce forgetfulness. Nevertheless, for these rare patients, the trauma remains. In her last word, Dr Kalra said: "Whatever limitations a doctor might face during surgery, they should make sure that the patient remains unconscious for the period. The trauma is real for those who have to go through it accidentally."