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The Fear of Anesthesia Awareness: How many people have ever woken up during surgery?
For many people, pre-surgery anxiety is often accompanied by worries about anesthesia. Anesthetic awareness, or intraoperative awareness, is a rare complication in which patients wake up under general anesthesia and are sometimes able to vividly remember events during the procedure. Although the incidence of this condition is rare, the psychological impact can be devastating. According to research, the incidence of intraoperative consciousness is approximately 0.1–0.2%. So, how many patients are aware of their surroundings during surgery?
Patient-reported experiences during surgery can vary widely, from a hazy dreamlike state to wide awake and experiencing surgical pain.
The experience of consciousness during surgery
The situation of consciousness during surgery varies. Some patients report vague, dreamlike experiences, while others can clearly remember specific events during the procedure, such as: hearing noises or conversations in the operating room, remembering details of the procedure, feeling the endotracheal tube, or Pain during surgery, feelings of helplessness and anxiety.
According to the report, about 35% of patients were able to report conscious events immediately after surgery, while the remaining patients took weeks or months to recall.
Causes of consciousness during surgery
1. Use of paralytics and muscle relaxants
Muscle relaxants, such as succinates, are often used during anesthesia and are one of the greatest risk factors for intraoperative consciousness. These drugs relax the patient's muscles but do not cause loss of consciousness.
2. Light anesthesia
In some cases, the anesthesiologist may choose to use a relatively light anesthesia, which helps stabilize the patient but also increases the risk of consciousness during the operation.
3. Anesthesiologist’s Error
For example, repeated intubation causing the anesthesia to wear off but the muscle relaxant to remain in the body are errors that may lead to intraoperative awareness.
4. Equipment failure
Faulty or misuse of anesthesia equipment may also result in insufficient anesthetic supply and the patient may become aware of his or her surroundings.
Potential consequences
The psychological consequences of intraoperative awareness can be serious. Many patients who experience consciousness develop post-traumatic stress disorder (PTSD) after surgery, which is characterized by repetitive anxiety, irritation, nightmares, fearful memories, avoidance-related triggers, and sleep disturbances.
Even if there are no obvious memories after surgery, in some patients subconscious trauma may surface over time.
Prevention of awareness during surgery
To reduce the risk of intraoperative consciousness, unnecessary use of muscle relaxants should be avoided, drugs, doses, and equipment should be carefully checked, and monitoring should be strengthened. In recent years, a number of consciousness-monitoring devices have appeared on the market, which typically monitor brain waves to assess a patient's depth of anesthesia.
Current status of academic research
Research and investigation on anesthesia consciousness are currently ongoing, and the medical community is also constantly improving methods to reduce the occurrence of intraoperative consciousness. However, the challenge of getting the depth of anesthesia just right remains.
When intraoperative awareness unfortunately occurs, the medical team must quickly recognize and take action to help the patient regain mental health. So, how can we reduce the risk of intraoperative awareness while protecting patient safety?
