It is every patient’s worst nightmare: that the anaesthetic won’t work… And now a review suggests that bad dreams can come true, after one leading expert found that incidences of so-called “accidental awareness” are far higher than was previously thought.
Professor Jaideep Pandit, a consultant anaesthetist and fellow of St John’s College, Oxford, has warned that the number of patients who are “dimly” conscious – for which read that they can feel that blade and see all the blood – could be very high. That’s the bad news. But tomophobes (people with an extreme fear of surgery) can take heart from the suggestion that being vaguely conscious isn’t necessarily a disaster.
It’s possible that some patients are floating in a “third state of consciousness”, dubbed “dysanaesthesia”, in which they have some awareness of the world around them, but feel no pain or distress. Or so Professor Pandit believes.
He came up with his theory after reviewing existing evidence that found large differences between the number of patients who, when asked, recall awareness while under anaesthetic, and those who report awareness without being asked.
National data released earlier this year, based on an audit for the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, showed that only one in 15,000 patients had told their doctor that they recalled something while under general anaesthetic; of those, only a third reported any distress. But on closer questioning a much higher number, one in 500, gave an answer that suggested they were dimly aware of something happening after being given an anaesthetic, instead of being out for the count.
“The difference between the incidence of 1:500 and 1:15,000 suggests that even in the rare instances where patients are experiencing awareness, in most cases the sensation is a ‘neutral’ one. What we are possibly seeing is a third state of consciousness – dysanaesthesia – in which the patient is certainly aware of events, but not concerned by this knowledge, especially as they are not in pain.”
A recent study in which 34 surgical patients were anaesthetised and had their whole body paralysed apart from one forearm reinforces this theory. The patients were asked to move their fingers, which a third were able to do. But intriguingly, none of the patients moved their fingers without being asked to.
Read More: Here