Awareness under anesthesia: the public freaks

[swpm]

It's even on Fark, so the unwashed masses are truly weighing in en masse ...

http://forums.fark.com/cgi/fark/comments.pl?IDLink=2731531&ok=1

There's a nice CRNA vs MD debate brewing though.

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[n2bait]

Hey did you check out this little nugget of advice?

It's in the comments, by Nobozo:

" Always ask if your anesthesiologist uses a bispectral brain wave monitor. (it beeps if you are concious)"



Is this guy a rep for the BIS?

It's even on Fark, so the unwashed masses are truly weighing in en masse ...

http://forums.fark.com/cgi/fark/comments.pl?IDLink=2731531&ok=1

There's a nice CRNA vs MD debate brewing though.

 

[swpm]

Hey did you check out this little nugget of advice?

It's in the comments, by Nobozo:

" Always ask if your anesthesiologist uses a bispectral brain wave monitor. (it beeps if you are concious)"



Is this guy a rep for the BIS?

Ugh.

I wonder how many of the hordes of people claiming recall in that thread were actually getting MAC with a spinal or some such kind of anesthetic, but were expecting to be asleep.

It's too bad there's a 24 hour delay between registering on Fark and being able to post.

 

[powermd]

Most, if not all of the anecdotes people are discussing relate to cases of conscious sedation where awareness and recall are expected. It pisses me off that so many anesthesia providers don't explicitly warn patients of this possibility. I ALWAYS explain to patients the difference between sedation and GA, and reassure them that we are pretty good and keeping people asleep for sedation, but it can't be guaranteed. Everyone here knows this, but patients need to understand it too.

Doing conscious sedation well for stimulating and/or uncomfortable procedures is an art that takes skill, experience, and balls. I use a variety of techniques and individualize it to the patient and procedure, and so far I've done really well. My favorites are prop/fent for endoscopy, ketofol for thyroids, porto-caths, simple I&Ds, and some painful cysto procedures, straight up prop for quick cystos, dexmetatomadine for ortho sedation in blocked patients, and prop/remi for AV fistulas. Ketofol seems to work especially well at keeping patients from moving during surgery. I haven't had any problems with emergence phenomena yet.

Sedation is as much fun for me as doing the big cases in sick patients. Surgeons often seem pleasantly surprised when you do it well. The patient is often very thankful too when they wake up feeling good, and not having remembered a thing.

 

[powermd]

(oops)

 

[jwk]

Check out the April ASA Newsletter. I can't believe they gave print space to the #1 for-profit awareness publicity hound.

http://www.asahq.org/Newsletters/2007/04-07/weihrer04_07.html

 

[huron]

It's even on Fark, so the unwashed masses are truly weighing in en masse ...

http://forums.fark.com/cgi/fark/comments.pl?IDLink=2731531&ok=1

There's a nice CRNA vs MD debate brewing though.

Just seen on CNN an awarness incident in WV. CNN claims awarness under anesthesia happens 200 times per day in the USA.

CNN was claiming the CRNA, Anesthesiogist team forgot to turn on the Vaporizer after induction.


Man Undergoes Surgery Without Proper Anesthesia and Commits Suicide as a Result
At;

http://www.associatedcontent.com/article/211557/man_undergoes_surgery_without_proper.html



Sherman Sizemore underwent exploratory surgery for abdominal pain and was not given anesthesia correctly; he felt extreme pain as they cut him open and performed the procedure. After two weeks of nightmares, unable to sleep, experiences of feeling like he was buried alive, extreme trauma and suicidal thoughts, he took his own life to get away from the suffering.

Anesthesia awareness is something that is not very well known but it is estimated that between 20,000-40,000 patients suffer from this medical mistake each year. They go through their surgical experience without proper anesthesia and as a result feel extreme amounts of pain, pulling, pressure but yet they cannot call out for help and are often unsure of what exactly is going on.

Sizemore was admitted to the hospital with stomach pains, which his family now says were a result of a gall bladder condition. Surgery started and he didn't receive anesthesia until 16 minutes after the first incision was made. He was awake during the procedure but not able to express his discomfort. He suffered extreme pain and was not sure if it was in his head or reality as he wasn't told at the time that he wasn't prepped properly for pain. He was given medication to control his muscle movements which resulted in temporarily paralyzing him during surgery. This was why he wasn't able to move and signal for help.

Sherman Sizemore was a 73 year old Baptist Minister from West Virginia. He also worked as a coal minor years ago. His daughters have filed a lawsuit against Raleigh Anesthesia Associates claiming they made errors in providing pain relief during the surgical procedure and didn't notify their father or the mistake.

As a result he suffered sever pain and trauma and was not even sure if his memories were real or part of his imagination. The incidence caused him to be unstable enough to shoot himself in the head only two weeks after being discharged from the hospital. Prior to the surgery, Sizemore did not have any mental or emotional problems that would cause him to become suicidal.

Studies show that problems similar to what happened during surgery for Sizemore occur in 0.1-.2% of procedures involving general anesthesia. While it sounds like a small number, the amount of patients who undergo surgery each year is high and those who suffer from anesthesia awareness often have psychological side effects as well.

 

[urgewrx]

I was told once that the OR of MGH was built far away from Harvard so that people wouldn't have to hear the screaming before the era of anesthesia. I guess there was no PTSD back then.

 

[urgewrx]

The author of that article is a pirate. Can you trust a pirate?

 

[huron]

The author of that article is a pirate. Can you trust a pirate?

That lady was on CNN she has her own web site to publicize awareness under anesthesia.


http://www.anesthesiaawareness.com/

from the web site;

The October 2005 ASA Advisory on Brain Activity Monitoring gives lip service to anesthesia awareness, but has no real teeth. Since the ASA Practice Advisory on Brain Activity Monitoring does not suggest, encourage, or mandate the availability of brain activity monitors in all hospitals, it would be difficult for those individual anesthesiologists "who choose to use monitoring on a case by case basis" to exercise that judgment if the hospital has no monitors available. This Campaign continues to encourage the ASA to strengthen the Practice Advisory by mandating the availability of brain adctivity monitors in all general anesthesia operating facilities.

 

[urgewrx]

http://www.anesthesiaawareness.com/

This too:
I am thrilled to share the news that through the generous support of friends of my father and his family, his immediate family, and Aspect Medical Systems, the Anesthesia Awareness Campaign is announcing the donation of six Bi-Spectral Index Monitors to Frederick Surgical Center in Frederick, Maryland.


Donation? What are they talking about? Seems odd to me. Aspect "loans" the BIS monitor for free. They just want you to buy the sensors. Same with Abbot, they'll "loan" you a vaporizer if you buy the Sevo from them.

 

[Planktonmd]

Aspect is an amazing company.
They were able to use what works most : Drama!
The only problem is that they are simply lying to the public, but they will get away with it, actually they already did.
They even managed to get many hungry university guys to go on national TV and openly say: If you don't use BIS then you are not giving good anesthesia.

Where is this heading?
BIS will become the standard of care out of fear of law suits, and all of you are going to have to use it and pay Aspect every time you give anesthesia.
Mark my word.

You have to remember, this is the same public that was programmed since childhood to respond to advertising, and to believe everything they say on TV. If it's on TV then it must be true!

 

[Mman]

My favorite day with the BIS was in an unparalyzed patient under GA with an ET Sevo of 2.4% and the BIS was reading 98. This was about 30 minutes into some random procedure and the patient had 2 of Midaz and maybe 150 of Fentanyl up front and was not moving.

I was so frustrated with the damn thing that I took it off and threw it in the trash and charted that the BIS monitor was malfunctioning.

I will say that I slap it on a decent proportion of patients and just consider it another piece of information. Sometimes it works well, sometimes it doesn't. When it doesn't I just have to figure out exactly what sort of BIS numbers I am going to tolerate. For example, if the patient appears appropriately anesthetized from a chemical perspective (MAC + opioids etc) and HR/BP are appropriate, what do I do with a BIS number hanging in the 60s when they say target is 40-60? Ignore it? Crank up the gas a bit more if their BP tolerates and see if I can get the BIS into the high 50s? Conversely, if the patient is on 0.5 MAC of gas and the BIS is in the 30s, am I comfortable turning the gas even lower in a paralyzed patient? Depends.