Sponsored by
Waking up to a nightmare: patients who come round on the operating table
In a list of worst nightmares, waking up in the middle of an operation is right up there with being buried alive.
Stories of the those who have felt the surgeon's knife while unable to move a muscle have sent shivers down even the most hardened spines and perhaps the only surprise the phenomenon has been seized upon by a film studio is that it has taken so long.
Awake opens in the UK tomorrow and while it has been made with a large helping of artistic licence and a big brush of Hollywood gloss – Hayden Christensen's character is out for the count for only a matter of seconds before he awakes to hear details of plot to murder him – the real life cases are no less traumatic.
"It's really important that we take a balanced view. The last thing anyone wants is for people to cancel life-saving surgery because of the fear they may wake in the middle of the operation," says Professor Michael Wang, who has spent the last two decades working with patients who have woken up during surgery.
"Usually, people wake up when the operation is well advanced and often only for a couple of minutes. Having said that, it can seem like an eternity and for some the resulting trauma has life-long effects. We estimate that around one in 600 patients will experience some kind of awareness, which is why we need an honest and open debate about it."
Open heart surgery and emergency operations on those admitted through accident and emergency departments both come with an increased risk of the patient waking and while exact figures are difficult to obtain, current evidence suggests women are more likely to wake than men.
Anaesthesia is a delicate balance of a variety of drugs and problems occur when insufficient amounts of drugs which induce unconsciousness are combined with the right levels of muscle relaxants, leaving the patient aware, but paralysed.
"I have a huge respect for anaesthetists," says Prof Wang, who began his research at the University of Hull before moving to the University of Leicester two years ago. "It's a profession which often finds
itself overshadowed by surgeons, but they do a fantastic and incredibly complex job of keeping people alive.
"Let's not forget too much anaesthesia can also be a dangerous thing, stopping the patient from breathing and there are so many outside factors, such as whether someone drinks a lot of alcohol, which affect the levels needed to be administered."
Those who have woken during procedures have likened the pain they felt to torture and have talked of the terrifying frustration at no one being able to hear their screams. However, there are an unknown number who never confront what happened to them.
"There are those who lie there thinking, 'No one is going to believe me, I better listen to what people say' and when they finally come round fully from the anaesthetic have a detailed account of what went on.
"However, there are also those who react by trying to bury what happened in the back of their minds and that can have just as devastating long-term effects. Everyone is different, but it can trigger depression, intense anxiety and other psychological problems and even for those who don't experience pain, the feeling or paralysis can be just as distressing.
"Some believe their spinal cord has been cut and they are going to be paralysed for life, while others believe they are experiencing the last few moments before death, or are quite literally in hell. They experience flashbacks, sometimes several times a day, they can smell the operating theatre, hear the sounds and feel the pain. They may have nightmares, panic attacks and phobias. Most do improve after a few months, but some will suffer from a particularly severe form of post-traumatic stress disorder and a lifetime of problems."
Cases where previously active individuals end up dependent on anti-depressants, housebound and living on benefits are extreme, but do exist and the wealth of case histories provides compelling evidence that awareness during operations is neither a figment of patients' imaginations nor a peculiar rarity.
However, while the Royal College of Anaesthetics broadly agrees with Prof Wang's estimate of one in 600 patients, individually many anaesthetists, convinced by their own personal experience, believe it to be much lower.
"Anaesthetists are taught to identify wakefulness by looking at heart and blood pressures rates, monitoring sweating and tear production," says Prof Wang. "These are highly skilled individuals who understandably think that if a patient was experiencing problems, they would be the first to know.
"However, there are no reliable clinical signs. For example a woman from Hull was definitely aware when she underwent a hysterectomy, but the clinical records of the operation showed no evidence of any change in her heart rate or blood pressure."
Prof Wang and his colleague Dr Ian Russell, a consultant anaesthetist at Hull Royal Infirmary, believe the way to allay patients' very real fears is far from rocket science.
For some years the pair have been trying to promote the isolated forearm technique, which involves tying a tourniquet around the arm before the muscle relaxant is administered. Put simply, if the patient does wake they would still be able to move their arm and so attract the attention of the anaesthetist. However, much of the medical profession has been resistant to suggestions of changing long-held practices.
"There have been various studies where anaesthetists have been asked how common they think awareness is, and they say one in 5,000 or one in 10,000 patients," says Prof Wang.
"It's a complete misapprehension, but it is part of the reason many don't think anything needs to be done. I try to remain optimistic that we are slowly breaking down barriers, but there are times when I can't help feeling slightly frustrated."
For all the painstaking research Prof Wang and Dr Russell have done in university laboratories, Awake may just give their work a shot in the arm.
While the film is unlikely to win any Oscars – one reviewer claimed Christensen was at his most compelling while lying inert on the operating table – when it opened in America there was a documented rise in the number of patients questioning anaesthetists about the risks.
"Patients shouldn't be afraid of having a conversation with their anaesthetist," adds Prof Wang. "If you are particularly anxious, or consume quite a lot of alcohol or use tranquillisers you should make sure they are aware as you will need a higher dose. I think anaesthetists should also be much more open about the effects of muscle relaxants, so if people do wake up, they will know the paralysis isn't permanent.
"The vast majority of people will experience no problems in the operating theatre, but we all need to recognise the potential problems."
'IT WAS LIKE BEING TORTURED...'
When Sally Pearson, right, underwent an emergency caesarean during the birth of her son 20 years ago, the tube providing nitrous oxide gas became disconnected. Unfortunately the anaesthetist didn't notice and Sally was totally aware of what was happening during the entire operation.
As the surgeon's knife sliced across her stomach, she tried to scream, but was unable to attract attention. She remained conscious throughout the delivery until the wound was stapled together, at which point the anaesthetist realised what had happened and connected the anaesthetic gas again.
"The first thing I was aware of were the voices of the medical team. I though I was dreaming, but then I felt the knife cut across my stomach. The pain was terrible. It was like being tortured.
"I tried to jump off the table, but I could not move a muscle. It was like one of those dreams where something terrible is going to happen to you an you cannot get out of the way."
Sally and her husband David were told it was a "very rare event" and when the hospital admitted mistakes had been made, the couple decided not to take legal action. However, after reading about other cases where the medical profession had been less than supportive, she decided to launch the UK arm of the Anaesthesia Awareness Campaign.
For more information and support, visit www. anaestheticawareness.net
Email to a friend
Print this page- Leeds lose Ward to Palace: Is there anyone they can afford now?
- Sheffield Wednesday leaving it late to hijack Leeds United over Ward
- As Snodgrass dithers over Leeds, Warnock throws a lifeline
- Ball is in Leeds United’s court over contract - Snodgrass
- Police turning blind eye to Asian voter fraud, says MP
Looking for...
Featured advertisers
Jobs
Search for a job
Motors
Search for a car
Property
Search for a house
Weather for Yorkshire
Saturday 26 May 2012
Today
Sunny
Temperature: 9 C to 21 C
Wind Speed: 17 mph
Wind direction: East
Tomorrow
Sunny
Temperature: 9 C to 22 C
Wind Speed: 13 mph
Wind direction: East
