Latest research* has found that more than 150 people a year are consciously aware of what is happening to them on the operating table. There are 3 million surgical procedures a year requiring general anaesthetic so, thankfully, it is a rare phenomenon. Indeed, because of continuing advancements and a focus on tightening up procedures, incidences are becoming even more infrequent with these figures a significant improvement on previous studies where 1 in 15,000 patients were reported to have experienced anaesthetic awareness.
For most people, it is a brief episode of awareness – usually at either the beginning of the procedure during the administration of anaesthetic drugs or when coming round – and they suffer no long-term consequences. However, for nearly a third, they are aware throughout the duration of the operation and, in up to two fifths of cases, this leaves them severely distressed and can cause them serious psychological damage.
Awake and paralysed
This is usually when the patient has been given muscle relaxant drugs, in addition to the anaesthesia, in order to paralyse them. The problem occurs that, if they do wake up during the operation, they are then unable to move or speak and so can’t alert the doctors or anaesthetists to the fact that they are aware of pain and everything going on around them. They may have difficulty breathing and feel as though they are suffocating but are unable to do anything about it.
Patients have described this helplessness as feeling like they are being tortured or buried alive and it is common for people in this situation to suffer from Post Traumatic Stress Disorder.
Why does anaesthetic awareness happen?
Usually, this happens when someone hasn’t been given enough anaesthetic or analgesic to make them unconscious. This can be for a number of reasons: the patient could be extremely poorly or weak – especially if there are cardiac problems – and so light anaesthesia is used. Or, in the cases of Caesarean section, the anaesthetist needs to balance the needs of the mother and the baby to make sure that the baby is kept awake and to help the mother participate in the birth.
As a patient under anaesthetic needs help to breathe, sometimes awareness can occur because of difficulties in intubating them at the start of the operation. Or there can be an interruption in the delivery of the drugs during transfer into theatre. Notably, women are more resistant than men to anaesthetics and report more instances of awareness. In addition, those who are obese have a greater chance of waking up during surgery, as are those with a high tolerance to drugs or who are on medication that can interact with the anaesthetic.
When could it be classed as medical negligence?
In some cases, it is through the inexperience or inadequate technique of the anaesthetist; occasionally, equipment malfunctions or there is inadequate monitoring. These are instances where there may be a claim of medical negligence.
At Gadsby Wicks, we have successfully handled compensation claims for patients who have suffered anaesthetic awareness. Please see here for a selection of our client case studies.
Risk factors and recommendations
The report has made a number of recommendations to help continue to reduce the likelihood of anaesthetic awareness, including the development of a checklist to be used in addition to that provided by the World Health Organisation. They have also recommended that psychological support and therapy be given quickly to people who experience anaesthetic awareness to aid their recovery and manage the after-effects.
It is also recommended that people should be properly informed of the risks involved with general anaesthesia, such as a higher risk of awareness for those undergoing Caesarean sections or cardiothoratic surgery and people who have been given muscle relaxants. Anaesthetists are now generally encouraged to meet with the patient in advance of the surgery, where possible, to discuss these risks and address any concerns.
Balancing patient safety and risk of awareness
Advances in anaesthesia have enabled many operations and procedures to take place. Anaesthetists themselves are highly trained medical doctors who balance the risks of using anaesthetising drugs with keeping the patient safe and stable. However, when human error results in the patient experiencing the trauma and distress of waking up during an operation, it is important that steps are taken to reduce the chances of it happening to someone else.
If you or someone you love has experienced awareness during an operation despite being given anaesthetic, you may have a claim for medical negligence compensation. Please contact us on 0800 321 3112 and speak to one of our medically qualified advisers or email us here to make an enquiry.
* Accidental Awareness during General Anaesthesia (AAGA): Study by the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI).Posted 1st October 2014 | Posted in News,Uncategorised