more awake and aware during surgery
- From: "OldGoat" <oldgoatmail@xxxxxxxxxxxxxxxxxx>
- Date: Thu, 13 Mar 2008 17:52:52 GMT
Monitors don't stop patients from waking
Wed Mar 12, 9:58 PM ET
Patients say it feels like being trapped in a corpse: They wake up during
surgery, unable to move or scream. Some remember hearing their surgeons
talk, and a few recall feeling intense pain.
Some experts have said special brain-wave monitors were the best way to
prevent anesthesia awareness. Now, in a big setback for efforts to prevent
it, the first large, independent test of the monitors shows they are no
better than older technology.
Researchers at Washington University School of Medicine in St. Louis
compared two groups of about 1,000 patients each, all deemed at high risk of
waking up during surgery because of health conditions, medication or other
factors.
One group used the leading brain-monitoring system, which uses electrodes on
the forehead to measure brain waves and software to calculate likelihood of
consciousness. The other used an older device that analyzes exhaled
anesthetic gas.
Anesthesiologists watched for movement and changes in vital signs and
followed protocols to maintain patients' depth of sleep, adjusting
anesthesia levels as needed. Patients were interviewed after their surgeries
about what they remembered.
Two people in each group had experienced awareness - and the two monitored
with the newer system reported having felt pain as well.
Lead researcher Dr. Michael Avidan said that in two of those cases - one
with each system - the monitors indicated no problems with the anesthesia.
In the other two cases, the monitors signaled problems.
The study analyzed groups of people who had surgery at the university's
partner hospital, Barnes-Jewish in St. Louis, in 2005 and 2006. It was
published in Thursday's issue of the New England Journal of Medicine.
Anesthesia awareness occurs in 1 or 2 of every 1,000 surgical patients -
possibly more often in children - and is thought to happen to roughly 30,000
Americans each year.
Some just have fleeting memories of things they heard, but others describe
"white-hot pain" and terror, triggering long-term emotional problems.
Carol Weihrer of Reston, Va., said that 11 years after awakening during
surgery to remove a diseased eye that caused severe pain, she still has
post-traumatic stress disorder, can sleep for just short periods and suffers
mood swings and panic attacks.
Weihrer, who founded the group Anesthesia Awareness Campaign Inc., said she
heard the doctor give instructions: "Cut deeper, pull harder." "I actually
saw them cut the optic nerve when everything went black," she said.
"While you're laying there on the table," she recalled, "you are thinking,
praying, cursing, plotting, pleading, trying to crawl off the gurney, trying
to kick, scream, move any part of your body to let them know you're awake.
In effect, you are entombed in a corpse."
Kathy LaBrie of Nashua, N.H., also suffered awareness during surgery for a
deviated septum. She said she heard "the sound of pushing and grinding and
the surgeon talking to the nurses about the kind of car he had. ... I tried
moving my arms and legs - I couldn't do anything. I thought I was dying."
Dr. Jeffrey Apfelbaum, president of the American Society of
Anesthesiologists, who was not involved in the study, said there is
"tremendous pressure" from industry and patient advocates to use the
brain-wave technology, despite the lack of solid evidence that it works
better.
The position of the anesthesiologists group has been that brain-wave
monitoring should not be done routinely, but may be helpful for certain
patients at high risk of awareness. But widespread use would be very costly.
The dominant maker of brain-wave systems, Aspect Medical Systems, says its
monitor, called a bispectral index or BIS, is used in about 17 percent of
the roughly 20 million U.S. surgeries each year in which anesthesia gas is
used.
The device can cost as little as $5,000. But the researchers estimated that
if it were used on all U.S. patients getting general anesthesia, the
disposable electrodes alone would cost more than $360 million a year.
The device, on sale since 1998, "can prevent both too little anesthesia,
which could cause awareness, and too much anesthesia, which could cause
prolonged recovery and anesthetic side effects" such as grogginess and
nausea, said Aspect's medical director, Boston anesthesiologist Dr. Scott
Kelley.
He said the new results show the system can help anesthesiologists "achieve
a very low incidence of awareness in high-risk patients."
But Avidan's fellow researcher, anesthesiology professor Dr. Alex Evers,
said he thinks having doctors closely follow a protocol to maintain the
patients' depth of sleep was the key to reducing anesthesia awareness in
both groups.
The Food and Drug Administration has stated only that the BIS device "may be
associated" with reducing awareness during surgery.
About 10 percent of U.S. surgical patients receive intravenous anesthesia,
without any gas. The study findings do not apply to them.
Dr. Douglas Jackson, assistant anesthesiology professor at University of
Medicine and Dentistry of New Jersey in Newark, said the study shows the BIS
system "is not a magic bullet."
"We still don't have a monitor that can tell us about depth of anesthesia
(and) awareness," he said, adding that controlling that is still an art.
.
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