Down But Not Out
Doctors disagree how best to keep patients from awakening during surgery
The exchange was fairly predictable. Most surgery patients who experience awareness don't tell the anesthesiologist or any other doctor, and if they do, they rarely are taken seriously, says Boston University psychiatrist Janet Osterman, probably the leading investigator of the psychological wreckage an awareness episode can inflict. Even family and friends may be kept in the dark. Months or years later, the event can burst into the open as anger, crying jags, withdrawal, and other behavior similar to that displayed by some combat veterans and rape victims--a sign of post-traumatic stress disorder, says Osterman.
"I do not sleep flat, because that was the position I was in during surgery," says Carol Weihrer of Reston, Va., who woke up while her diseased eye was being removed in January 1998. "I sleep in a reclining chair. I have nightmares. I wake up with scratches and bruises. I tear my hair." A former flutist and office administrator, Weihrer, 53, responded by creating the Anesthesia Awareness Campaign (box).
"The question about BIS monitoring is, are you better off with it or are you better off without it?" says Donald Mathews, an anesthesiologist at St. Vincent's Hospital Manhattan who has used the device on all his general anesthesia patients for about five years. His answer: "I'm totally convinced that the information you get improves the way you take care of people."
Staying Blissfully Unaware
Patients worried about consciousness during surgery can ask whether a BIS monitor is available and about the possible use of an amnesiac drug. In addition, these resources have useful information:
American Society of Anesthesiologists. The ASA's draft report on BIS monitoring is available for comment (asahq.org).
Joint Commission on Accreditation of Healthcare Organizations. Click on "patient safety" to read the "sentinel event alert" (jcaho.org).
Anesthesia Awareness Campaign. News, brochures, and a MedAlert-type bracelet for those who have gone through an episode (anesthesia awareness.com).
Association for the Advancement of Behavior Therapy. Locate experts in post-traumatic stress syndrome (aabt.org).
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