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Thursday, April 10, 2008

i've actually experienced this during an endoscopy years ago - Should You Be Worried The Events In The Movie "Awake" Can Happen To You? | Scientific Blogging

"Awake", a film starring Hayden Christenson and Jessica Alba, is a psychological thriller about a horrifying phenomenon called "anesthetic awareness" where a patient's failed anesthesia leaves him fully conscious but physically paralyzed.

How common is it? Research shows that between one and three in every 1,000 patients experience some form of wakefulness during operations.

Some may not remember a period of consciousness during an operation – anesthetic drugs can interfere with recall – but they may still suffer subsequent psychological difficulties. In some cases patients aren't given enough of the sedative element of an anesthetic to keep them asleep.

Jessica Alba as Sam in "Awake." © The Weinstein Company 2007.

Professor Michael Wang, of the University of Leicester School of Psychology, has spent more than 20 years working with patients who have woken up during operations. He believes part of the problem is that anaesthetists themselves do not realise just how common anaesthetic awareness is, or how difficult it is for them to detect it when it happens.

Professor Wang said episodes of full awareness with explicit recall during operations with general anaesthesia are more common than many realise. "The common reason for failure to identify intra-operative awareness is the paralyzing effects of muscle relaxants. Contrary to traditional belief there are no reliable clinical signs to enable the identification of wakefulness," he said.

Professor Wang will speak at a conference on anesthetic awareness in Munich next month, arguing more should be done to prevent patients waking during operations. Wang is also due to address an international conference on the subject where a patient undergoing medical treatment is under anaesthesia but is conscious of all the pain of the operation.

He urges anesthetists to use the Isolated Forearm Technique in which a tourniquet is applied to the arm before paralyzing muscle relaxant is administered, allowing patients to communicate with doctors should they become wakeful. He said: "In most cases if a patient becomes wakeful, no one knows about it until after the operation is over. The effects of these experiences can be devastating. People suffer depression, intense anxiety and other psychological problems." The problem is more common among women, although it is not known why.

Studies conducted by Prof Wang and Dr Ian Russell (Hull Royal Infirmary) have made use of the isolated forearm technique to determine levels of consciousness during general anesthesia, which allows communication despite the muscle paralysis.

"Often patients will demonstrate high levels of consciousness during an operation but without conscious recall afterwards. This is because many anaesthetic drugs interfere with memory. I and colleagues have also investigated benzodiazepine sedation as another clinical circumstance in which there may be dissociation between unconscious and conscious recall. There is an intriguing literature in which patients have developed psychological disturbance following operations with general anaesthesia in which the patient has no conscious recall, but the nature of the disturbance is indicative of inadequate anaesthesia. Experimental studies that attempt to investigate the mechanisms by which this may occur are reviewed."

Should You Be Worried The Events In The Movie "Awake" Can Happen To You? | Scientific Blogging
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