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is dedicated to the acceptance, medical
treatment, and legal
protection of individuals correcting the misalignment
of their brains and their anatomical sex, while supporting their transition
into society as hormonally reconstituted and surgically corrected citizens.
Awake Despite Anesthesia Print E-mail
SciMed - Healthcare
TS-Si News Service   
Tuesday, 25 January 2011 04:00
Berlin, Germany. Out of every 1000 patients, two at most wake up during their operation. Unintended awareness in the patient is thus classified as an occasional complication of anesthesia — but being aware of things happening during the operation, and being able to recall them later, can leave a patient with long-term psychological trauma.

How to avoid such awareness events, and what treatment is available for a patient who does experience awareness, is discussed by Petra Bischoff of the Ruhr-Universität Bochum and Ingrid Rundshagen of the Charité - Universitätsmedizin Berlin in the journal Deutsches Ärzteblatt International.

Choosing A Surgeon. Planning for a sex change involves an assessment of surgical options for Sex Reassignment Surgery (SRS — aka GRS) and quite possibly a variety of other related surgical procedures.

The doctors and surgeons you consider should fit at least these basic criteria:

1. The doctor is board certified by one or more of the 24 member boards of the the American Board of Medical Specialties (ABMS). Plastic and Reconstructive Surgeons are certified by the American Board of Plastic Surgery (ABPS).

2. The doctor is an active member of medical societies that relate to her or his specialty, and those with missions for public safety, ethics and excellence in practice. See the American Society of Plastic Surgeons (ASPS).

3. The doctor practices exclusively in the specialty in which he or she holds board certification. For example, there is no requirement that a doctor have any training or experience to purchase breast implants and surgically place them into your body. Certification is important.

4. The doctor listens to your concerns and answers your questions directly. The focus is on you.

5. The doctor has performed the procedure you are interested in (e.g., SRS) many times and can provide recent before-and-after photographs of actual patients. The doctor should explain the outcomes and how they were achieved.

6. The doctor performs all procedures that require more than a local (topical) anesthetic in accredited or licensed office-based, ambulatory or hospital surgical facilities. The doctor should clearly define the anesthesia you will have and the credentials of the person charged with its administration.

7. The doctor has privileges at a local accredited hospital facility to perform the specific surgical procedure you are considering. If a local hospital has barred the doctor to perform surgery on hospital property, do not consider letting this doctor perform surgery on you.

8. The office is clean and orderly. The staff is respectful of your time and presence. The attention you get should be consistent. Your privacy is respected. You should feel safe and welcomed.

9. You have checked with the applicable state medical board and the doctor is licensed to practice in the state. There should be no prior or pending actions against her or him. Lawsuits are frequent but only actual negligence can jeopardize the status of a doctor’s medical license.

10. You are comfortable with the doctor and willing to place your life in her or his hands.
The usual culprit in cases of unintended awareness during an operation is an inadequate depth of anesthesia. In addition, several risk factors exist that promote awareness events.
  • Children have eight to ten times the risk of being aware under anesthesia.

  • Long-term use of painkillers or misuse of medication can also make patients more liable to this kind of experience.

The nature of the operation and the surrounding circumstances can also play a part.
  • Cesarean sections and emergency operations carry a higher risk of awareness than other kinds of surgery.

  • Operations at night pose a higher risk than those carried out during the day.

For prevention of awareness during anesthesia, the authors recommend taking into account the risk factors that have been mentioned and several other factors.
  • Raise the level of vigilance among medical personnel for awareness phenomena by regular training sessions.

  • Premedication with benzodiazepines and not using muscle relaxants are also worthwhile measures.

  • Measure the anesthetic gas concentrations regularly and monitor brain electrical activity by EEG.

  • If possible, the patient should be given hearing protection.

  • If a post-traumatic stress disorder does occur, the prognosis is good if professional treatment is started without delay.

CitationAwareness during general anesthesia. Petra Bischoff and Ingrid Rundshagen. Deutsches Ärzteblatt International 2011; 108(1-2): 1-7. doi:10.3238/arztebl.2011.0001
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Abstract

Background. Awareness while under general anesthesia, and the later recall of what happened during surgery, can be experienced by patients as horrific events that leave lasting mental trauma behind. Patients may have both auditory and tactile perception, potentially accompanied by feelings of helplessness, inability to move, pain, and panic ranging to an acute fear of death.

For some patients, the experience of awareness under anesthesia has no sequelae; for others, however, it can lead to the development of post-traumatic stress disorder, consisting of complex psychopathological phenomena such as anxiety, insomnia, nightmares, irritability, and depression possibly leading to suicidality.

Methods. The literature on the subject was selectively reviewed.

Results. In the absence of risk factors awareness phenomena occur in one to two per 1000 operations under general anesthesia (0.1% to 0.2%) and are thus classed as an occasionally occurring critical event. In children, the risk of such phenomena occurring is 8 to 10 times higher.

These phenomena are due to an inadequate depth of anesthesia with incomplete unconsciousness. They can be promoted by a number of risk factors that are either patient-related (ASA class III or above, medication abuse), surgery-related (Caesarean section, emergency procedures, surgery at night), or anesthesia-related (anesthesia without benzodiazepines, use of muscle relaxants).

Conclusion. Strategies for avoiding awareness phenomena under anesthesia include the training of staff to know about the problem and, specifically, the use of benzodiazepines, the avoidance of muscle relaxants if possible, and shielding the patient from excessive noise. EEG monitoring is effective but provides no guarantee against awareness.

If awareness under anesthesia occurs despite these measures, the patient must be given expert, interdisciplinary treatment as soon after the event as possible in order to minimize its potential sequelae.

TS-Si News ServiceThe TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. The sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates.

We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.


TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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Last Updated on Monday, 24 January 2011 21:10
 
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