Distress may persist after waking during surgery
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Patients who wake up from general anesthesia during surgery and have a clear memory of the event may develop acute distress and emotional reactions, investigators in Sweden report, and in some patients, long-term psychological symptoms may persist.
Dr. Peter Samuelsson and his associates, from County Hospital in Kalmar, interviewed 2,681 consecutive surgical patients between 2001 and 2002 who underwent general anesthesia 1 to 3 days earlier.
Ninety-eight patients (3.7 percent) believed they woke up during general anesthesia in a previous surgery. These subjects were considered eligible for evaluation for possible long-term consequences of this event.
According to their report in the medical journal Anesthesiology, the researchers were able to interview 79 patients by telephone. After further questioning additional patients did not met the study criteria, which left 46 available for evaluation.
The 45-minute interview included the patient’s detailed description of the awareness event, as well as sensory perception, emotions, and cognition during the episode. Subjects were also asked about delayed psychological symptoms.
Awareness episodes occurred between the ages of 6 and 62 years old. Even though some events had occurred many years earlier, the memories remained quite clear. All patients had some kind of sensory perception. Twenty had experienced pain, which was severe for 14. Seventeen felt paralyzed.
An acute emotional reaction was reported by 30, characterized as helplessness, fear, and panic. Fifteen patients (33 percent) reported late psychological symptoms, including nightmares, anxiety and flashbacks; six said that they had symptoms for years afterwards. During subsequent surgeries, 19 patients reported a lack of trust in medical staff.
Some patients never told anyone about their awareness experience. Of the 39 who did, 13 were “greeted with skepticism,” the investigators report.
Samuelsson’s team attributes the higher rates and greater severity of late psychological symptoms reported by other researchers who completed similar studies to faulty study design. They suggest that patient selection bias may have occurred in these studies, based on the manner in which patients were recruited, which included advertising, referral, and closed claims analysis.
SOURCE: Anesthesiology, January 2007.
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