November 9, 2018
Accidental awareness is one of the most feared complications of general anaesthesia for both patients and anaesthetists. Accidental awareness occurs when the patient becomes conscious during a general anaesthetic and can remember things that happened. It is rare, but can be very distressing.
According to the National Audit Project 5 (NAP5) report; the largest study of awareness by the Royal College of Anaesthetists and Associated of Anaesthetists of Great Britain and Ireland, awareness occurs in approximately 1 in every 19,000 cases.
The most common type of awareness is a brief recall of some event during anaesthesia or surgery. More serious is the feeling of paralysis, which is a consequence of muscle relaxant drugs used during some surgeries. Pain is felt by around 1 in 5 patients who report accidental awareness.
Most reported episodes of awareness are short, less than 5 minutes, but can be very distressing. Patients report anxiety, sleep disturbance, flashbacks and nightmares. In some patients, a post-traumatic stress disorder develops. Not surprisingly, there is often a fear of future general anaesthesia.
So, what should you do if you think you have been aware during general anaesthesia?
You should not hesitate to raise it, either with the hospital, or if you have been discharged from hospital, you may wish to speak to your GP. You can also contact the patient Advice and Liaison Service at your hospital. Studies have shown that some people do not realise that they have been aware until several days later, or even longer, so it does not matter if it was not reported at the time. The anaesthetist will talk to you about your experience and try to work out what has happened and why. It may be helpful to see a psychologist or psychiatrist who has experience of working with people who have had similar experiences, and the hospital may be able to arrange this for you.
If you have had an episode of awareness, is it more likely to happen to you again?
For most people, probably not. If your episode was caused by a problem delivering the anaesthetic to you, such as an equipment problem, you will not be at any increased risk. A small minority of patient may have some resistance to anaesthetic drugs and may need an increased dose – it is important that you tell your anaesthetists about a previous episode of awareness so they can judge the right amount of anaesthetic for you.
Are there any risk factors which make awareness more or less likely?
The NAP5 study identified a number of situations in which the risk of accidental awareness is increased. The most important risk factor is the use of a muscle relaxant drug as most cases of accident awareness which lead to longer term distress occurs in people who have received muscle relaxants. The risk of awareness is increased in certain types of surgery such as in obstetric operations, because there is a need to minimise the dose of anaesthetic drugs to reduce effects on your unborn child. Some studies suggest that if you take certain medications you will require more anaesthetic, these include prolonged and heavy use of alcohol, some types of sleeping tablets and morphine like drugs.
Our medical negligence solicitors completely understand the trauma involved with anaesthetic awareness and we focus not only on securing compensation but also on arranging the best treatment to help you recover.