Expert: JM Starkman, MD - 11/7/2009

Question
My girlfriend recently had surgery and everything went quite well, but it has caused me to think quite a lot about a couple of things that happened earlier in my life.  I had several minor surgeries when I was a child (the year was about 1970 and  I was put under with gas) - during one surgery I had limited anesthesia awareness.  I heard people talking and the radio playing but experienced no pain.  As a kid I thought nothing of this - I heard some music playing, no concern at all.  But as an adult I realize that if I had been a little less sedated it could have been a torture-chamber.  Also, at age 19 (1984) when I had my wisdom teeth removed.  The oral surgeon injected the anesthesia (unsure of the type) and told me to start counting back from 100.  I got to 90 and said it not working very well - he had to push in more.  No awareness, but was hung over for hours afterward.  He had to give me more than he thought an average weight teenager would need.

I am fearful that someday I will need surgery or have an accident or illness and end up in an emergency room.  I don't ever want to be given a paralytic - not ever - not for any reason because of my worry about anesthesia awareness.  I know that some procedures could be more difficult or even impossible because of this decision, but I want things done on my terms.  What is the best way to make my decision binding upon medical workers so they have to respect my wishes.  Advance directive?  Wallet card?  Med-alert bracelet?  Are there other things I should do?  What is the best way to make sure my wishes will always be respected?

Answer
In the event of ELECTIVE surgery you'll have time to re-write or modify the consent for surgery and anesthesia to suit your desires. For example, you might elect to cross out areas of the consent that speak to the uses of paralytic-type drugs.  Or you might add to it:  "The use of paralytic drugs is not authorized or consented to."

In the event of emergency surgery this opportunity may not present itself (i.e. if you are unconscious), so the use of an advanced directive in the form of a wallet card or medic-alert bracelet might suffice.

[You didn't ask, but you are likely obsessing over something irrelevant.  The only cases of awareness I've heard of were in the morbidly obese, and almost every one of them were women.  The situations described above are not the same as being "aware under general anesthesia", and they were both conducted safely.]