Expert: Dr Ian Jackson - please note UK based - 9/2/2009

Question
I've found that some medical professionals seem to consider pain to be irrelevant in conscious patients if they have amnesia.
- How widespread is this philosophy among medical professionals?
- How often, if ever, does this philosophy result in the abandonment of pain management techniques for conscious patients that have amnesia?

I understand that RECALLING events under general anesthesia is rare.
- How common is it to experience WAKING up during general anesthesia but not recalling afterward?

Thank you for your time.  I appreciate it.

Answer
Hi Trevor
I don't believe that many medical colleagues in the UK would consider induced amnesia as a method of managing patients in pain. It is very difficult to induce amnesia reliably so that patients will not remember painful events. However it is also certain that drugs that induce a degree of amnesia are used for some procedures that are unpleasant and involve discomfort. I can think of gastroscopy and colonoscopy as examples. Having been a patient myself I know that the drugs were used to help me tolerate the procedure and did not induce amnesia - indeed I remember much of what happened.
As you mention recall of events under general anaesthesia (awareness) is rare - often quoted around 1-2 per 1000 cases but is probably even less these days. Now as for waking up during an anaesthetic and not recalling it then I suspect this is more common but have no evidence to support this. I know that people have used the 'isolated forearm technique' developed by Tunstall in the UK to look at patient wakefullness during anaesthesia and it is possible to communicate with patients who then do not remember anything afterwards. It is also a fact that patients in the recovery room do not remember conversations they have had there even though they have appeared fully awake, indeed we try to keep surgeons away from them as telling them what was found during their operation is a waste of time.
So apart from saying I'm sure it happens I cannot give any incidence - if no one recalls then it is difficult to monitor.
Hope the above helps in some way.
Dr Ian Jackson