Expert: Dr Ian Jackson - please note UK based - 2/13/2004

Question
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Followup To
Question -
Hello I was woundering if you could be of some assistance to a question I have. I am looking into why people experence intraoperative awareness. How important is it to give a amnesia drug before surgery starts? I have come to learn of a person I read about who woke up about five min. right befor surgery was to be performed for gallbladder removal. She stated she can hear them talking beside her then she heard them say lets begin. She was totally paralized. But could hear and feel them cutting into her. For what she believes was for about 7 to 10 min. After being awake for that time it ended with her not being able to breath. She says she experienced herself dieing not being able to breath and she blacked out. My question is "what would make her resperatory drop?" Could it be the the fact the drugs wore off 5 min. into begining of surgery, to were the drugs were not being given continuosly overlaping, then a big dose was given and that compramizing her resperatory depression? All the while the neuro muscular drug stayed in tact to were she could not move. What are some reasons that you think could be the reason for her to have decreased resperatory to the point she blacked out. Also, dont you think it would be necessary to give that amnesia drug so she would have no recelection of the surgery itself?
Thank you, I know its alot, but i appreciate it if you can get back to me.
Marielle Brown

Answer -
Marielle

Awareness during an operation only occurs when someone has been paralysed so they cannot move or breath for themselves. As you can imagine if you were able to move in these circumstances you would as it is a reflex to the pain experienced.

So lesson one is to paralyse as few people as possible.

The next thing is to ensure that patients are fully anaesthetised during their operation so they have no recall - that is a large part of our job. If we fail in this, which can and does happen though thankfully very rarely these days, it can be due any number of causes. These are usually linked to a failure to continue to deliver the required agent in sufficient quantities.

Your friend probably didn't blackout - it is more likely that someone spotted a problem and gave them what they needed.

Awareness is terrible and your friend should be offered help to deal with this.

Kind regards
Ian Jackson Thank you for anwering my questions, I appreciate it. But one more if you dont mind. You said "she probably didn't black out-its more likely that someone spotted a problem and gave them what they needed" so my question is what do you mean? Why did her breathing stop? Can you give me some options? Thank you, Marielle Brown

Answer
Marielle

Complicated this bit

It is virtually impossible to be aware and be able to breathe for yourself. If you are paralysed then you can't breathe - we have to do that for you. If you can breathe then you are not paralysed and so would move - indeed jump off the operating table!

Now it is possible that she started to move and so this is why anaesthetist was alerted she needed something else. It is also possible this included a muscle relaxant and this worked before she was properly asleep and so she felt she stopped breathing. However it could also (more likely) have been a very strong pain killer - these also stop you breathing.

However I am really just guessing and it is impossible for me to say exactly what happened.
Hope this helps.