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PATIENT STORIES
"I remember feeling the cold plastic tube being inserted down the back of my throat," the patient reported afterwards. "I remember trying to cough, talk, open my eyes and do anything to signal that I was still awake. At that point, I began to panic, and I could feel my heart racing. I was crying inside, but no one noticed my tears. The sensation and memory were similar to what I have read about people being buried alive."
Two observers in the operating room, probably students, noted that the patient's pupils were not dilated. But the anesthesiologist lectured them on how anesthetics worked and shut the patient's eyes. Later, the patient tried to flutter her eyelids. The surgical team eventually decided she was waking up from anesthesia and administered more muscle relaxant, which made it impossible for her to signal further but apparently did nothing for her pain. The patient reportedly suffered for 45 minutes while the surgeons opened her stomach, removed her spleen, explored the other organs, then sutured her wounds.
After the muscle relaxant wore off, she shouted, "I was awake in there!" The anesthesiologist immediately investigated the source of the problem and discovered that the oxygen supply had been locked in the "on" position during the operation, effectively diluting the anesthetic. The woman subsequently had recurring nightmares and panic attacks and required psychiatric help.
About 20,000 to 40,000 cases of anesthesia awareness are estimated to occur each year.
His condition did not improve, however. C.B.’s memory continued to deteriorate. Six months later, he could not care for himself and became totally dependent on his wife. The couple tried to initiate a lawsuit, but to no avail. Experts agreed that there was no deviation from the standard of care by the surgeons and anesthesiologist.
Examples of perioperative complications taken from the medical literature and our clinical experience:
Postoperative cognitive dysfunction I
C.B., a 61-year-old writer and literary critic who recently married his long-time companion, received an offer to teach at a college in Maine, where the couple was planning to move in six months. Before the move, C.B. decided to have heart surgery to fix a problem with his aortic valve. The surgery was successful, although he did experience postoperative confusion, which was attributed to the temporary effects of anesthesia. He was discharged home after a week in the hospital.
Postoperative cognitive dysfunction I
C.B., a 61-year-old writer and literary critic who recently married his long-time companion, received an offer to teach at a college in Maine, where the couple was planning to move in six months. Before the move, C.B. decided to have heart surgery to fix a problem with his aortic valve. The surgery was successful, although he did experience postoperative confusion, which was attributed to the temporary effects of anesthesia. He was discharged home after a week in the hospital.
Anesthesia awareness
A 31-year-old woman with Hodgkin's disease was due to have her spleen removed and other organs biopsied. She was anesthetized but awoke before the operation began, fully sensitive to pain but paralyzed except for some slight ability to move the eyelids.
A 31-year-old woman with Hodgkin's disease was due to have her spleen removed and other organs biopsied. She was anesthetized but awoke before the operation began, fully sensitive to pain but paralyzed except for some slight ability to move the eyelids.
Postoperative cognitive dysfunction II
M.G. was a 78-year-old retired businessman with middle-stage Alzheimer’s disease. He was home-bound, requiring help with various activities of daily living, such as bathing and dressing, yet he was alert and communicative. He falls in the shower, breaking his right hip. Two days later, he has hip-replacement surgery. The surgery was a success, but the patient took three days to begin to emerge from anesthesia. However, he remained confused, delirious, and incommunicative and was transferred to a nursing home. After three weeks, his condition improved to the point where he could be sent home, with round-the-clock nursing care. Over the next few months, his cognitive function began to improve, though he still required near-constant home-health care.
M.G. was a 78-year-old retired businessman with middle-stage Alzheimer’s disease. He was home-bound, requiring help with various activities of daily living, such as bathing and dressing, yet he was alert and communicative. He falls in the shower, breaking his right hip. Two days later, he has hip-replacement surgery. The surgery was a success, but the patient took three days to begin to emerge from anesthesia. However, he remained confused, delirious, and incommunicative and was transferred to a nursing home. After three weeks, his condition improved to the point where he could be sent home, with round-the-clock nursing care. Over the next few months, his cognitive function began to improve, though he still required near-constant home-health care.
Stroke
S.D., a 68-year-old man with chronic hip pain and poor mobility due to osteoarthritis, was admitted to the hospital for a total hip replacement. A former executive of a large financial institution, he had retired two years earlier with the goals of getting a doctorate in philosophy and playing golf. S.D. had a history of high blood pressure and cerebrovascular disease and a year earlier had a stent placed in his right carotid artery in order to alleviate restricted blood flow to his brain. For the hip replacement, S.D. chose to have general anesthesia because he was afraid to hear "noise from cutting his bone."
It took a long time for S.D. to wake up after surgery. After two hours in recovery, his breathing tube was removed. S.D. was asked to move his arm and leg, but he could not move the limbs on his right side. An MRI revealed a massive stroke in the left side of his brain. He spent four months in a rehabilitation institute. Although he eventually regained some use of his right arm, he remained wheelchair-bound and had to move to an assisted living facility.
Intraopertive myocardial infarction
S.O., a 52-year-old business executive and father of four, suffered a spinal injury while exercising. At risk for paralysis, he was rushed to the O.R. for emergency surgery. During the operation, he suffered a fatal heart attack. An autopsy reveals that he had significant undiagnosed coronary artery disease.
The case of S.O. is not unusual. According to a 2001 report in The New England Journal of Medicine, of the millions of patients who undergo non-cardiac surgery each year, about 50,000 will have a perioperative myocardial infarction (heart attack), and an estimated 1 million will have a perioperative cardiac complication. The economic burden of these complications was estimated to be $20 billion annually.
S.D., a 68-year-old man with chronic hip pain and poor mobility due to osteoarthritis, was admitted to the hospital for a total hip replacement. A former executive of a large financial institution, he had retired two years earlier with the goals of getting a doctorate in philosophy and playing golf. S.D. had a history of high blood pressure and cerebrovascular disease and a year earlier had a stent placed in his right carotid artery in order to alleviate restricted blood flow to his brain. For the hip replacement, S.D. chose to have general anesthesia because he was afraid to hear "noise from cutting his bone."
It took a long time for S.D. to wake up after surgery. After two hours in recovery, his breathing tube was removed. S.D. was asked to move his arm and leg, but he could not move the limbs on his right side. An MRI revealed a massive stroke in the left side of his brain. He spent four months in a rehabilitation institute. Although he eventually regained some use of his right arm, he remained wheelchair-bound and had to move to an assisted living facility.
Intraopertive myocardial infarction
S.O., a 52-year-old business executive and father of four, suffered a spinal injury while exercising. At risk for paralysis, he was rushed to the O.R. for emergency surgery. During the operation, he suffered a fatal heart attack. An autopsy reveals that he had significant undiagnosed coronary artery disease.
The case of S.O. is not unusual. According to a 2001 report in The New England Journal of Medicine, of the millions of patients who undergo non-cardiac surgery each year, about 50,000 will have a perioperative myocardial infarction (heart attack), and an estimated 1 million will have a perioperative cardiac complication. The economic burden of these complications was estimated to be $20 billion annually.
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PERIOPERATIVE RESEARCH & EDUCATION
PERIOPERATIVE RESEARCH & EDUCATION