On Thursday’s episode of Grey’s Anatomy, a patient woke up during her own surgery. She was able to smell her own flesh burning during the procedure (heat is used during surgery to burn down bleeding blood vessels), able to see her abdomen open and to see the surgeons operating on her. The only thing she wasn’t able to do was move. Not even her mouth or vocal cords – meaning she couldn’t even scream.

Sounds like science fiction, right? Unfortunately, this condition, called anesthesia awareness, happens to around 30,000 people a year in the US alone.

Danger level: High

What is it?

Anesthesia awareness is the condition in which a person is awake during surgery, being aware of the surgery, even though they are supposed to be asleep.

Imagine being cut down while awake. Photo by Brit.

Who gets it?

It occurs in about 1-2 out of every 1,000 surgical patients. Probably more in children.

What causes it?

When undergoing surgery, a patient is usually put to sleep using anesthesia. But that is not the only drug given to them. In order to insert a tube down a patient’s throat to ventilate them, and in order to cut through muscle, the patient’s muscles have to be paralyzed. A drug that causes that is given prior to surgery.

When the anesthesia doesn’t work, for any reason, the patient is left with the paralyzing drugs working – meaning they can’t move, speak, blink the eyes or otherwise respond to the pain, if they feel it.

So when does anesthesia not work? There can be a number of reasons:

1. Not using the full dose of anesthesia – In some high-risk surgeries, such as trauma, cardiac surgery, emergency c-sections, or when the patient’s condition is unstable, using the usual dose of anesthetic could harm the patient. In these situations awareness may not be completely avoidable.
2. Patient physiology – Some people (like the woman on the Grey’s Anatomy episode) may be more resistant to anesthetics than others. This can happen due to a genetic condition. Other things, such as other drugs, may interfere with the action of the anesthetic drug and may require using a higher dose of it in order for it to work effectively.
3. Human error – Sometimes a drug dose which is too low may be the cause. Also inadequate monitoring during surgery may be the cause, when there is a need for an increase in drug dosage, but no one has noticed.

How does it feel?

Most people don’t feel the pain of surgery. But even without pain, the experience can be traumatic. The patient can recall the details of their own surgery. Some describe it as being trapped inside a corpse.

This video shows the story of former patients who experienced the condition -

The bottom line – how do I avoid it?

Before surgery, you should meet with your anesthesiologist to discuss anesthesia options. You should share with them any problems experienced with previous anesthetics. You should discuss all prescription and over-the-counter medications you’re taking.

During surgery, the anesthesiologist monitors your vital signs, such as your heart rate, breathing rate and blood pressure. When you are awake when you shouldn’t be, these will change, indicating the need for more anesthesia.

There are also new tools being studied to assess how awake you are during surgery. It is still unclear how effective they are. No monitor exists yet that can completely guarantee you will not experience awareness during surgery.

What next?

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Related posts:

1. As Seen on Grey’s Anatomy – Posttraumatic Stress Disorder – It Can Happen To Anyone
2. As Seen on Grey’s Anatomy – Acute Porphyria
3. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
4. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)
5. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)