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Nightmare in the operating room

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Although very uncommon - are between 1 and 3 cases per every 1,000 patients - it is possible that a person regain consciousness during surgery despite having been anesthetized, and can also be found paralysed and incapacitated to articulate word if in addition have been administered you relaxing neuromuscular, by what could also warn doctors of the situation. This kind of nightmare in the operating room is what is known as wake intraoperative awareness under anesthesia.
The general anesthesia, as explained by Dr. Fernando Gilsanz, head of Department of anesthesia of the Hospital Universitario la Paz, Madrid, is a medication with "various components to produce unconsciousness and amnesia - the patient should be oblivious to anything and not remember nothing — in addition to analgesia to prevent pain." Some interventions - continues the specialist-require the use of relaxing neuromuscular. If a patient is aware and feels pain which makes it's move, however, the danger of the use of neuromuscular relaxants is that if you are paralyzed and do not have a monitor depth of anaesthesia - BIS-, there may be an intraoperative awakening."
After a case of recovery of consciousness during an operation, even though the person has not felt pain because analgesia was effective, and remained paralyzed because they had induced him also a neuromuscular blockade, the patient usually concerns auditory memories, feeling of suffocation, fear, anxiety, or panic attacks, and in the most severe cases can reach suffering psychiatric disorders such as post-traumatic stress syndrome.
As the Chief of anesthesia of the peace service, "frequency of intraoperative awakening is very low – approximately - 0.13%, and there are several ways to experience it", i.e. when it occurs than usual is that the patient can remember things, but without having felt no pain, while the degree more extreme - and unusual - it is having intraoperative pain.

How to prevent and detect the intraoperative awakening

To prevent intraoperative awakening is necessary in the first place a previous assessment that identifies possible risk factors that favor the appearance of the phenomenon. Some patients, explains Dr. Gilsanz, are more likely to suffer these events, because due to their physical condition, it is not possible to administer a proper dose of drugs. This is what happens, says the expert, with persons with a reservation myocardial limited, with which they have good hemodynamic conditions, the patients hypovolemic, septic, traumatic...
Other risk factors associated with the characteristics of the patient, adds this specialist, chronic alcoholism , addiction to opiates or cocaine, and hepatic enzyme induction, a condition that causes that drugs are quickly destroyed by the liver, preventing adequate anesthesia levels are reached.
The incidence of intraoperative awakening is also higher in certain types of surgery, like the obstetric, trauma, or the heart, due to an insufficient dosage of anesthesia. There are cases of intraoperative awakening, for example, when general anesthesia is administered to a pregnant woman who has had to do an emergency c-section in a situation of fetal distress.
To detect a possible state of alert during surgery and to intervene to resolve it, there are systems monitoring anesthetic depth which, as its name suggests, evaluating the depth of anesthesia and are able to diagnose intra-operative awakening. The BIS or the bispectral index monitoring, explains Dr. Gilsanz, allows to observe the effect of drugs on consciousness, and offers value that ranges between 40 and 65 indicates that the patient has no conscience; If you were awake it would overcome the 65, and then it would be necessary to give more doses of anesthetic drug.
Article contributed for educational purposes
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