The 65-year-old retired school teacher lay in the pre-operative area, anxious about his impending prostate surgery. He glances over the paper work he is asked to sign about the anesthesia to be administered during his surgery.
“Will I wake up after surgery?” the patient asks Dr. Michael Goldberg, Chief of Anesthesia at Cooper.
“We are going to do our best to make sure you are well taken care of during and after surgery. We use the best technology to monitor your consciousness, but there are risks,” Dr. Goldberg says, pointing to the paragraph that explains to every patient the inherent risks of anesthesia. “Anesthesia is an art, not a science,” Dr. Goldberg says.
With a successful surgery completed under the watchful eyes of Cooper anesthesia providers, and talented surgeon Dr. Raul Parra (who performed the procedure using the DaVinci robot), the patient opens his eyes to the light of the post-operative room, relieved that he remembered nothing about the operation.
Many patients are nervous before entering the operating room, asking their surgeons and anesthesiologists the question, “Will I wake up during surgery?” The reality, though extremely rare, is that anesthesia awareness – when a patient can feel or hear things during surgery – does occur. This month, the blockbuster thriller AWAKE hit movie theatres around the country, bringing attention to the phenomenon of anesthesia awareness.
“The potential of true anesthesia awareness is very rare, one out of 40,000 patients a year,” says Dr. Goldberg, who was interviewed extensively by local television and newspapers on this subject surrounding the movie. He explains that the art of anesthesia is about vigilance.
“Prevention of such occurrences of awareness starts with safeguards anesthesia providers are extensively trained in. This includes knowing the medications a patient is on prior to surgery, allergies to medications, if they use recreational drugs or alcohol, and age and weight of a patient. All these factors are combined into the treatment plan when administering anesthetic drugs into a patient,” Dr. Goldberg says.
The American Society of Anesthesiologists predicts that one in 1,000 patients report some type of awareness. This statistic reflects different stages of awareness that are possible.
“For example, if a trauma patient is brought in and needs an immediate breathing tube inserted, then there is no time for full sedation to be administered, and the patient may recall the tube insertion,” says Dr. Goldberg.
Awareness occurs more in unstable patients, such as open-heart surgery patients, pregnant women who have emergency c-sections, and trauma patients who need immediate life-saving care.
Anesthesia providers look for signs and symptoms during surgery of “light” anesthesia. Signs include increased blood pressure, tearing, wrinkled forehead movements or purposeful movement of any extremity.
Cooper was one of the first in the region to adopt a brain monitoring device that reads the consciousness of a patient while under anesthesia. The device, called the BIS monitor, rates the patient’s “awakeness” on a scale of one to 100. The higher the number, the more awake the patient. This helps the anesthesia provider determine if more anesthetic is needed during a surgery.
One of the most important steps patients can take is being honest with their caregiver in explaining any medications they may be taking. With all these safeguards in place, Dr. Goldberg and his team at Cooper University Hospital treat every patient with expertise and the highest quality of care.