Anesthesia awareness isn't just in the movies

The tag line for the new movie "Awake" promises that the film will "do for surgery what 'Jaws' did for swimming."

In other words, scare the daylights out of us. The movie centers on a man who awakens during heart surgery to find he is paralyzed and can't signal the surgical team. The technical term is anesthesia awareness.

Carol Weihrer of Reston, Va., doesn't need some Hollywood version of this phenomenon to drive home the horror that happens when anesthesia fails. Ten years after an anesthesiologist botched her anesthesia during an operation to remove her right eye, she can still recall in vivid detail the terror of the experience.

"I heard the surgeon talking to the resident, saying, 'Cut deeper and pull harder,'" she says. "I tried to scream and nothing happened. At that point I began to pray, curse, anything to tell the doctors I was awake. I finally realized I was paralyzed."

Todd Whitlock of Kansas City, Mo., was undergoing hip surgery last July when he, too, woke up on the surgical table.

"I was unable to bat an eyelash," he recalls. "I was hearing everything and knew my leg was sliced open. That scale they use for pain, grading it from one to 10? This pain was off that scale. You're screaming and screaming inside your head and nothing's coming out."

According to the Joint Commission on Accreditation of Healthcare Organizations, which inspects the nation's hospitals, each year between 20,000 and 40,000 of the 21 million people (roughly one to two per 1,000) who receive general anesthesia experience anesthesia awareness, also called intraoperative awareness. About half of those who wake up can hear or feel what is happening to them. Almost 30 percent feel pain.

These statistics are in dispute. Anesthesiologists point to another recent large study that found an incidence of awareness much lower than the statistics cited by the Joint Commission -- more like one in 14,000 patients.

This much is known: During general anesthesia, three drugs are typically given -- a drug to put the patient to sleep, a painkiller and a paralytic that prevents them from moving. When anesthesia fails, the paralysis prevents the patient from being able to communicate this to the doctors.

The aftereffects of anesthesia awareness can be devastating. According to the Joint Commission, more than half of such patients experience psychological distress after surgery, including an "indeterminate number" with post-traumatic stress disorder, a condition more commonly associated with victims of natural disasters or soldiers returning from war.

Weihrer, who founded an advocacy group called the Anesthesia Awareness Campaign Inc., says the number who experience PTSD -- marked by nightmares, sleeping troubles, panic attacks and other psychological woes -- can be as high as 80 percent.

"There are people who lose their jobs, their families over this," says Weihrer, who a decade after her experience still cannot lie down to sleep and must sleep in a recliner. "There are people who commit suicide after experiencing awareness."

The Joint Commission issued an alert in 2004, calling anesthesia awareness an "under-recognized and under-treated" problem in health care organizations.

The incidence of awareness is likely underreported, say experts, because patients are loath to tell their doctors about it.

"I think some patients are embarrassed to talk about it because they're afraid their doctors will think they're crazy," says Peter S. Sebel, a professor of anesthesiology at Emory University whose study found that 100 patients wake up every day in operating rooms across the country.

Whitlock, who has been unable to sue his anesthesiologist because he can't find a lawyer to take his case ("They say I have no 'structural damage,'" he says), blames a "brotherhood of silence" among anesthesiologists when it comes to acknowledging the problem of anesthesia awareness.

"They accuse us of dreaming or hallucinating," he says. "They've been saying that for years."

Many factors affect risk level

Anesthesia awareness can happen for a variety of reasons. Patients who habitually take certain drugs, such as Valium, may be more prone to wake up, says Jim Walker, a spokesman for the American Association of Nurse Anesthetists. People can metabolize anesthesia at different rates. Certain surgeries, such as those for trauma, cardiac operations and emergency Caesarean sections, may require lighter anesthesia for safety reasons.

"These types of surgical procedures increase the risk of awareness and there's not much we can do to prevent it," he says. "For example in trauma injury, where the blood pressure is already very low, it's just not safe for us to give additional anesthesia."

The Joint Commission also noted that the increasing use of intravenous anesthesia, vs. inhalation, accounts for some instances of awareness, as does "the premature lightening of anesthesia at the end of procedures to facilitate (operating room) turnover."

Then there's human error or machine malfunction. Weihrer, who successfully sued her anesthesiologist (the settlement is confidential), says he showed up late for surgery and didn't check the canister. It turns out there was no gas inside it.

"The vast majority of awareness is caused by human error or machine malfunction," she asserts.

But Walker, who in 14 years of practice says he's never seen a case of awareness, says human error is a "rare" cause of waking up during surgery. A brochure about anesthesia awareness from the American Society of Anesthesiologists also characterizes doctor error as rare, cites the low rate of awareness and says when it does occur, "it is often fleeting and not traumatic to the patient."

Dr. Susan Dobbs Curling, an anesthesiologist in Houston and a spokesperson for the ASA, says she hasn't had a single patient bring up awareness in the past 20 years.

"That's not to say it's not very serious, and we take it very seriously," she says. "My personal experience is if you have a vigilant anesthesiologist, the incidence should be very low, unless of course there's a life-saving reason why you're not giving as much anesthesia as you would like."