Undertaking any medical procedure, especially those that require anesthesia, often demands a certain amount of trust between patient and caregiver. Most of the time, this trust is well-placed, as the majority of medical professionals are well-trained, attentive, and have the necessary experience to complete these routine medical procedures without incident. Unfortunately, that doesn't mean that accidents don't occur. One of the most nightmarish of these is accidental awareness during general anesthesia, or AAGA… and it happens more than you think.
A recent report about AAGA in the U.S. estimated that AAGA occurs in one to two out of every thousand surgeries conducted. That may not seem like a large number for a country where thousands of surgeries occur each day, but this is most definitely a sobering statistic. AAGA occurs when someone either fully wakes or becomes mentally conscious during an operation. In certain circumstances, the patient will be mentally aware and able to hear the surgeon and surgical technicians' voices and other sounds but still remain unable to feel pain.
Other times, the patient is not so lucky. There have been reported cases where patients become mentally alert during surgery and experience pain from the procedure but remain physically paralyzed, incapable of moving or making a sound. If it's detected, the anesthesiologist will adjust the patient's dose and the patient will only remain conscious for a few minutes; however, if it remains undetected, it could put the patient through an excruciating ordeal for hours.
Obviously, this can cause serious psychological damage to patients who experience this kind of trauma. It's estimated that 41% of patients who experienced AAGA had moderate to severe long-term psychological effects. These included debilitating symptoms of post-traumatic stress disorder, like nightmares, flashbacks, avoidance of medical care or facilities, insomnia, and psychosomatic pain, and this can last anywhere from a number of weeks to the rest of their lives. Many patients who experience AAGA become frustrated when met with a lack of accountability on the part of the surgical team, some of whom deny responsibility or tell the patient it didn't happen. Many patients are not comfortable reporting the experience to hospital staff and then do not seek additional help for the psychological trauma. The best method for dealing with AAGA comes from active early support from the patient's physician and other health care staff.
The exact cause of AAGA is still the subject of a healthy amount of speculation, with theories ranging from a person's weight and lifestyle to a possible genetic link that would make certain people more resistant to the effects of anesthesia than others. One of the reasons why much of this research has remained inconclusive is because still not much is known about human consciousness and the effects of anesthesia on the mind.
Luckily, most patients who experience AAGA do not experience pain. Those cases only account for roughly 18% of the reported accounts of AAGA. This doesn't mean the experience is any less traumatic; many people report feeling unable to breathe, experiencing dreams very vividly, or experiencing terror because of the paralytic effects of anesthesia. What is more disturbing and much more prevalent is the lack of preparedness that many medical facilities have for dealing with, reporting, or supporting individuals who experience AAGA. As research continues, interest and awareness about this very real problem are sure to increase along with development of methods to help victims of AAGA cope and mitigate the harmful effects.