“Like a patient etherized upon a table”: The horror of anaesthetic awareness

Whilst the statistical likelihood of finding yourself awake on the surgical operating table is less than 0.5%, the horrific idea of ‘anaesthetic awareness’ remains active in the popular consciousness. Although grouped under the title ‘general anaesthesia’, in fact anaesthesiologists administer a wide range of different drugs to place their patient into a sustained state of unconsciousness.

Despite the fact that televised medical dramas have made many of us familiar with the notion of being ‘put to sleep’ (we’ve all seen the injection of an induction agent such as sodium pentathol being given to the patient just before they’re wheeled into theatre), the process of anaesthesia is much more complex. After injecting this first drug, the anaesthesiologist also typically gives his patient an opiate (which works as a pain-eradicating analgesic), a benzodiazepine to reduce anxiety and a neuromuscular ‘blocking’ agent such as vecuronium. This sleeping state is then maintained by having the patient breathe oxygen laced with a vaporized liquid anaesthetic such as isoflurane.

Whilst medical advances have made anaesthesia the safest it has ever been, there are inevitably certain subsections of society who are more at risk of experiencing anaesthetic awareness. Although steps can be taken to offer alternative drugs to patients with medical conditions that would put their health in danger (like those with low blood pressure or women who require emergency caesarean operations) there will always be a margin of risk for anyone who undergoes surgery. Indeed, it is clear that any error in planning – no matter how small – could see the paralysing effects of a neuromuscular blocking agent become catastrophic for the patient. Even though the agent is used with very good reason (anaesthesia slows down the patient’s respiration rate and the paralysis induced by a neuromuscular blocker facilitates effortless control over their breathing), the fact that neuromuscular drugs make no impact on the patient’s consciousness leaves them vulnerable to an unimaginably horrific experience.

Certainly, in the event of any mishap (unanticipated patient tolerance, human or mechanical fault or if the other anaesthetic agents prove insufficient) then the patient is potentially left wide awake, unable to move and terrified. Whilst the clues are there for an observant anaesthesiologist (an increase in blood pressure and heart rate show that the anaesthesia is wearing off slightly), there is always a chance this could be missed.

Statistics vary on the specifics, but there is no doubt that anaesthetic awareness causes deep psychological effects for those who experience it. Although anaesthesia awareness remains relatively rare, the anxiety suffered by those who experience it should not be underestimated, with over 70% of victims experiencing lasting psychological symptoms for the rest of their lives. With such troubling and traumatic potential effects from anaesthesia, it’s no wonder that there are now medical negligence claims specialists helping people secure compensation for this horrible ordeal.