Imagine waking up in the middle of surgery. While your eyes remain closed, you hear the metal instruments snipping, snicking, and clinking! Your body is cut open; you know it, but can’t feel anything. Your conscious self feels encased in a rock. You hear a voice saying, “The blood pressure is dropping!” You can hear them. You want to speak. Open your eyes, get up and stop them. Run away! But your body doesn’t respond; it feels frozen. Such a terrifying experience is not just a hypothetical nightmare; it is a real experience for a few patients. Anaesthesia is used to make an individual’s sensations numb and unconscious; however, rarely yet certainly at times the individual might regain their consciousness while the effect of anaesthesia makes them unable to move or sense anything. This is termed “anaesthesia awareness” or “accidental awareness during general anaesthesia (AAGA)”.
What Is Anaesthesia Awareness?
During surgery, the patient needs to be unconscious and numb (especially the portion to be operated on). General anaesthesia is applied to patients to ensure a temporary loss of sensation. However, in rare scenarios, they regain their consciousness and even sensation at times due to the anaesthetic level becoming too light. Regaining a complete sense of awareness is a gradual process rather than an immediate one.
While the anaesthesia dosage is minutely evaluated considering factors like blood pressure, age, etc., it can rarely but possibly be lighter than needed, thereby resulting in the regain of consciousness in patients before the surgical process is over. Some of the patients reportedly have a vague memory of hearing conversation, pulling sensations, and feeling pressure and pain, while a few of them have been observed to have vivid memories. To most, the inability to communicate and feel paralysed is more terrifying and exhausting than the pain of the surgery.
Studies have approximated the cases of anaesthesia awareness to be 1-2 per 1000 general anaesthetic procedures; however, the numbers slightly vary with factors like surgery type and risk factors (Mashour et al., 2012).
Being Alive but Dead Is Horrifying
Surgeries require muscle relaxants to temporarily paralyse the patient and nullify movements. Despite being completely conscious, the individual cannot move, communicate or even open their eyes. This state is termed “extreme uncontrollability”. Studies have shown that the impact associated with an event worsens when the individual feels powerless and helpless (van der Kolk, 2014). Patients have often described the experience of anaesthesia awareness as being buried alive.
In threatening situations, the human brain prioritises survival. The inability to move or feel their own body is interpreted as a danger with no escape by the human brain. The stress hormones intensify the emotions associated with the memories getting stored in the brain (LeDoux, 2000). Thereby making every sensation deeply memorable.
Surprisingly, medications fail to blur c; instead, they are often found to be remembered with clarity. Thus, although the wounds of the surgery heal, the trauma persists for a prolonged time.
Wounds Heal, but Trauma Doesn’t
While some overcome the trauma, others develop post-traumatic stress disorder (PTSD).
Studies have concluded a significant link between anaesthesia awareness and later PTSD symptoms (Samuelsson et al., 2007). Further research has concluded that individuals having experienced anaesthesia awareness are prone to developing insomnia, intrusive memories, panic attacks, depression and even distrust towards healthcare professionals to such an extent that they completely avoid hospitals.
Unlike physical wounds, trauma is invisible. Many a time, it goes unnoticed by the individual themselves as they discard it as just a strange dream. However, eventually they start doubting as they realise the memories might have been real. Several questions arise in their minds, such as:
- Am I just dreaming, or is it real?
- Did it actually happen, but when?
- Am I overstressing on this?
The effect of general anaesthesia makes the memories hazy; however, the intense emotions associated with those trigger the individual’s anxiety and fear.
Consciousness Is Mysterious
Consciousness remains a mystery to modern scientists. However, anaesthesia awareness leads to the fascinating conclusion, i.e., consciousness is not like an on-or-off switch. Even when a healthy individual’s nervous system is temporarily numbed, consciousness can remain active.
Modern anaesthetics temporarily affect the brain systems; however, individual responses still differ. Although monitoring technologies have improved patient safety, no system can guarantee safety in every circumstance (Avidan et al., 2008).
Actual Fear Is Powerlessness
One of the universal human fears is the fear of being paralysed, i.e., existing but with no control. During surgery, individuals trust themselves to the doctors, believing that they will be safely operated on while they are unconscious. However, the sudden regain of consciousness makes them question their trust. The ability to listen but not express forces in questions such as the following:
- What if I never regain my control?
- Why can’t I open my eyes? I can hear them.
- Why does the body feel so heavy to move?
Anaesthesia awareness is a medical and psychological phenomenon that showcases the close linkage of a sense of safety with the ability to express.
Conclusion
Earlier, the idea of anaesthesia awareness was discarded as a false feeling. However, modern science acknowledges it. Although anaesthesia awareness is uncommon, the survivors are heavily impacted by it. Early exposure to trauma care, regular check-ups and post-operation follow-ups have proved to be beneficial for the patients to restore their sense of reality. Believing them allows them to process the event more calmly.
Being aware, conscious and yet helpless and powerless to move is a traumatic experience. Studying these experiences leads to the ultimate conclusion that even when the nervous system is numb, consciousness exists and desperately seeks communication.
References +
LeDoux, J. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23, 155– 184.
Sandin, R. H., Enlund, G., Samuelsson, P., & Lennmarken, C. (2000). Awareness during anaesthesia: A prospective case study. The Lancet, 355(9205), 707–711.
Osterman, J. E., Hopper, J., Heran, W. J., Keane, T. M., & van der Kolk, B. A. (2001). Awareness under anaesthesia and the development of posttraumatic stress disorder. General Hospital Psychiatry, 23(4), 198–204.
Ekman, A., Lindholm, M. L., Lennmarken, C., & Sandin, R. (2004). Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiologica Scandinavica, 48(1), 20–26.
Samuelsson, P., Brudin, L., & Sandin, R. H. (2007). Intraoperative awareness during general anaesthesia: A long-term follow-up of patients’ experiences. Acta Anaesthesiologica Scandinavica, 51(8), 1040–1047.
Avidan, M. S., Zhang, L., Burnside, B. A., Finkel, K. J., Searleman, A. C., Selvidge, J. A., et al. (2008). Anaesthesia awareness and the bispectral index. New England Journal of Medicine, 358(11), 1097–1108.
Mashour, G. A., Shanks, A., Tremper, K. K., Kheterpal, S., Turner, C. R., Ramachandran, S. K., et al. (2012). Prevention of intraoperative awareness with explicit recall in an unselected surgical population. Anesthesiology, 117(4), 717–725.
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
