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Patients Awake During Surgery: What to Do?

Oct 25, 2005 | AP

A national doctors' group adopted new standards Tuesday to help prevent patients from awakening during surgery.

But the physicians stopped short of embracing the use of new devices that monitor patient awareness.

The American Society of Anesthesiologists, meeting in Atlanta, approved the group's first-ever standards on preventing a rare but terrifying situation in which patients wake up during surgery and sometimes feel excruciating pain without being able to cry out.

Such awakenings occur in 1 or 2 cases out of every 1,000, the group said. But the phenomenon received press coverage following some lawsuits by patients, and after the Joint Commission on Accreditation of Healthcare Organizations last year urged hospitals to better monitor patients for the problem and ask them about it after surgery.

The anesthesiologists' society called for doctors to follow a checklist protocol for anesthesia equipment to make sure proper doses are being delivered.

However, the group decided against adopting a new generation of brain-function monitors as a standard of care.

Perhaps the best known of the machines is the Bispectral Index (BIS) monitor made by Aspect Medical Systems Inc. of Massachusetts. The BIS monitor tracks brain-wave activity and provides doctors a reading that represents the mathematical probability the patient is wide awake.

The machine has been on the market since 1996. It retails for about $9,500, but the negotiated purchase price is frequently $5,000 or less, a company spokeswoman said.

Aspect has pushed for its machines to become a standard feature in operating rooms, but some doctors have resisted, saying clinical evidence of BIS monitors' effectiveness was wanting.

On Tuesday, the society said doctors can consider the devices on a case-by-case basis particularly in trauma surgeries and Caesarean sections, which are two procedures in which deep anesthesia is often avoided and partial awareness is most likely.

But while at least one study has found the devices to be effective, others have reached a different conclusion, society members said.

"There is insufficient evidence to justify a standard, guidelines, or absolute requirement that these devices be used," said the recommendation the society adopted.


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