A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Dianne Taylor
Published: 10/10/2007
Like being entombed in a corpse. That's how Carol Weihrer describes being aware for some potion of her five-hour enucleation/coral implant surgery in 1998. Nearly seven years later, Ms. Weihrer, 52, of Reston, Va., sleeps in two- to three-hour intervals in a recliner because she cannot lie supine. She often awakens with cuts and scratches on her face. At one point, she says she unconsciously dug out her punctum plugs.
Today, Ms. Weihrer suffers from post-traumatic stress disorder (PTSD) because, she says, she became aware during her surgery and cannot rid her mind of the memories. Memories like one surgeon delivering the instructions "cut deeper" and "pull harder" to the other surgeon. Intense tugging on her eye. A blinding white surgical light. Painful burning sensations scorching through her body after an injection of paralytic medication. Most of all, Ms. Weihrer remembers the horrifying feeling of being consciously "entombed" on the operating table with no means of escape.
She has since dedicated her life to warning of the dangers of anesthesia awareness and agitating for changes in how doctors monitor a patient's consciousness. "Shortly after I personally experienced anesthesia awareness - being awake but unable to move while supposedly under full general anesthesia - while having my eye removed, I vowed to make it my mission to prevent even one person from experiencing the same horror and long-lasting consequences," she writes on her Web site, www.anesthesiaawareness.com.
Ms. Weihrer's experience represents the worst that can happen when patients become aware during surgery. Nevertheless, it - along with the ensuing legal battle that Ms. Weihrer says ultimately ended in a "significant" settlement - demonstrates that patients, providers and facilities alike can suffer when a patient awakens during surgery.
Here's a look at what you can do to prevent anesthesia awareness. We also recap what's happened in the EEG-monitoring realm over the last year (see "Update on Consciousness Monitors" on page 43).
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What causes awareness?
Research shows that one or two of every 1,000 patients who receive general anesthesia experience awareness with recall. Researchers have defined five possible causes of awareness:
Consequences
Anesthesia awareness can be very distressing for patients, especially when the patient is paralyzed. The majority of patients who experience awareness tend to suffer some sleep disturbances, nightmares, anxiety and/or flashbacks. Some-times, as in the case of Ms. Weihrer, chronic PTSD sets in.
There are consequences for practitioners and facilities, as well. A 1999 analysis of 4,183 closed malpractice claims from the database of the American Society of Anesthesiologists showed that 1.9 percent were awareness claims. Payments ranged from $1,000 to $23.2 million, although the median payments for patients inadvertently paralyzed while awake and for patients who experienced recall during general anesthesia were $10,250 and $105,000, respectively, according to Dr. Spitellie's report.
Tips for prevention
To prevent anesthesia awareness, experts recommend considering the following guidelines:
Treatment
When awareness does occur, the worst thing the healthcare team can do is disbelieve or ignore the patient. Intraoperatively, if a patient becomes aware, the practitioner should explain the situation and offer affirming comments until the patient loses consciousness, according to one expert. Post-operatively, Dr. Spitellie and his colleagues recommend compassionate consultation or debriefing to prevent a prolonged traumatic reaction. Frequent follow-up is important, as is a referral to a psychologist or psychiatrist if symptoms like anxiety, flashbacks and nightmares persist.
Some patients fail to report awareness experiences, however, and this can prevent or delay treatment. Although some practitioners may resist the idea of discussing the potential for awareness with patients before surgery, Dr. Spitellie and his colleagues suggest that this could prevent patient suffering and subsequent litigation because the patient will be more likely to report the incident early and receive appropriate treatment.
Overall protection
Research suggests that many patients worry about awakening during surgery, and growing media attention to this issue may increase these anxieties. By counseling appropriate patients, taking measures to prevent anesthesia awareness and initiating proper care when it does occur, you can address these fears head-on while better protecting your facility, your practitioners and your patients.
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