A 22-year-old woman is admitted to an ambulatory surgical facility for a cosmetic rhinoplasty. Other than occasional alcoholic beverages and a history of smoking, the 5-foot-2, 113-pound woman is healthy.

After evaluating her and classifying her as an ASA PS I patient, the anesthesiologist induces anesthesia uneventfully. As part of her surgical procedure and for hemostasis, the surgeon infiltrates 30cc of 1% Xylocaine with epinephrine in and around the nasal area. The rhinoplasty takes about two-and-a-half hours to complete. The patient's vital signs are stable throughout the procedure, with no increases in pulse or blood pressure, signifying a light level of anesthesia. The anesthesiologist maintains anesthesia with a combination of light inhalation anesthesia administered via endotracheal tube and intravenous narcotics. After an unremarkable PACU stay, the staff discharges the patient home with no complaints.

She heard every word
The next day, the patient tells her plastic surgeon that she's "going crazy" because she vividly remembers parts of her operation. The surgeon initially dismisses her complaints, believing that the patient is only recalling the emergence. But when he presses her, the patient recites, verbatim, conversations that occurred during the procedure.

The patient tells the surgeon that she hadn't felt pain, but that she'd been terrified because she was acutely aware of what people in the room were saying, but couldn't talk or move. She couldn't state for how long she'd been "awake," but it was several minutes. She also states that she felt some "pressure" around her nose and felt some "scraping" going on. The surgeon persists, but she repeatedly denies feeling any pain whatsoever. She tells her surgeon that she'd been thinking about the episode and is upset about the care she had received.

Patient urged to file suit
The surgeon, convinced that the patient had indeed suffered intraoperative recall, immediately contacts the anesthesiologist, who asks the patient to meet him at the hospital later that week at a mutually convenient time. In the meantime, the patient's friends and family urge her to consider bringing suit against the anesthesiologist for the psychological distress caused by her intraoperative awareness.

The anesthesiologist reviews the anesthesia record, talks to the surgeon and interviews the nurses who assisted in the case, but finds no suggestion of light anesthesia. He wonders whether the infiltration of local anesthesia had blocked the stimuli normally responsible for sympathetic signs of light anesthesia.

When he interviews the patient later that week, he explains that awareness sometimes occurs, although it's rare. He also reassures the patient that she was not crazy and that her recollection had actually occurred. The patient shares with the anesthesiologist that her friends are suggesting she bring suit because she is upset and is having trouble sleeping. What was the outcome?