Claims for being awake during surgery -“Anaesthetic Awareness”

Claims for being awake during surgery -“Anaesthetic Awareness”

Learn about compensation claims for being awake during surgery

anaesthetic awareness and a lady patient

Our friendly team of specialist lawyers at Medical Solicitors help people who have suffered from negligent medical treatment leading to anaesthetic awareness. Compensation can be claimed where a patient has suffered pain and trauma from being aware during surgery due to Medical Negligence. 

If you think that you have been awake during surgery, then something has gone wrong with the anaesthetic and you may be able to claim compensation for what is called ‘anaesthetic awareness’. 

Do contact our friendly team of specialist lawyers at Medical Solicitors. We conduct most of our Clinical and Medical Negligence claims under ‘No Win, No Fee’ agreements, also known as Conditional Fee Agreements. So, you do not have to worry about how you are going to afford to bring a claim. You have nothing to lose in speaking to us.

When can anaesthetic awareness happen?
Anaesthetic awareness can occur during surgery but also after surgery, in the recovery room. Also, after surgery in intensive care, where patients are kept sedated or tranquilised. It can occur whilst patients are paralysed (and intubated) and are connected to life-support machines.

Some patients may dream around the time of surgery. This is common (3 to 6%), but it does not constitute awareness and can confuse the issue. Patients may also recall sounds or conversations as well as the presence of airway devices still in their body as they regain consciousness. A patient may mistakenly think this was as awareness. On the other hand, true cases of being awake during surgery can be difficult to detect.

How often does being awake during surgery happen?

Doctors now recognise that patients being awake during surgery ocurrs more than many previously thought. Public awareness is also increasing, with cases involving failings in medical care receiving more attention in the media than ever before.  Do you remember the 2007 Hollywood film “Awake” that drew many people’s attention to the subject? In addition, doctors have conducted research (through clinical trials involving large numbers of patients) that have shown that around 1 or 2 patients out of every 1000 experience some form of awareness.

How do patients know if they have been awake during surgery?

Some patients report anaesthetic awareness immediately after surgery. Others may not realise they were aware until days or even weeks after the event. A well-established method of detecting awareness involves the use of what is called a ‘Brice interview’. This method involves asking the following questions:

  1. What was the last thing you remembered happening before you went to sleep?
  2. What was the first thing you remembered happening on waking?
  3. Did you dream or have any other experiences while you were sleep?
  4. What was the worst thing about your operation?
  5. What was the next worse thing?

Consequences of anaesthetic awareness during surgery:

Awareness can lead to anxiety, fear of surgery and anaesthesia and sleep disturbances. It can also lead to flashbacks, nightmares and post-traumatic stress disorder or depression.

There are also consequences for the anaesthetist too. A study by the American Society of Anesthesiologists (ASA)  showed that 1.9% of claims were for anaesthetic awareness. The blame was put on substandard care, such as mistakes in drug labelling and administration.

Contributing factors:

There are often various causes of intra-operative awareness:

  1. Misjudging the dose needed for a patient
  2. Problems tolerating side effects of anaesthetic agents
  3. Failure to detect that a patient is in a state of awareness, or light anaesthesia
  4. Problems with equipment and drug delivery

Problems with anaesthetic side effects:

General anaesthesia can slow down the cardiovascular system. There are some types of surgery where anaesthetic doses may be deliberately reduced for safety, to maintain blood pressure. However, the risks of a patient then experiencing some degree of awareness during surgery does increase.

These typically include cardiac surgery, emergency or trauma surgery and Caesarean section. In Caesarean section, there are also concerns about the effects of general anaesthetic upon the unborn child, more so where there are pre-existing concerns about the unborn child.

Pre-operative checks:

A thorough history and examination can identify whether a patient is at greater risk of suffering anaesthetic awareness. Specific factors may include:

  • A history of previously having reported feeling awake during a surgery.
  • Drug abuse. Also being a long-term user of opiates for chronic pain, heart and vascular problems.
  • A previous history of difficult intubation or anticipated difficult intubation.
  • Heart, Caesarean, emergency and trauma surgery carry higher risks of anaesthetic awareness.
  • The anaesthetic technique may also increase the risk, if muscle relaxants are used.
  • Also, the risks increase with the where the anaesthetic is given just by inhalation (this is called ‘TIVA’), rather than through the veins or if  rigid bronchoscopy is used.

If risk factors are present, this should be discussed with you and you may be offered medication (benzodiazepines) before the anaesthetic to relax you (called ‘pre-medication’).

Methods for reducing the risks during surgery:

  • Drugs (benzodiazepines) can be used at the start of anaesthesia, particularly if a difficulty is anticipated the intubation stage.
  • There are other methods for managing blood pressure and heart rate, other than adjusting the level of anaesthetic. For example, using a vasopressor or an inotrope rather than continually reducing the anaesthetic concentration.
  • Monitoring brain activity in  a patient (through ‘EEG’) is a technique. However, this is not routinely used in the UK.

It may also be worth considering using depth of anaesthesia monitoring when available (see below). Despite precautions and good technique, some cases of anaesthetic awareness will still occur. Anaesthetists’ records should be clear about when drugs were administered and in what dose. It should also be clear what forms of monitoring were used.

What should happen if a patient reports being awake during surgery?

If a patient complains of being awake during surgery, it is important a doctor visits them to identify exactly what has happened. It is necessary to differentiate between dreams or recall of events that represent real awareness. Denying the patient’s version of events may contribute to a worse psychological outcome for them so it is important to apologise for their experience and express some sympathy. Detailed written records of these processes are vital.

The patient should receive adequate psychological support afterwards not only in the form of a regular visit by the anaesthetist but with the referral for counselling or psychotherapy if necessary. The patient’s general practitioner should also be informed so that this information can be taken into account when future treatments may be planned.

Summary:

So, although being aware during surgery is a potentially devastating it is a rare event. It may not be possible to prevent every case from happening, but it is possible to identify high-risk cases. Once risks have been identified your doctors can plan to reduce the risks. In any event, for all patients, doctors must take great care to avoid errors.

Follow our links below to quickly access our information pages about how we can help with: a complaint about care, funding a medical negligence claim for anaesthetic awareness, and more:

Follow our links below to quickly access our information pages about how we can help with: a complaint about care, funding a medical negligence claim and more:

Read Dianne Parr’s story in the Daily Mail:

http://www.dailymail.co.uk/health/article-537510/I-awake-feel–I-paralysed-speak-Pass-scalpel-said-surgeon-.html

<< Back to different types of Medical Claims