The Joint Commission on Accreditation of Healthcare Organizations on Tuesday urged hospitals nationwide to take steps to prevent "anesthesia awareness" -- instances in which patients wake up during surgery and sometimes feel excruciating pain without being able to cry out.
An estimated 20,000 to 40,000 patients wake up during general anesthesia each year, and about one-quarter of them report feeling pain, the JCAHO said in an alert sent to the 4,579 hospitals it monitors nationwide.
The sensation is described by some as being like "entombed in a corpse."
"Some patients describe these occurrences as their 'worst hospital experience,' and some determine to never again undergo surgery," the alert said.
Dennis O'Leary, M.D., the commission's president, said patients who might wake up during an operation should be warned and that all general anesthesia patients should be monitored and asked about any awareness during surgery. He said patients who suffer such an experience deserve an apology and should be offered counseling if needed.
"When a patient says, 'I was awake during surgery,' you don't laugh and blow them off," which sometimes is the response, O'Leary said.
Carol Weihrer, who runs a patient advocacy group called the Anesthesia Awareness Campaign, said none of those actions were taken before or after a 1998 operation in which her diseased right eyeball was surgically removed.
"I felt the pulling and tugging and the pressure of the cutting while the surgeon was instructing the resident to cut deeper and pull harder," said Weihrer, 53, of Reston, Va.
Weihrer said she is delighted with JCAHO's alert. "I'm hoping that the impact will be that this will finally come to a head in the professional community" and help prevent other cases, she said.
JCAHO's recommendations could eventually become accreditation requirements, O'Leary said. That would mean that hospitals that fail to act could risk losing accreditation, along with federal dollars and prestige.
Anesthesia awareness has been known to happen during some heart, emergency obstetric and trauma operations in which patients might be too ill to get heavy doses of anesthetic drugs. Patients often do not become fully conscious but report hearing doctors' conversations or feeling unable to breathe. Because of the routine use of paralytic drugs during general anesthesia, patients often are unable to alert the surgeons.
Using shorter-acting intravenous drugs rather than inhaled anesthesia can lead to patients' gaining consciousness on the operating table. So can decreasing the drug dose too soon after surgery to get patients in and out of the operating room more quickly, JCAHO said.
Some doctors favor the shorter-acting IV anesthetics because they allow patients to become alert more quickly after an operation, with fewer side effects, said Asokumar Buvanendran, M.D., an anesthesiologist at Rush University Medical Center in Chicago.
Roger Litwiller, M.D., president of the American Society of Anesthesiologists, said JCAHO's alert will help raise awareness about the problem, which he called uncommon but still a concern.
"If it happens to one patient and it's something we can prevent, that's one patient too many," he said.