Anesthesia Awareness During Surgery Not Linked to PTSD: Study

Rare problems with anesthesia may occur during surgery that leave patients awake and experiencing the pain and discomfort of the procedure, but unable to move or speak. However, a new study suggests that individuals who experience such “anesthesia awareness” events do not appear to be at risk for suffering post-traumatic stress disorder (PTSD).

Anesthesia awareness is a known surgical complication that can occur when patients are not given proper amounts of general anesthetic or analgesic to render them unconscious during the procedure. However, paralyzing drugs that are typically given before the surgery to prevent involuntary muscle movements, leaving the patient unable to communicate their awareness to the healthcare providers.

In addition to the severe pain that may be experienced due to these rare anesthesia problems, concerns have been raised about the long-term psychological impact such events may have on patients, including the possibility of PTSD caused by memories of being operated on while awake.

In a study published in the July issue of the medical journal Anesthesia & Analgesia, researchers found no different psychosocial outcomes among patients who were aware during surgery when compared with those given proper anesthesia.

Researchers from the Centre for Military Medicine in Helsinki, Finland, studied nine patients who experienced episodes of awareness during anesthesia and nine control patients who had not.

All patients underwent psychiatric diagnostic interview and questionnaires, including diagnostic interviews which assessed PTSD, anxiety, depression and other psychiatric disorders. They studied the patients an average of 17 years after the documented awareness episode.

The nine patients who suffered the episodes had a “definite awareness with recall” during surgery and accurately described events that occurred during surgery. They were identified from other Finnish studies of intraoperative awareness.

Researchers found patients with awareness episodes did not seem to differ from their matched controls in psychosocial outcome, psychiatric morbidity or quality of life. In fact, measures of quality of life were similar between the two groups.

“We found no indication that intraoperative awareness with recall had any deleterious long-term effects on patients psychosocial outcome,” said Dr. Tanja Laukkala, lead author of the study.

None of the patients who experienced episodes were diagnosed with PTSD. Those patients also did not meet the criteria for experiencing a “potentially traumatic event,” the type leading to PTSD.

Researchers said anesthesiologists should respond to the findings with optimism and caution, but also realize more research is needed to find which patients and procedures are associated with a higher risk of experiencing an awareness episode.

The study was the longest followup study of patients with documented awareness episodes during surgery. The patients were offered psychiatric support and services following the episodes.

It is often difficult to find patients who have undergone the experience. Other studies have researched the phenomena, however researchers say the results may be skewed considering advertising was conducted to find the patients.

Researchers emphasize the importance in preventing intraoperative awareness and offering support to potentially traumatized individuals.

Some experts say it is important to monitor anesthesia awareness with new technologies, such as brain wave monitors or alarms to notify doctors if anesthetic concentrations are too low in exhaled gas, to avoid complications or side effects.