Sunday, August 12, 2007

Ninth Circle of Helll

I remember waking up on the operating table during an operation I had a few years back; experiencing pain so intense, it permeated every cell of my being. I writhed on the table howling in horror at what was happening to me. I remember the doctor cursing at everyone ordering that I be put back under and then nothing...I was totally free of what was the worst pain I have ever felt.

But what if I could not move? Could not shout? Could not alert anyone to the pain I cannot find words to describe? I could only lie there, totally paralyzed, feeling every slice of the surgeon's scalpel as he sliced and diced my flesh and internal organs, every suture or staple as it pierces my skin. Every second seems like a minute, every minute, and an hour and on and on until I could only assume I descended into Dante's Ninth Circle of Hell.

Unfortunately, this is all too real for some people in a rare occurrence called anesthesia awareness. The patient lies there fully aware of the surgery that is taking place on their body and feeling all the pain of the operation without being able to move a muscle, moan, scream...totally powerless over what can only be described as the most grisly nightmare except that it is really happening. It is the unseen pain, that cannot be shared which must make the patient feel so alone and left only to conclude what can only be described as the deepest alienation from God.

There is a relatively easy remedy to prevent this from happening to anyone but it is only used in 17% of anesthesia patients. Monitoring the brainwaves of the patient while anesthetized will more than likely show the patient's level of awareness. There are also other precautions the anesthesiologist can take:

* Consider premedication with amnesic drugs, e.g., benzodiazepines or scopolamine, particularly when light anesthesia is anticipated.

* Administer more than a "sleep dose" of induction agents if they will be followed immediately by tracheal intubation.

* Avoid muscle paralysis unless absolutely necessary and, even then, avoid total paralysis [by using only the amount clinically required].

* Conduct periodic maintenance of the anesthesia machine and its vaporizers, and meticulously check the machine and its ventilator before administering anesthesia.

* In addition, anesthesia practitioners should be alert to patients on beta-blockers, calcium channel blockers and other drugs that can mask physiologic responses to inadequate anesthesia.


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