panic attacks about upcoming surgery

. Now we have sophisticated sedation systems, but the fear of an anaesthetized patient regaining consciousness during surgery remains, for those on both sides of the knife. By the beginning of the 19th century, a number of drugs began trickling into public consciousness. Alcohol and opiates had been available for centuries and their intoxicating properties were occasionally exploited during surgery, but it was in 1799 that the English chemist Sir Humphrey Davy discovered the anaesthetic properties of nitrous oxide (laughing gas). It could do wonders for a toothache, he claimed. Two decades later, his protégé Michael Faraday found that ether had similar effects. The first official public demonstration of ether anaesthesia took place on 16 October 1846 at Massachusetts General Hospital in Boston. It's difficult to overstate the importance of this medical milestone. For patients, the deep, ether-induced sleep offered escape from a terrifying trauma. For surgeons, it opened the door to a whole new world of operative inquiry. With the patient sedated, surgery could slow down, allowing a much-needed element of accuracy and control to come into the operation. The surgeon's scope of activity, once limited to speedy amputations and work at the surface, could now encompass more delicate areas like the inside of the chest, the abdomen and the skull. Suddenly, surgery was no longer seen as a last resort, but as an integral part of medical practice. ABC of anaesthesia First up is a thorough evaluation of the patient: in some ways, this is the most important aspect of the procedure. An assessment of the patient's weight, age, medical history and current medication enables the anaesthetist to make informed decisions on which drugs to use, when to use them, and in what dosages. Before a patient enters the operating theatre, they are often given a sedative to help them relax and relieve any anxiety they may be feeling about the operation. This is followed by the general anaesthetic itself, usually administered via intravenous injection, which will cause loss of consciousness in the patient. At this stage, it's also common to inject a muscle relaxant, so that the patient's body becomes more submissive to the surgeon's knife. Early forms of muscle relaxant were derivatives of the plant extract curare, a potent neurotoxin used by South American Indians to make poison arrows. With the muscles paralysed, breathing is impossible, so the patient must be intubated and attached to a breathing machine throughout the operation. To sustain the anaesthesia, the patient typically breathes a sleepy blend of nitrous oxide, oxygen and halothane. This mix of gases is sometimes augmented by drugs fed intravenously through a canula in the patient's hand. As soon as the operation is over, the patient is injected with a cholinesterase, a drug which reverses the effects of the muscle relaxant. Once normal breathing is re-established, the intubation tube can be removed and the breathing machine turned off. As the patient comes round, analgesic drugs are made available to control any post-operative pain. A waking nightmare In 1960 the medical community woke up to a startling revelation. A study had found that more than 1% of patients experienced some kind of awareness whilst under general anaesthetic, ranging from full-blown consciousness to recollection of fragments of surgical events. Pain and anguish during the operation were followed, in many cases, by mental problems afterwards. Some patients suffered from anxiety, depression and a pre-occupation with death. This was years before post-traumatic stress disorder was a recognised syndrome, but its symptoms were already on full display. Anaesthesia has come a long way since this seminal study. More sophisticated drugs and improvements in technology mean that anaesthesia is safer than it's ever been. But the fear of consciousness regained during surgery still haunts the operating theatre. In a recent survey of over 10,000 patients who were due to undergo an operation, 54% said that they were anxious about anaesthetic awareness. Are these fears justified? Latest estimates suggest that about 1 in 1000 patients will experience some level of awareness during surgery. What seems like a small percentage becomes far more significant when you realise that worldwide there are about 100 million operations annually. Which means that about 100,000 people will suffer from anaesthetic awareness every year. In 90% of cases, patients will suffer no pain, but the memory of the experience may lead to psychological trauma. In a sense, anaesthetic awareness is a more terrifying prospect than the unsophisticated surgery of yesteryear, before the advent of anaesthesia. Back then, patients could at least register their discomfort with a scream. Today, there's no such luxury. The drugs for muscle paralysis that are often administered during surgery may leave patients utterly helpless. If the patient does wake up, there's no way to raise the alarm. They may hear and feel everything that's going on around them, but they are unable to communicate their pain. The anatomy of failure Mistakes are inevitable in any procedure involving a human operator. Some patients have woken up during operations simply because the anaesthetist failed to spot an empty gas bottle or a leak in the breathing system. But negligence alone cannot explain all cases of anaesthetic awareness. Anaesthesia remains an inexact science. While things normally go according to plan, the whole procedure is dogged by elements of uncertainty. The anaesthetist's initial evaluation will direct him towards the most appropriate course of treatment, but the system isn't foolproof. Patients don't always tell the truth about themselves, especially when it comes to sensitive issues like drink and drugs. Even when patients are forthcoming, exact outcomes are impossible to predict. Individuals vary in their response to anaesthesia because of differences in health, history and genetics. And while the anaesthetist may be able to get a handle on the first two factors, tailoring an anaesthetic to an individual's unique genetic make-up is still something for the future. Added complications arise in those operations where the anaesthetist is already walking a fine line. In caesarean sections, for instance, the anaesthetist must balance the needs of the mother with the needs of the unborn child. If he uses too much anaesthetic he runs the risk of damaging the child. But use too little and there is a real danger that the mother will wake up. Of course, the modern operating theatre is equipped with all kinds of gadgets designed to help the anaesthetist monitor and control the anaesthesia. But the depth of anaesthesia remains a notoriously difficult quantity to measure. A monitor that provides a definitive guide to awareness is seen as the Holy Grail of anaesthesia. Currently, there is considerable excitement surrounding the bispectral index (BIS), a new device which turns the electrical activity of the brain into a simple measure of awareness. The memory effect General anaesthesia can be seen as a controlled coma, in which the anaesthetist steers the patient into unconsciousness and back again. Throughout the operation, the patient should remain oblivious to the surgeon's knife and unresponsive to instructions. When the patient wakes up, the surgery should be a blank to them. Of course, anaesthetic awareness represents a catastrophic failure of these principles. But the picture is far from black and white. Evidence seems to suggest that even patients who have been adequately anaesthetized retain some sense of memory. In one experiment, for instance, patients under general anaesthetic were read a series of words during surgery. After the operation, they had no memory of the event. But when asked to pick out the suspect words from an identity parade, they were far more successful at doing so than the control subjects. In other words, explicit memory had been wiped clean, but implicit memory (involving the sub-conscious processing of information) was intact. Interestingly, not all anaesthetic agents produce these kinds of effects. The physiological mechanisms underlying the action of anaesthetics are still poorly understood, but it seems clear that different anaesthetics act in varying ways, leading to correspondingly different effects on implicit memory. There is concern among some physicians that any memory retained during operation, implicit or otherwise, represents a failure of general anaesthesia. Although implicit memory doesn't imply awareness, there are cases where patients have experienced classic post-operative symptoms of anaesthetic awareness, like depression, nightmares and anxiety, without any explicit recall of surgical events. Thankfully, anaesthesia has come a long way in 160 years, but with gaps like this in our knowledge it remains something of an enigma.

Sweety .. I am sure you are scared about the surgery . And from the looks of this post you are really delving into research . And that is good ... but I am thinking you are getting way to far into the logistics of it all . This surgery has come so far over the last 5 years . And as you posted there are risk with the anesthisia .. but the doctors that perform this are highly trained .. and the likely hood of you waking up during this is very slim . They will be monitoring you like a hawk and the first signs of any abnormal activity such as your blood pressure rising .. increased heart rate the start adjusting your meds . They know trust me .. I have had in the course of the last 20 years a total of 15 major surgeries . And one so drastic that I was under for 7 hours .. My RNY I was under for 6 .. ( due to hernias and scar tissue ) And not one time do I ever remember being awake .. I tell you .. when they came in to the surgery suite the day of my RNY I was given all of my IV's and then they told me they where about to give me something to help me " forget " Then they began scrubbing my back to insert the needle for my epideral .. that is all I remember from that point on .. I do not remember being wheeled into the operating room .. the next time I was awake was when I awoke in ICU . 6 hours later .. THANK GOD FOR THE GOOD DRUGS RIGHT ! I would express your concerns to your doc .. he will make you comfortable .. Try not to worry .. I know it is easy to say .. I am over here on this side ...just have faith that they do know what they are doing and you will be fine . Hugs to you .. Natalie

Thanks. I have to admit not only do I overanalyze everything, I really enjoy the process. It is a key to understanding what makes me tick. For the most part, this is a good thing, but clearly in these type of situations, instead of making things bette, I start to fuel my insecurities. Your observation was dead on, and exactly what i need to stop doing now before surgery. Thank you!

Hey Kristine! This is actually one of the fears I have been battling myself. I saw a tv show a year or two ago where this woman was interviewed who was aware of what was going on during the surgery. There was more to the story, and needless to say I was freaked Finally (a couple of months ago), my rational took over, and I realized these people are well trained in their jobs. Unfortunately, sometimes bad things happen that are beyond our control. This afternoon, I could be struck and killed by a car in the crosswalk on campus. Let's hope not, but it has happened before. I don't want to miss out on "life" because of my fear of anaesthesia. I've been working on stress reducing techniques and plan on bringing my electronic solitaire game to keep my focus away from the surgery when I have alone moments during pre-op (my mind races most when I am left alone). This is going to be my first surgery. I've never broken a bone, had stiches, had an x-ray, etc. What a way to jump right in I hope this helps. It was nice to know someone else out there has the same fear as me. Julie