A new study offers insight into what happens in the brain when a person is given anaesthesia, and the finding could help spare patients the traumatic experience of becoming aware of their own surgery.
The British researchers suspect they've found a type of brain activity that marks the point when patients truly go under, and are no longer conscious. If further research confirms that this is the point where people lose awareness, "it may change the way that anaesthetics are delivered worldwide," said study co-author Katie Warnaby, a research fellow at the University of Oxford in the United Kingdom.
At issue: Patients who aren't fully anaesthetized when they undergo an operation or who begin to regain consciousness before the surgery is finished. Physicians believe so-called "accidental awareness" is rare, with one survey of anaesthesiologists suggesting that the rate of such cases is just one in 15 000 patients. But another estimate suggests 20 000 to 40 000 patients in the United States become aware while under anaesthesia each year.
Levels of awareness
It's important to understand that there are different levels of awareness, said Dr Russell McAllister, an associate professor of anaesthesiology at Texas A&M Health Science Centre College of Medicine. "For a patient under light or deep sedation, it would not be uncommon to experience recall of certain events during the procedure. For a patient under general anaesthesia, it is not a common event," he said.
It's clear, however, if accidental awareness can be horrific for patients who feel the intense pain of surgery but have no way to let anyone know in the operating room. Some of the patients report lasting emotional scars and even symptoms of post-traumatic stress disorder.
In the new study, researchers used EEG tests and functional MRI scans to study the brain activity of 16 patients who were given propofol, a commonly used anaesthetic drug. "We were trying to pinpoint the changes that occur in the brain that lead to anaesthetic-induced loss of consciousness," Warnaby said.
The researchers focused on a certain type of brain waves known as low-frequency electrical waves, or slow waves.
"We found that if we focused on this slow wave frequency band, we saw that the amount of electrical brain power in this band reached a maximum level before the anaesthetic dose had finished rising," Warnaby said. "These slow waves started to increase when each individual became unresponsive and reached a maximum later in time."
The findings suggest that EEG machines could be put to better use to monitor whether patients are in deep sleep, she explained.
The researchers suggest it's fairly rare for anaesthesiologists to use EEG machines to monitor patients under anaesthesia, Warnaby said. "There isn't much evidence that these current methods are that much better than traditional monitoring at reducing awareness during surgery," she noted.
She said it's possible that a system could be developed to better monitor awareness in patients that would be comparable in cost to current systems, and it could save money by delivering the right amount of anaesthesia and preventing lawsuits after a patient becomes accidentally aware during surgery.
McAllister offers one caution. He said the new study is limited because it just looks at one kind of anaesthesia when it's common to give combinations of drugs to patients. For now, he said, "the best monitor for preventing awareness under anaesthesia is an experienced and vigilant anaesthesia provider. Additional monitors can provide useful information that can guide an anaesthetic. However, the research regarding reliability of these monitors thus far have not indicated that they should be a standard of care."
What's next? The researchers believe they'll see the same kind of brain activity in patients who are actually undergoing surgery, "but we will need to do further experiments to see how it can be affected by other drugs given during surgery, like painkillers," Warnaby said.
The study appears in Science Translational Medicine.
For more about anaesthesia, visit the U.S. National Library of Medicine.
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