22 October 2009


When one of my patients is emerging from an anaesthetic, I often ask them to open their eyes as confirmation that they are awake before moving through to the recovery room. I never really wondered before what their level of awareness might be before this point.

A patient came for a routine incision and drainage of an abscess, and recieved a routine anaesthetic for the procedure. The whole process was completed uneventfully. As the surgeon was about to place the dressing, a nurse pointed out to him that the particular dressing he was using was inappropriate, and suggested another (as she had previously been a rep for a company manufacturing dressings, and knew what she was talking about). The surgeon changed his mind, and used the suggested dressing. When this was done, I closed the gas and woke the patient.

The next day, the nurse sought me out to tell me that the patient had thanked her for suggesting the alternative dressing to the surgeon! The patient had heard, and remembered every word of the conversation! I must say, I was taken aback.. to my eyes the patient had been asleep, there had been no signs of possible awareness, she had not even been breathing on her own at the time (no muscle relaxants were on board) and this implied a deep level of sedation! (In addition to my usual approach wherein I tend to give more of an agent rather than less - this is the first such case that I know of in one of my patients). The nurse re-assured me that the patient had not seen it as a negative experience. I assume therefore that she must thankfully have had an adequate level of analgesia. Unfortunately, I didn't get a chance to talk to the patient myself.

This led me to wonder how often this happens? Maybe more often than we think, and the patients just never say anything? How many and how much of our conversations are they actually evesdropping in on? Thats quite a scary thought...

Maybe I should play them some music, or maybe I should start using the entropy monitor more often...

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