Think of it as a dream, not a nightmare if you wake on the operating table: Incidences of 'accidental awareness' are far higher than previously thought

But research suggests that you won't worry – or feel a thing

It is every patient's worst nightmare: that the anaesthetic won't work... And now a review suggests that bad dreams can come true, after one leading expert found that incidences of so-called "accidental awareness" are far higher than was previously thought.

Professor Jaideep Pandit, a consultant anaesthetist and fellow of St John's College, Oxford, has warned that the number of patients who are "dimly" conscious – for which read that they can feel that blade and see all the blood – could be very high. That's the bad news. But tomophobes (people with an extreme fear of surgery) can take heart from the suggestion that being vaguely conscious isn't necessarily a disaster.

It's possible that some patients are floating in a "third state of consciousness", dubbed "dysanaesthesia", in which they have some awareness of the world around them, but feel no pain or distress. Or so Professor Pandit believes.

He came up with his theory after reviewing existing evidence that found large differences between the number of patients who, when asked, recall awareness while under anaesthetic, and those who report awareness without being asked.

National data released earlier this year, based on an audit for the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, showed that only one in 15,000 patients had told their doctor that they recalled something while under general anaesthetic; of those, only a third reported any distress. But on closer questioning a much higher number, one in 500, gave an answer that suggested they were dimly aware of something happening after being given an anaesthetic, instead of being out for the count.

"The difference between the incidence of 1:500 and 1:15,000 suggests that even in the rare instances where patients are experiencing awareness, in most cases the sensation is a 'neutral' one. What we are possibly seeing is a third state of consciousness – dysanaesthesia – in which the patient is certainly aware of events, but not concerned by this knowledge, especially as they are not in pain."

A recent study in which 34 surgical patients were anaesthetised and had their whole body paralysed apart from one forearm reinforces this theory. The patients were asked to move their fingers, which a third were able to do. But intriguingly, none of the patients moved their fingers without being asked to.

"The difference between one third of patients who can respond to commands to one in 15,000 who report remembering something, tells us that there must be a different state between full awareness and full anaesthesia," said Professor Pandit. "Logically, it follows there is a large group of patients who are experiencing something in a neutral way.

"I liken it to a jigsaw puzzle – if being aware is the ability to recognise the image of a jigsaw puzzle, then anaesthesia is something that takes away the pieces. A point comes when you take away so many pieces that you can't tell what the picture is, but you can still see it is a jigsaw. That's what I call dysanaesthesia – you can see the pieces but there's no recognisable image, so you're not interested."

Professor Pandit called for more research to be carried out to see if dysanaesthesia could be identified by monitoring brain signals and, if so, whether it could be a warning sign that patients are more conscious than they should be.

Accidental awareness during surgery is the second most common concern raised by patients before operations, and the third commonest cause of litigation against anaesthetists in the UK.

The problem for anaesthetists is that they cannot risk putting a patient to sleep too soundly because that would be far more dangerous.

Suggested Topics
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Arts and Entertainment
Buttoned up: Ryan Reynolds with Helen Mirren in ‘Woman in Gold’
filmFor every box-office smash in his Hollywood career, there's always been a misconceived let-down. Now he says it's time for a reboot
News
people
News
Actress Julianne Moore wins the Best Actress in a Leading Role Award for 'Still Alice' during the 87th Annual Academy Awards in Hollywood, California
people
Sport
Ross Barkley
footballPaul Scholes says it's time for the Everton playmaker to step up and seize the England No 10 shirt
News
'We will fix it': mice in the 1970s children’s programme Bagpuss
science
Life and Style
2 Karl Lagerfeld and Choupette
fashion
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Customer Service Executive

    £18000 - £22000 per annum: Recruitment Genius: This is an exciting opportunity...

    Recruitment Genius: Retail Buyer / Ecommerce Buyer

    £30000 - £35000 per annum: Recruitment Genius: Working closely with the market...

    Recruitment Genius: Sales Executive - CAD Software Solutions Sales

    £20000 - £50000 per annum: Recruitment Genius: A reputable company, famed for ...

    Ashdown Group: Client Accountant Team Manager - Reading

    Negotiable: Ashdown Group: The Ashdown Group has been engaged by a highly resp...

    Day In a Page

    War with Isis: Iraq declares victory in the battle for Tikrit - but militants make make ominous advances in neighbouring Syria's capital

    War with Isis

    Iraq declares victory in the battle for Tikrit - but militants make make ominous advances in neighbouring Syria
    Scientists develop mechanical spring-loaded leg brace to improve walking

    A spring in your step?

    Scientists develop mechanical leg brace to help take a load off
    Peter Ackroyd on Alfred Hitchcock: How London shaped the director's art and obsessions

    Peter Ackroyd on Alfred Hitchcock

    Ackroyd has devoted his literary career to chronicling the capital and its characters. He tells John Walsh why he chose the master of suspense as his latest subject
    Ryan Reynolds interview: The actor is branching out with Nazi art-theft drama Woman in Gold

    Ryan Reynolds branches out in Woman in Gold

    For every box-office smash in Ryan Reynolds' Hollywood career, there's always been a misconceived let-down. It's time for a rethink and a reboot, the actor tells James Mottram
    Why Robin Williams safeguarded himself against a morbid trend in advertising

    Stars safeguard against morbid advertising

    As film-makers and advertisers make increasing posthumous use of celebrities' images, some stars are finding new ways of ensuring that they rest in peace
    The UK horticulture industry is facing a skills crisis - but Great Dixter aims to change all that

    UK horticulture industry facing skills crisis

    Great Dixter manor house in East Sussex is encouraging people to work in the industry by offering three scholarships a year to students, as well as generous placements
    Hack Circus aims to turn the rule-abiding approach of TED talks on its head

    Hack Circus: Technology, art and learning

    Hack Circus aims to turn the rule-abiding approach of TED talks on its head. Rhodri Marsden meets mistress of ceremonies Leila Johnston
    Sevenoaks is split over much-delayed decision on controversial grammar school annexe

    Sevenoaks split over grammar school annexe

    If Weald of Kent Grammar School is given the go-ahead for an annexe in leafy Sevenoaks, it will be the first selective state school to open in 50 years
    10 best compact cameras

    A look through the lens: 10 best compact cameras

    If your smartphone won’t quite cut it, it’s time to invest in a new portable gadget
    Paul Scholes column: Ross Barkley played well against Italy but he must build on that. His time to step up and seize that England No 10 shirt is now

    Paul Scholes column

    Ross Barkley played well against Italy but he must build on that. His time to step up and seize that England No 10 shirt is now
    Why Michael Carrick is still proving an enigma for England

    Why Carrick is still proving an enigma for England

    Manchester United's talented midfielder has played international football for almost 14 years yet, frustratingly, has won only 32 caps, says Sam Wallace
    Tracey Neville: The netball coach who is just as busy as her brothers, Gary and Phil

    Tracey Neville is just as busy as her brothers, Gary and Phil

    The former player on how she is finding time to coach both Manchester Thunder in the Superleague and England in this year's World Cup
    General Election 2015: The masterminds behind the scenes

    The masterminds behind the election

    How do you get your party leader to embrace a message and then stick to it? By employing these people
    Machine Gun America: The amusement park where teenagers go to shoot a huge range of automatic weapons

    Machine Gun America

    The amusement park where teenagers go to shoot a huge range of automatic weapons
    The ethics of pet food: Why are we are so selective in how we show animals our love?

    The ethics of pet food

    Why are we are so selective in how we show animals our love?