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Carol Weihrer, 52, from Virginia, heads a campaign to educate people about the possibility of anesthesia failure during surgery, otherwise known as awareness. She awoke on the operating table six years ago while having her eye removed.

The anesthesiologist met Marielle Brown, a 32-year-old mother from Tracey, Calif., at the operating room doors. He placed a mask over her face. "Breathe deeply," she remembered him saying.

Brown woke to pitch black, unable to open her eyes. She tried to scream and move, but everything was paralyzed except her mind. "Then I felt the knife on my navel, them slicing me open, widening the incision, and digging," Brown said, sobbing. "I felt the pain."

Brown prayed, asking God what she had done to deserve this. "I felt I died on the table," she said.

About 100 Americans a day who receive general anesthesia during surgery suffer, like Brown, from "awareness," according to Dr. Peter Sebel, professor of anesthesiology at Emory University. The American Association of Nurse Anesthetists, based in Park Ridge, Ill., reports the figure could reach 40,000 a year.

Anesthesia typically consists of three medications: a paralytic to ensure the patient doesn't move, a hypnotic to induce unconsciousness and a narcotic to numb pain. "It's the combination of these drugs in their various doses that determines the depth of unconsciousness," said Sandra Tunajek, the association's director of practice.

The anesthesiology team must combine and administer proper drug dosages so the patient stays unconscious. If the formula fails, as happened in Brown's case, patients can wake up during surgery. But they cannot move or speak to reveal their conscious state.

Breakdown or misuse of equipment, and patient health factors like obesity and alcohol or drug abuse, can also cause anesthesia to fail. So the team must always watch for warning signs, like high blood pressure and sweating, Tunajek said.

In March 1998, the Food and Drug Administration approved an awareness-detecting device that, according to medical studies conducted in Sweden and Australia, has an approximate 80 percent success rate. The bispectral index (BIS) measures brain activity and thus calculates a patient's depth of sedation on a scale of zero to 100.

Why these monitors are not widely used is baffling to Carol Weihrer, 52, from Reston, Va., who suffered awareness when a medication canister ran dry during a five-and-a-half-hour procedure to remove her eye. "I could hear what was being said, and disco music in the background," she said. "I was thinking as clearly as I am now."

Weihrer, who has since been diagnosed with post-traumatic stress disorder, watched surgical implements enter her face until her optic nerve was cut. In the six years that have passed since the ordeal, she has slept only in a chair because sleeping in a bed reminds her of being on the operating table.

"The experience was worse than a rape, a kidnapping or being trapped in a burning building, because you can't move or scream. You are absolutely helpless," she said. "I was ready to sell my soul and I'm a person of great faith."

Weihrer now heads the Anesthesia Awareness Campaign, an international advocacy effort she launched in 1999. "I've had over 25,000 Web hits so far and thousands of victims who say, 'When I read your story, it was mine,'" she said.

The group wants medical practitioners to recognize that anesthesia failure occurs and is demanding measures to prevent it. "My surgeon did not know about awareness at all, and that's the case with most surgeons," she said.

Weihrer said her doctor noticed her finger wiggle during the operation, but instead of interpreting the movement as a sign of wakefulness, he ordered another excruciating shot of paralytic medication. "It burnt like the coals and fires of hell," she said.

Weihrer claimed this torture could have been prevented with the BIS monitor. "You have a machine that will prevent this horrible thing from happening to me, and you better use it," she said.

In a survey distributed to its members last year, the American Association of Nurse Anesthetists found that roughly 50 percent of hospitals owned the machine, but only about 30 percent used it, Tunajek said. "The technology is expensive," she said, "especially the electrodes that attach to the head and are good for only one use."

The BIS monitor costs $9,500 and each electrode strip $17.50, according to Emily Anderson, director of corporate communications for Newton, Mass.-based Aspect Medical Systems, the lone manufacturer of the device. But she suggested that the machine could help facilities save between $5 and $20 per patient since less hypnotic anesthesia would be used with it.

While price may be an issue, Anderson claimed there are other reservations. "Using [the BIS monitor] requires that clinicians make a change in the way they practice, and change doesn't happen overnight," she said.

Although awareness recently captured the attention of the Joint Commission on Accreditation of Healthcare Organizations, the nation's primary health care standard-setter, it remains a relatively unexplored subject.

"At this point, we are not offering any particular opinion or advice," said Rick Croteau, the commission's executive director for strategic initiatives. "We have not yet gotten a sense of the best way to deal with it," he added, ruling out that the machine would be recommended in the near future as a way to prevent surgical patients from awakening.

Nonetheless, Weihrer continues to publicize her story so others do not suffer her fate. She wants those who have never experienced surgical awareness to know it is a possibility, and to request the BIS monitor.

Until that time, more people may suffer similar ordeals.

In bad weeks, Brown endures terrifying dreams almost nightly, reliving her ordeal. Although four years have passed since the experience, she suffers terrible bouts of rage, anxiety and depression.

"I feel like something was stolen from me," she said.

culled from www.jrn.columbia.edu