We all have heard horror stories of anesthesia awareness, where a patient is conscious during surgery, and it's something that every anesthesia provider wants to avoid. But how can we prevent this from happening? It all depends on anesthesia dosing and how much I can give. It also depends on your mindset before you ever enter the operating room.
Anesthesia awareness depends on anesthesia dosing: how much the patient requires and how much the patient can handle
Anesthesia Awareness (aka Anesthesia Recall)
Anesthesia awareness, also known as intraoperative recall, is a rare but potentially traumatic event where a patient is conscious during surgery and can feel pain or discomfort. As the anesthesiologist, it is our responsibility to ensure that this does not happen to our patients. In this video, we will be discussing the best practices for anesthesia dosing to prevent anesthesia awareness and achieve balanced anesthesia.
Prevent Medical PTSD by Giving the Right Anesthesia Dose
Anesthesia recall occurs when the patient is not given enough anesthesia to fully sedate them and prevent new memory formation. To prevent this from happening, it is important to use the appropriate dosing techniques and to constantly monitor the patient's vital signs. Some important signs we monitor in patients include:
- Heart rate
- Blood pressure
- Breathing pattern
- Heart rate variability
- Conversation (if under sedation as opposed to general anesthesia)
Anesthesia dose is usually limited by toxic side effects on your heart - the healthier the heart, the more anesthesia it can typically handle
Balanced anesthesia is the key to preventing both anesthesia awareness and over sedation. It's a balance between over sedation and under sedation. The risks of over sedation include:
- Respiratory depression (stopping breathing)
- Cardiopulmonary arrest (heart stops beating)
- Nausea and vomiting
- Excessive grogginess
- Possibly (but we don't know for sure yet) memory impairment
- Possibly delirium
To achieve balanced anesthesia, I use a combination of different types of anesthesia, such as general anesthesia and regional anesthesia (nerve blocks, epidurals, etc.), to achieve the desired level of sedation. This helps reduce the risks of overdosing anesthesia and causing the heart to stop beating.
Medical PTSD from Anesthesia Dosing
Another important aspect of anesthesia dosing is the potential for medical PTSD. This is a condition where patients suffer from psychological trauma after an anesthesia event, such as awakening during surgery or having an adverse reaction to the anesthesia. Proper dosing can help prevent this condition by minimizing the chances of anesthesia awareness and ensuring a smooth, comfortable experience for the patient.
The mindset my patients have before entering the operating room plays a big role in preventing medical PTSD, as well. The more trusting and safer you feel before going under anesthesia, the lower the chance of any traumatic event turning into PTSD in the future.
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