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You can find the current article at its original source at https://www.theguardian.com/society/2018/feb/12/its-very-rare-to-wake-up-during-a-general-anaesthetic
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| It’s very rare to wake up during a general anaesthetic | It’s very rare to wake up during a general anaesthetic |
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| Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic. | Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic. |
| The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished. | The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished. |
| Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals. | Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals. |
| The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events. | The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events. |
| Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfoDr Liam Brennan President, Royal College of AnaesthetistsDr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland | Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfoDr Liam Brennan President, Royal College of AnaesthetistsDr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland |
| • General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain. | • General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain. |
| Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors. | Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors. |
| While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.Dr Chris EdgeConsultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London | While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.Dr Chris EdgeConsultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London |
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| • Read more Guardian letters – click here to visit gu.com/letters | • Read more Guardian letters – click here to visit gu.com/letters |
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