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Wednesday, May 19, 2004  

Health: Anesthesia failure hurts

I don't drug easily. Normal dosages of anesthesia doesn't take with me. Never have. I felt just about everything during a surgery as a teenager and again when I had my wisdom teeth removed at 19. I suffered in silence. But, I was well-informed enough to raise the issue with doctors in later years. Needing large does of anesthesia continues to be a problem mainly in regard to dentistry. I have known most ot the endo I've had intimately. Those root canals have been so painful that I prefer breaking my ankle. At least that pain ended quickly. So, I fully support a woman who has made a crusade of informing the public and the medical community that not every patient is out when she is down.

McLEAN, Va. (AP) - The pain in Carol Weihrer's eye was so severe she decided to have it surgically removed, believing it was the only way to get on with life.

Instead, the surgery was the beginning of an unending nightmare. Her anesthesia failed, leaving her awake but paralyzed for a five-hour surgery in which doctors cut and gouged to remove her right eye.

``You feel really grueling pulling on your eye, but you can't move to relieve the pressure,'' Weihrer said recently.

She felt no pain from the cutting, because the painkilling portion of the anesthesia was effective. But the tremendous pressure exerted to remove the eye was painful in its own way.

I agree with Weihrer that what one feels when inadequately drugged during surgery is often excessive pressure -- pulling or pressing down to the point that you thinks something has to give. Except when it comes to mouth surgery. What I feel then is just plain pain. The paralysis the drugs cause makes it impossible to complain.

I've had some success with doctors when I say I need high doses of anesthesia. However, dentists' balk. I guess they get so many people who complain about ordinary discomfort they don't believe the handful who have a legitimate problem with anesthesia. Another possiblity may be they think patients who seek additional medication, particularly post-op, are drug addicts. I've had several experiences when I got that impression.

Weihrer is spreading the word that the problem is real.

Since her ordeal in 1998, which brought her an out-of-court settlement, she has suffered from post-traumatic stress disorder, and sleeps in a chair because lying down triggers the feelings of fear and helplessness.

Weihrer, who lives in Reston, has since dedicated her life to warning of the dangers of anesthesia awareness and agitating for changes in how doctors monitor a patient's consciousness.

She has won significant attention in the medical community, but some anesthesiologists worry her campaign may be causing undue fear.

Roger Litwiller, a Roanoke anesthesiologist and president of the American Society of Anesthesiologists, said it's important to keep the issue in perspective - that awareness during surgery occurs only in about one or two of every 1,000 procedures.

One or two people per thousand for full awareness when supposedly anesthesized seems like a rather high number of patients to me. I have not seen estimates of the number of people who are semi-aware. I suspect the ASA is more concerned about its image than what may be a widespread and painful problem. The organization also dismisses the suggestion that a device that can identify wakefulness in a supposedly drugged patient be used.

As for prevention, Weihrer points to a simple, relatively inexpensive brain activity monitor.

The technology, approved by the Food and Drug Administration, is called a bispectral index (BIS) monitor. The theory is that if a patient is awake but paralyzed, it will show a high level of awareness to alert the anesthesiologist to adjust the medication and put the patient to sleep.

Litwiller contends the research is inconclusive on a BIS monitor's usefulness to an anesthesiologist.

I have been putting off an operation to remove a defective cornea for more than a year. Part of the reason for the delay is that I fear being paralyzed under anesthesia and in pain. One of the criteria for choosing a doctor for the surgery will be the availability of a BIS monitor.

I wish Weihrer the best in her crusade for anesthesia awareness.

Reasonably related

•More information about failure of anesthesia.

•The Anesthesia Awareness homepage.

6:42 AM