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Hundreds report waking up during surgery

10:30am Wednesday 10th September 2014 content supplied byNHS Choices

The awareness was more likely to occur:

  • during caesarean section and cardiothoracic surgery
  • in obese patients
  • if there was difficulty managing the patient's airway at the start of anaesthesia
  • if there was interruption in giving the anaesthetic when transferring the patient from the anaesthetic room to the theatre
  • if certain emergency drugs were used during some anaesthetic techniques


What recommendations have been made?

64 recommendations were made covering national, institutional and individual health professional level factors. The main recommendations are briefly outlined below.

They recommend having a new anaesthetic checklist in addition to the World Health Organization (WHO) Safer Surgical Checklist, which is meant to be completed for each patient. This would be a simple anaesthesia checklist performed at the start of every operation. The purpose of it would be to prevent incidents occurring due to human error, and monitoring problems and interruptions to the administration of the anaesthetic drugs.

To reduce the experience of waking but being unable to move, they recommend that a type of monitor called a nerve stimulator should be used, so that anaesthetists can assess whether the neuromuscular drugs are still having an effect before they withdraw the anaesthetic.

They recommend that hospitals look at the packaging of each type of anaesthetic and related drugs that are used, and consider ordering some from different suppliers, to avoid multiple drugs of similar appearance. They also recommend that national anaesthetic organisations look for solutions to this problem with the suppliers.

They recommend that patients be informed of the possibility of briefly experiencing muscle paralysis when they are given the anaesthetic medications and when they wake up at the end, so that they are more prepared for its potential occurrence. In addition, patients who are undergoing sedation rather than general anaesthesia should be better informed of the level of awareness to expect.

The other main recommendation was for a new structured approach to managing any patients who experience awareness, to help reduce distress and longer-term psychological difficulties called the Awareness Support Pathway.


How does this affect you?

As Professor Tim Cook, Consultant Anaesthetist in Bath and co-author of the report, has said: "It is reassuring that the reports of awareness . are a lot rarer than incidences in previous studies", which have been as high as one in 600. He also states that "as well as adding to the understanding of the condition, we have also recommended changes in practice to minimise the incidence of awareness and, when it occurs, to ensure that it is recognised and managed in such a way as to mitigate longer-term effects on patients".

 Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.


"At least 150, and possible several thousand, patients a year are conscious while they are undergoing operations," The Guardian reports. A report suggests "accidental awareness" during surgery occurs in around one in 19,000 operations...

Links to Headlines

Awareness during surgery can cause long-term harm, says report. The Guardian, September 10 2014

Some patients 'wake up' during surgery. BBC News, September 10 2014

Three patients each week report WAKE UP during an operation because they are not given enough anaesthetic. Mail Online, September 10 2014

Hundreds of people wake up during operations. The Daily Telegraph, September 10 2014

More than 150 people a year WAKE UP during surgery: How does it happen? Daily Mirror, September 10 2014

Useful Links

Further Readings

5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland (PDF, 7.7Mb). September 2014

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