One in ten patients responds to commands under general anesthesia

Authors of a new international study want to clarify one thing: None of the participants remember anything, not even those who said they were in pain at the time.

That’s good because the study’s main finding was that one in ten participants “were able to respond to commands under scheduled general anesthesia.”

This phenomenon is known as ‘connected consciousness’ – when people under general anesthesia can ” respond to external stimuli, such as pain, but may not remember the event afterward”.

Previous studies found it to affect one in 20 patients under general anesthesia, but the number appears to have doubled for some reason not yet known.

The new study also found that “connected awareness” is more common in young people and three times more common in women.

Nearly half of those who responded to commands also responded to confirm they were in pain.

One in ten patients responds to commands under general anesthesia

The research

The study’s primary aim was to “determine the incidence of connected consciousness after tracheal intubation in adolescents aged 18-40 years”.

The study, the largest of its kind, involved 338 patients and 10 hospitals in Australia, Belgium, Germany, Israel, New Zealand, and the United States of America.

The patients were under general anesthesia and intubated (a breathing tube was inserted into their windpipe), but the surgery hadn’t started yet when the experiment was performed.

The researchers examined whether the patients experienced “connected consciousness” by asking them a series of questions and testing whether the patient could respond to spoken commands such as “squeeze my hand” and “squeeze my hand twice if you’re in pain.”

The main findings were:

11 percent of participants responded to commands while under general anesthesia. Of the 11 percent who responded to commands, half reported pain. Women were three times more likely to respond than men.

The study also found that maintaining a constant level of anesthesia before intubation reduced the risk of ‘connected consciousness’ in patients.

The researchers say that “providing continuous anesthesia during that time is standard practice in Australia”.

What does the study mean?

Professor Robert Sanders is an anesthetist from the University of Sydney and the Royal Prince Alfred Hospital. (None of the patients recruited were from the Royal Prince Alfred Hospital.) He is also a senior author of the new paper.

Professor Sanders said: “The data from the study has given us a crucial starting point to improve our understanding of ‘connected consciousness’.

“Patients under anesthesia expect to be unconscious and in no pain, which shows why anesthesia research is important.”

He said there is an urgent need for “further research into the biological differences, especially gender, that may influence sensitivity to anesthetic drugs”.

Co-author Dr. Amy Gaskell of Waikato Hospital, New Zealand, noted:

“In this study, we confirmed that the state of connected consciousness not infrequently occurs after intubation in younger patients.

“We identified quite a bit of variation in practice around the time of intubation, which could explain why some of the responses were possible.”

She said the higher incidence in women “is also very interesting, and we look forward to exploring the reasons behind this”.

Although none of the participants remembered the commands, one person (0.3 percent) reported that they “could clearly remember the surgery experience after the procedure had ended.”

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