Doctors adopt new checklist to ensure patients are asleep during surgery

Oct 27 2005

At a meeting of the American Society of Anesthesiologists in Atlanta, new standards were approved on preventing a rare but terrifying situation in which patients wake up during surgery and sometimes feel excruciating pain without being able to cry out.

But the physicians stopped short of embracing the use of new devices that monitor patient awareness.

Apparently such awakenings are very rare and only occur in one or two cases out of every 1,000.

But because of press coverage of some lawsuits by patients, the phenomenon has received attention.

The joint commission on accreditation of healthcare organizations last year urged hospitals to better monitor patients for the problem and ask them about it after surgery.

The anesthesiologists' society has called for doctors to follow a checklist protocol for anesthesia equipment, to make sure proper doses are being delivered, but have decided against adopting a new generation of brain-function monitors as a standard of care.

The best known of the machines is the Bispectral Index (BIS) monitor made by Aspect Medical Systems Inc. of Massachusetts.

The BIS monitor tracks brain-wave activity and provides doctors a reading that represents the mathematical probability the patient is wide awake.

The machine has been on the market since 1996 and retails for about $9,500, but the negotiated purchase price is frequently $5,000 or less, according to a company spokeswoman.

Aspect has pushed for its machines to become a standard feature in operating rooms, but some doctors have resisted, saying clinical evidence of BIS monitors' effectiveness was lacking.

However the society does say that doctors can consider the devices on a case-by-case basis particularly in trauma surgeries and Caesarean sections, which are two procedures in which deep anesthesia is often avoided and partial awareness is most likely.

But some doctors say that while at least one study has found the devices to be effective, others have reached a different conclusion.