MONITORING SURGICAL SLEEP MONITORING SURGICAL SLEEP About 30,000 people a year wake up during surgery, but because they are paralyzed, their anesthesiologists think they are still asleep and unaware of what is happening to them. A brain monitor, called the Bispectral Index (BIS) monitor, is used in about 60% of the nation's operating rooms to help doctors see when a patient is awake during surgery. How it works: 1. Brain waves that tell whether a person is asleep travel through electrodes placed on the patient's forehead toward the BIS monitor. 2. A device converts those analog signals from the brain into digital data that the computer can analyze. 3. The computer inside the monitor converts the signals into a number that represents the patient's level of consciousness. How it compares The more traditional methods of monitoring, heart rate and blood pressure, don't always tell the whole story. But the BIS monitor lets doctors see how awake a patient is at a glance during the operation. Higher risk The following are associated with higher rates of awareness under anesthesia: • Acute trauma with blood loss

• Cardiac surgery

• Cesarean section

• Bronchoscopy or laryngoscopy

• Low blood pressure during surgery

• Severe end-stage lung disease

• Drug or alcohol abuse Sources: American Association of Nurse Anesthetists, Aspect Medical Systems By Karl Gelles, USA TODAY The anesthetized patient on the operating table is immobilized to prevent movement during surgery, but nobody on the medical team knows that behind those eyes taped shut is a mind that is still awake. Every word is heard, every cut is felt. The scenario is horrifying fiction. Hayden Christensen portrays the patient in the movie Awake, which opened nationwide Friday. But scarier still is the fact that about 30,000 people a year experience their own real-life versions of the operating room nightmare. "To hear them say, 'You have to cut deeper' and 'pull harder' is traumatic," says Carol Weihrer, who founded the Anesthesia Awareness Campaign after she was alert but paralyzed when doctors removed her right eye. "I was awake. I was awake." She could not make a noise during her painful surgery. She felt them moving a breathing tube in her throat. She listened to them discuss how long it would take to fix a broken piece of equipment. The movie brought the whole trauma back. "I screamed when I saw it," she says. She suggests people who have suffered similar traumas avoid the movie or don't see it alone. For anesthesiologists, "it should be required viewing." "They have to face it," says Weihrer, who as a patient advocate works with medical associations on prevention efforts. Thousands of doctors have adopted a safety technology: a monitor that watches brain activity during surgery and reduces by 80% the chances the patient will wake up. Weihrer and others who have awakened during surgery hope the movie and the increased public awareness of the problem will lead to a change of heart among doctors who have been reluctant to use the technology. The monitor was used in about 700 hospitals in 2000 and now is used in nearly 3,000 hospitals and 400 surgical centers, according to the manufacturer, Aspect Medical Systems. That's about 60% of all U.S. operating rooms. Tom McKibban, former president of the American Association of Nurse Anesthetists, says some hospitals balk at the cost of the monitor — $5,000 to $9,000, depending on how many are purchased. Some doctors still object because the monitor is imperfect. "The device doesn't tell you if the patient is going to move," says Marc Bloom, an anesthesiologist at New York University Medical Center. But he likes it because he "can use significantly less drug" to keep patients asleep by watching their brain activity. Weihrer says just because there is a monitor doesn't mean that the staff will use it. "Ask them if they are going to use it on you," she says. One is too many Doctors say it is extremely rare for a patient to wake up on the operating table. It happens in 0.1% to 0.2% of surgeries, according to studies. The vast majority of the 21 million people who are put to sleep in an operating room each year wake up after their procedures with no memory of the surgery. And most people who do awaken hear voices and feel pressure but not pain. An increasing number of anesthesiologists are taking a "one is too many" stance. "I am impatient," says Daniel Cole, a Mayo Clinic Medical School anesthesiologist and a member of the American Society of Anesthesiologists task force on the issue. "We need to get this down to zero as soon as possible." A patient might wake up during surgery for reasons ranging from mechanical failure to human error such as miscalculating drug dosage. Doctors try to strike a delicate balance between too little anesthesia and too much. "It's some science and a bit more art," Bloom says. Doctors and nurses use a mix of medications that induce hypnosis, reduce pain and cause paralysis. Surgeons don't want their patients to move, feel pain or recall operating-room chatter. The job of the anesthesiologist, who usually meets the patient minutes before the procedure, is to keep the patient alive and safe. The drug dosages are based on averages, but people respond differently to the medications. The question, Bloom says, is "Are you average?" What complicates matters is that no two operations are exactly alike. Different medical conditions and medications can affect anesthesia. Some patients are intentionally given less of the drugs. Women having emergency cesarean surgery, for instance, get less medication because doctors don't want to overdose the baby. Trauma victims and others with low blood pressure get less because the medications could put them into shock. Those patients are among a subset who are 10 times more likely to experience "intraoperative awareness." Too much anesthesia can lead to something as harmless as nausea after surgery, but doctors also are learning more about the long-term risks of giving too much medication, known as "running too deep." A recent study showed patients who died within a year of surgery were more likely to have had higher doses of anesthesia. "There seems to be an association of running too deep and mortality," Bloom says. The link does not mean the anesthesia caused the deaths, and more research is needed, he says, but the message appears to be: Less is better. Sometimes, a patient wakes up because of something as simple — and preventable — as an intravenous line getting crimped, a vaporizing machine running dry of a drug or the wrong medication being used because two labels are similar. Whatever the cause, the stories are haunting. Examples filed in a brief to the Supreme Court in a lethal injection death penalty case: •Kathleen LaBrie awoke during sinus surgery, according to court documents. "I awoke to the grinding and pushing in my nose. I also could hear conversations. I was awake and unable to let anyone know. I really thought I was slowly dying and not one person in that room cared. If anyone wants to know what HELL is like this is it." •Kelly Haapala awoke during hip surgery after a car crash, the brief says. "Slowly the pain began to surface. I kept telling myself it must be a nightmare but the pain was so unbearably severe that I began to worry that my body would not be able to withstand this stress and pain and that I would die! It was as if a hot poker was being jammed into me." •Diana Todd awoke during hysterectomy surgery. "I was awake, aware, paralyzed, utterly terrified, unable to do anything about it no matter how hard I tried, and I wished I could die. I remember thinking, 'Take me now, please take me.' This was the most traumatizing experience of my life. It takes away your basic humanity. That kind of terror is cruel beyond description. There is simply no way to adequately describe what it is like to have every single scrap of your own self control stripped away." The bottom line, McKibban says, is "a vigilant anesthesia professional" can prevent such traumas. A possible genetic link Awake grew out of writer and director Joby Harold's own struggle in a hospital. He was suffering the intense pain of a kidney stone, and he tried to distract himself by thinking of other things, which Christensen's character does in the movie. Harold calls it "a primal fear, the act of having your body penetrated, and you can't protect yourself." Weihrer and some anesthesiologists hope people who come forward after seeing the movie to tell of their experiences might drive more research. A registry sponsored by the American Society of Anesthesiologists (www.awaredb.org) captures stories and key details. Studying each case could help doctors understand the phenomenon, says Orin Guidry, an anesthesiologist at the Medical University of South Carolina and past president of the association. The registry "is looking for a common link." Genetics could play a role. Angela DeLessio of South Hempstead, N.Y., awoke during the emergency C-section to deliver her son. "I was perfectly conscious, but I couldn't let anybody know," she says. "The first thing I remember was severe burning pain, and you actually feel the incision, then being pulled apart and torn open." When her daughter recently had surgery, the anesthesiologist was surprised by how much drug it took to keep her asleep. She stirred during surgery but did not remember anything or feel any pain. DeLessio says every surgical patient should be so lucky. In her daughter's case, the doctor said there might be a genetic link. "Nobody should ever wake up during surgery," DeLessio says. Enlarge By Robert Deutsch, USA TODAY Carol Weihrer, president and founder of the Anesthesia Awareness Campaign, woke up while doctors were removing her right eye. Conversation guidelines: USA TODAY welcomes your thoughts, stories and information related to this article. Please stay on topic and be respectful of others. Keep the conversation appropriate for interested readers across the map.