The movie is based on a condition called anesthesia awareness, or introperative awareness, and although the American Society of Anesthiologists (ASA) estimates such occurrences at around one in 87,000 patients undergoing general anesthesia, those who have experienced it say it is nothing less than horrifying.
"Of course, how terrifying would that be?" said Dr. Michael Mann, head of anesthesiology at Sutter Delta Medical Center in Antioch. "For years we didn't want to believe that it could happen, that it does happen. But in the past 10 to 15 years we have begun to listen to patients and understand that it does occur."
Patients who have experienced anesthesia awareness say that while they were awake and conscious of what was happening around them - such as hearing the surgeon's conversations or feeling pain or tugging sensations during their procedure - they couldn't communicate because of the paralyzing drugs that are used as part of the general anesthesia.
But a new device has appeared on the surgical scene that addresses the problem of anesthesia awareness: the Entropy Monitor and Sensor, a plastic strip placed on a patient's forehead and connected to a machine that monitors brain waves and facial muscle responses.
Sutter Delta has been using the entropy monitor for two years, and has had such
success that it recently purchased a machine for each of its five operating theaters at a cost of $7,000 a piece.
"What this does is give us one more tool to help our patients, and to give them and ourselves another level of comfort," said Mann.
Inquiries were made to Kaiser Permanente and John Muir Medical Center, asking if they use the entropy machines, but the calls were not returned.
While the movie "Awake" is a fictional exaggeration of anesthesia awareness, Angela Lombardi, communications and marketing director for Sutter Delta, said the hospital has received numerous calls from the public since the movie's premiere.
"This just seemed like a good time to let people know about it," said Lombardi, "and to let them know that here at Sutter Delta, the monitor is standard procedure."
But how is it possible that a doctor or surgical staff person could not see the fear or recognition in the eyes of a patient who has awakened during surgery?
According to Mann, the majority of hospitals, Sutter Delta included, tape a patient's eyes closed during surgery to minimize tear duct dryness, making it impossible for a surgical team to see any facial reaction in a patient's eyes.
And that is where the entropy machine comes in. "The sensor monitors facial muscle responses, which are those little signals that are sent to the eyes that create that fight or flight reaction," said Mann. "This way, we can monitor it even though we can't see their eyes."
Mann said that those most at risk of anesthesia awareness include elderly patients and trauma and shock patients; fragile individuals who are at a higher risk of complications and thus generally given the minimum amount of anesthetic. Conversely, patients who require larger doses of anesthetic than their size and health would normally tolerate are at risk of anesthesia awareness.
Medications, including herbal supplements, can also reduce the effectiveness of anesthetic.
When preparing for surgery, said Mann, the best offense is simply a good defense. "Patients should always take a proactive approach with their doctors and anesthesiologists," he said. "Discuss your concerns, let your team know your past experiences and be up-front about any fears you have.
"The bottom line is that even one incident (of anesthesia awareness) is one too many."
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