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New movie stirs anesthesiology debate by Mary Helen Yarborough Public Relations The motion picture thriller, “Awake,” has prompted renewed discussions about anesthesia awareness that are being led by MUSC anesthesiologist Fred Guidry, M.D.   The former president of the American Society for Anesthesiologists, Guidry participated in a recent national panel, “A Wake-Up Call About Anesthesia Awareness: Striking a Balance in Public Perception,” sponsored by medical device maker Styker Instruments.   A professor of anesthesiology, Guidry came to MUSC in July to serve as vice chair for Faculty Development and Anesthesiology chief for Ashley River Tower.   Guidry said that while anesthesiology has come a long way since its first demonstrations in the 1840s, the practice continues to evolve.   In the movie released Nov. 30, Clay Beresford (played by Hayden Christensen) is a wealthy young business man who suffers a massive heart attack and must undergo a heart transplant. During the heart procedure, Beresford is anesthetized, which leaves him paralyzed but mentally awake and aware. He is unable to move or communicate that he can feel and hear what is happening, and, as many thrillers go, unable to resist or flee a diabolical plot to kill him.   In real life, an estimated 0.1 percent of the 21 million people that are administered general anesthesia annually are aware during surgery. For some, it is a horrifying experience.   Guidry said that though the incidence of anesthesia awareness is statistically remote, clinicians should do more to assure that it doesn’t occur.   “While ‘Awake’ may send shockwaves through the systems of those about to have surgery, and those who have suffered this rare event, it also serves as a wake-up call to health professionals to do all we possibly can to reduce the occurrence of anesthesia awareness,” said Guidry.   Guidry emphasized that an ongoing dispute regarding the number of cases should not distract from the shared sense of urgency to address the issue.   “Let’s get out of this box of how often it occurs. Really, one case is too many,” he said. “As anesthesiologists, we are not going to stop until we can get that risk down to zero.”   Guidry said one way to reduce the occurrence of anesthesia awareness is through increased use of brain monitors, such as those located in every operating room at MUSC. Guidry said that the cost of using a brain monitor is negligible (about $15 to operate during surgery), but they are not always used. Sometimes, the type of surgery or placement of the patient on an operating table makes using the monitor, which uses adhesive sensors attached to the forehead, impractical.   Five components make up general anesthesia: unconsciousness (hypnosis); amnesia; analgesia; blocked reflexes; and muscle relaxation.   Brain monitors help the anesthesiologist detect the level of a patient’s consciousness. If the brain shows heightened activity, then the anesthesiologist can increase medications.   Studies have shown that the use of brain function monitors during surgery can reduce the likelihood of a patient experiencing anesthesia awareness, according to Guidry and his fellow panelists.   “These monitors provide additional information that nothing else in anesthesia monitoring does. I would like to see consciousness monitors in every operating room and available for every surgery at the discretion of the patient and the anesthesiologist,” said Daniel Cole, M.D., professor and chair of Anesthesiology, College of Medicine, Mayo Clinic; and member of the American Society of Anesthesiologists Task Force on Intraoperative Awareness.   Cole cited a 2005 American Society of Anesthesiology survey that showed that 64 percent of anesthesiologists reported not using a brain function monitor. In a 2007 Stryker National Attitudes and Perceptions survey, 22 percent of those surveyed reported not using monitors.   While Guidry, Cole and others agreed that monitors are an important strategy, they are not a complete solution to anesthesia awareness.   Guidry said another way to decrease anesthesia awareness is for patients to be honest about drug and alcohol use, which inhibit or exacerbate effectiveness of drugs administered during anesthesia.   Cole explained the next steps to reducing anesthesia awareness to the lowest levels possible. “I see four primary drivers. One is medical science, always the basis for the best patient care. Second is the patient/physician relationship. I believe it’s essential for patients to come in engaged and empowered; to ask tough questions and get honest answers,” Cole said. “Next is industry, which plays an important role, and will continue to in the future. And finally, patient advocates have a substantial role in bringing this issue forward.”    For information on the panel discussion, visit http://www.OR-Live.com/AnesthesiaAwareness; or for information on anesthesia, see http://www.asahq.org/patientEducation.htm.     Friday, Dec. 7, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.