An autistic child became aware during surgery, and the anesthesiologist called a halt to the operation

The warm and healing medical drama "All About Doctor Tang" starring Qin Lan, Wei Daxun and others is currently on the air. In the drama, Wei Daxun plays the role of Ye Yiming, an anesthesiologist who is the "favorite" of Anhe Jisheng Hospital. He is a professional deputy chief physician of the anesthesiology department and a doctor who always protects the lives of patients. In the latest episode, Ye Yiming, an anesthesiologist played by Wei Daxun, encountered an intraoperative knowledge and decisively stopped the operation, which caused heated discussions.

Zhong Xiaoxing, an autistic child, is an orphan abandoned by his father. He suffers from congenital heart disease and needs a second valve replacement at the age of 10. If he follows conventional treatment, he will need another valve replacement when he grows up. The pain can be imagined. After diagnosis, the director of cardiac surgery, Tang Jiayu, decided to solve Zhong Xiaoxing's problem once and for all. However, during the operation, Xiaoxing had intraoperative coma...

According to the editor, this is not the first time that intraoperative awareness has been presented to the general public through film and television works. The American movie "AWAKE" and the Korean movie "Return" have once shown the horror of intraoperative awareness to the audience.

Everyone can't help but ask, is the real intraoperative awareness the same as what is described in movies and TV shows? How does it happen? Which surgeries are prone to intraoperative awareness? Today we will talk about the topic of intraoperative awareness~

01 What is intraoperative awareness?

Intraoperative awareness refers to the state of consciousness of a patient under general anesthesia during surgery. That is, after the patient is anesthetized, he or she regains consciousness or feels pain during the operation, but the body cannot move, and after the operation, he or she can recall events related to the operation that occurred during the operation.

According to statistics, the incidence of intraoperative awareness during general anesthesia is 0.1% to 0.2%, while in cardiac surgery, cesarean section and trauma surgery, the risk of intraoperative awareness is as high as 1%. Intraoperative awareness brings great trauma to patients, especially psychological trauma. The incidence of post-traumatic stress disorder in patients with intraoperative awareness is as high as 70%.

02 Why does intraoperative awareness occur?

When it comes to intraoperative awareness, we have to talk about general anesthesia. General anesthesia is one of the main anesthesia methods in modern anesthesia. It means that anesthetic drugs enter the blood circulation through veins or inhalation, and eventually act on the brain to produce a temporary inhibitory effect on the central nervous system. Among them, loss of consciousness, muscle relaxation and adequate analgesia are the three cornerstones to ensure general anesthesia, and none of them can be missing.

If intraoperative awareness occurs, it means that there may be a problem with the loss of consciousness, but muscle relaxation and analgesia still exist. In this case, the patient may be conscious and can hear the sounds of the surrounding environment, but cannot control any movement of the limbs, such as opening eyes and coughing, with or without the perception of pain.

Some special surgeries, such as cardiac surgery, laparoscopic surgery, and emergency hemorrhagic shock surgery, are reserved in the dosage of anesthetic drugs because the patient's cardiovascular function cannot be excessively suppressed during the operation, resulting in a higher incidence of intraoperative awareness. Elderly patients with poor physical fitness are prone to fluctuations in vital signs such as blood pressure and heart rate during anesthesia surgery, and are prone to misjudging the depth of anesthesia, and may also experience intraoperative awareness. In addition, some patients have chronic alcoholism and drug abuse, which causes changes in the sensitivity and quantity of anesthetic-related receptors, increasing their demand for anesthetic dosages, and are also prone to intraoperative awareness.

03 What are the dangers of intraoperative awareness?

The degree of pain felt by patients varies from person to person. Although this situation usually occurs in only one or two thousandths of general anesthesia surgery, it can cause irreparable physical and psychological trauma to patients who experience intraoperative awareness. Patients who experience intraoperative awareness, especially those who have experienced severe trauma, may develop post-traumatic stress disorder after surgery.

This is a serious mental disorder, with the same consequences as people who have experienced war or natural disasters. Most people cry and complain about pain all day after surgery, suffer from depression, anxiety, continuous nightmares, and fear of surgery and hospitals. These mental and psychological abnormalities can lead to serious obstacles in patients' postoperative life, such as difficulty in communication, loss of work, and even loss of the ability to live independently.

Although there are many dangers of intraoperative awareness, there is no need to worry too much. As early as 2005, the American Society of Anesthesiologists passed the "Guidance on Intraoperative Awareness and Brain Function Monitoring" for intraoperative awareness. In 2020, the Anesthesiology Branch of the Chinese Medical Association also issued the "Expert Consensus on Prevention of Intraoperative Awareness and EEG Monitoring" in order to guide the prevention of intraoperative awareness. Therefore, anesthesiologists will take certain measures for intraoperative awareness when implementing general anesthesia to avoid the occurrence of intraoperative awareness.

Back to the plot, Ye Yiming, played by Wei Daxun, is an anesthesiologist who is bold and careful. He observed in time that Xiaoxing had ventricular fibrillation due to fear of surgery. He immediately stopped the operation and analyzed the cause, thus preventing Xiaoxing, who suffers from autism, from experiencing intraoperative coma and causing more serious psychological trauma.

His professionalism and responsibility give patients a great sense of security. Wei Daxun not only interprets the professionalism of anesthesiologists in the play, but also publishes articles to popularize the duties of anesthesiologists. He said that anesthesiologists have a great responsibility and hope that the profession of anesthesiologists can be seen by more people, and that every patient can wake up safely under the protection of anesthesiologists.

"Surgery cures diseases, anesthesia saves lives! My work is not over until he gets off the operating table safely." Just like what Ye Yiming, the anesthesiologist played by Wei Daxun said in the play, surgery cures diseases, anesthesia saves lives. I believe this is the belief that thousands of anesthesiologists stick to, and it is also their life creed.