Experts disagree on how best to prevent the problem

Facing surgery to remove her right eye, Carol Weihrer was taking it in stride.

“I went into this with a very good frame of mind,” Weihrer, now 53, of Reston, Va., said of the operation performed more than eight years ago.

She’d been struggling with a serious condition called corneal erosion syndrome, and could no longer stand the pain. So Weihrer decided the surgery was the best solution.

Little did she know the nightmarish experience would alter her life. And it began on the operating table.

“I remember hearing disco music, and then I heard the surgeon say to the resident, ‘Cut deeper,’” Weihrer said. “I realized I was awake and the surgery had just started.”

She tried frantically - and futilely - to blink her eyes to alert the surgeons. She couldn’t move her head, either. “I was screaming at the top of my lungs but no noise was coming out.”

Weihrer experienced “anesthesia awareness” - or what doctors call “awareness with recall” - when patients aren’t fully anesthetized and are aware they’re being operated on.

Earlier this month, the Joint Commission on Accreditation of Heathcare Organizations, which accredits 16,000 U.S. hospitals and other health-care facilities, issued an alert about anesthesia awareness. It called the phenomenon an “under-recognized and under-treated” problem.

The commission suggested that hospitals and health-care facilities that perform surgery using general anesthesia develop a policy that includes, among other steps, education of staff, identification of patients at particularly high risk and conducting postoperative follow-up to detect any problems. The group also recommended that hospitals ensure that patients who suffer mental distress after enduring anesthesia awareness be given access to counseling or other support programs.

While the exact number of patients affected by anesthesia awareness isn’t known, a study published earlier this year in Anesthesia and Analgesia estimated the number at one to two patients per 1,000. That translates to 20,000 to 40,000 patients annually in the United States, according to the commission.

For some, the experience is so terrifying they suffer post-traumatic stress syndrome (PTSD), said Dr. Peter S. Sebel, a professor of anesthesia at Emory University School of Medicine in Atlanta, who co-authored the study in the anesthesia journal.

Weihrer said she has suffered PTSD since her ordeal.

“I have all the classic symptoms. I have not slept in a bed for six-and-a-half years, I can’t lie down in a bed,” said Weihrer, who sleeps in a chair. She also sees a psychiatrist every one to three weeks, she added.

Weihrer founded The Anesthesia Awareness Campaign, a nonprofit advocacy group that seeks to make people aware of the problem.

She and others say the solution is relatively simple: besides making patients aware of the potential risk, hospitals should install monitoring technology that can alert anesthesiologists if a patient is on the verge of waking up.

The monitoring technology, which is already available, “measures brain waves and gives a read-out,” said Sebel. This lets the anesthesiologist increase the anesthetic to reduce the chance of a patient awakening.

Two recent studies revealed the value of such monitoring, Sebel said. In one, published in the May 29 issue of The Lancet, researchers assigned about half of 2,463 patients to a monitored group; the others received standard care. Only two reports of awareness occurred in the monitored group, compared to 11 in the standard care group.

The second study, published in January in a Scandinavian anesthesiology journal, found that 0.04 percent of 4,945 monitored patients had suffered anesthesia awareness, compared to 0.18 percent of 7,826 patients in a standard care group.

“I think the data are sufficiently convincing to make a case for using the monitoring technology,” said Sebel, who works as a consultant for a company that produces monitoring equipment.

But Dr. Roger W. Litwiller, president of the American Society of Anesthesiologists, said solutions aren’t that simple.

“Each person’s body reacts differently to anesthesia,” he said. “And there are many different types of anesthesia. We take everything we know about the patients and the surgery, and based on that information we must determine the types and amounts of drugs to use, and how to administer them.”

Awareness is more likely during cardiac surgeries, traumas and emergency C-sections, Litwiller explained, because “it isn’t safe for the patient or the baby to have the deepest level of anesthesia.”

The society, he said, has assembled a task force to study the issue. It expects to issue some findings next year.

While Litwiller said brain-wave monitoring technology may help, it’s too soon to say that for sure.

On some points, both sides agree.

Giving your surgeon and anesthesiologist the most accurate medical history possible can help prevent problems. And you should always tell health-care providers about any previous problems with anesthesia.