Summary
The author presents his personal evaluation of the nature of awareness during anaesthesia. This is primarily based on the actual cases described in the literature to date.
When a patient feels pain or discomfort ( and also hears ), this must be clearly interpreted as inadequate anaesthesia. In the absence of pain or discomfort and when the patient is apparently “properly anaesthetised,” awareness has consistently been characterized by the persistence of hearing.
The level of anaesthesia fluctuates during an anaesthetic. The patient may thus enter a “zone of subconscious attention” when there is a risk that he may hear something. This risk will be greater if the patient is worried about his condition (increased subconscious activity). Conversation during the operation should always be discreet, both in topic and sound level. Earplugs are of value, especially when the operation demands very light anaesthesia, or higher oxygen percentage ( e.g. Caesarean sections and poor risk cases ).
Hypnosis is of value in research on awareness and possibly in the treatment by hypnoanalysis of a patient who has been adversely affected by the subconscious memory of events during surgery.
Subconscious traumata should be regarded as “the invisible scars of surgery.” They may have a profound effect on the patient’s psyche and future life. It is the anaesthetist’s duty always to ensure oblivion as well as analgesia during surgery.
Résumé
Ľauteur présente sa façon personnelle ďévaluer ľétat de conscience du malade durant ľopération. Au départ, cela est basé sur les cas trouvés dans la littérature actuelle.
Lorsqu’un malade ressent de la douleur ou manque de confort (et aussi peut entendre) il faut conclure que, de toute évidence, ľanesthésie est inadéquate. En ľabsence de douleur ou de manque de confort, si le malade semble anesthésié adéquatement, ľétat de conscience a toujours été caractérisé par le persistance de ľouïe.
Les niveaux ďanesthésie peuvent varier au cours ďune opération. Le malade peut, en conséquence, atteindre une “zone ďattention subconsciente” et c’est à ce moment qu’il peut entendre ce qui se dit. Cette possibilité ďentendre sera plus grande si le malade est inquiet de son état personnel (activité subconsciente accrue). Les conversations au cours des opérations devraient toujours être discrètes aussi bien sur le sujet de la conversation que sur la force de la voix. Des bouchons dans les oreilles peuvent toujours être ďune certaine utilité, particulièrement si ľopération ne requiert qu’une anesthésie superficielle ou un pourcentage ďoxygène plus élevé ( au cours ďune césarienne ou chez les mauvais risques ).
Ľhypnose peut avoir de la valeur dans la recherche de ľétat de conscience et également, dans le traitement, par hypnoanalyse, ďun malade qui aurait été psychiquement touché par le souvenir subconscient ďévénements survenus au cours de la chirurgie.
Les traumatismes subconscients pourraient être envisagés comme des cicatrices invisibles de la chirurgie sur le psychisme du malade et, sur son avenir, ils peuvent exercer des influences importantes. C’est à ľanesthésiste qu’il appartient de fournir, au cours de la chirurgie, ľinconscience aussi bien que ľanalgésie.
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Scott, D.L. Awareness during general anaesthesia. Canad. Anaesth. Soc. J. 19, 173–183 (1972). https://doi.org/10.1007/BF03005047
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DOI: https://doi.org/10.1007/BF03005047