Figures vary (sometimes wildly, depending in part on how they are gathered) but big American and European studies using structured post-operative interviews have shown that one to two patients in 1,000 report waking under anaesthesia. More, it seems, in China. More again in Spain. Twenty to forty thousand people are estimated to remember waking each year in the US alone. Of these, only a small proportion are likely to feel pain, let alone the sort of agonies described above. But the impact can be devastating.
Cole-Adams suggests that the answer maybe a personal touch:
So if you were my anaesthetist and I your patient, there are some other things I’d hope you would do in the operating theatre. Things that many already do. Be kind. Talk to me. Just a bit of information and reassurance. Use my name.
For some argue that there should be care that goes beyond consciousness:
Japanese anaesthetist Jiro Kurata calls this “care of the soul”. In an unusual and rather lovely paper delivered at the Ninth International Symposium on Memory and Awareness in Anaesthesia in 2015, he wondered if there might be “part of our existence that cannot ever be shut down, which we cannot even conceive by ourselves” – a “subconscious self” that might be resistant to even high doses of anaesthetics. He called this the hard problem of anaesthesia awareness.