I will be the first to put my hand up on this. In some situations, I suffer from claustrophobia. When I fly I have to have an aisle seat. I can’t sit next to the window or in the middle seat. In a crowded lift I don’t like being at the back. But I’m okay on the underground. I feel trapped and nervous. My palms sweat and my breathing rate increases.

A phobia is an excessive, extreme, irrational, fear, or panic reaction about a situation, living creature, place or object as my example clearly shows.

Most of us will avoid coming into contact with whatever causes the phobia. When we can’t avoid the situation we become fearful and anxious and that can lead to a panic attack. We all know the names of  many phobias. How many from the following list do you know? Answers at the end of the blog.

1. Anatidaephobia

2. Alektorophobia

3. Coulrophobia 

4. Lockiophobia

5. Nomophobia

6. Plutophobia

7. Trypanophobia

8. Trypophobia

In a survey of 22 countries, 7.4% of respondents reported that they experienced specific phobias within their lifetime, and 5.5% of respondents had a specific phobia within the last 12 months.(1)  

So, phobias are relatively common, but there is one phobia that is very common and that is the fear of surgery. It’s called Tomophobia and a fear of anaesthesia is linked to it. In a study 75% of the subjects felt anxious about going under an anaesthetic(2) and as many as 80% of people experience preoperative fear. One of the main factors driving this fear is the concern in the patient that they are going to wake up during their operation. In a study published in 2018 41% of patients were concerned they would wake up during surgery.(3)   

Clinically, waking up during surgery is known as anaesthesia awareness or interoperative awareness. But is this fear of waking up during surgery based on any evidence or is it just an irrational fear?

Intraoperative awareness is a rare but serious complication of general anaesthesia that occurs when patients regain some level of consciousness during their surgery and can remember what happened. Patients may recall hearing conversations, feeling pressure or pain, or being unable to move. This can be very distressing and traumatic for the patients, especially if they experience pain, paralysis, panic, helplessness, or fear.

In some cases, intraoperative awareness can lead to long-term psychological problems, such as post-traumatic stress disorder (PTSD), anxiety, depression, or insomnia.

The exact causes and mechanisms of intraoperative awareness are not fully understood, but there are some factors that can increase the risk of this phenomenon. These include:

• Anaesthetic factors: such as low doses of anaesthetic agents, technical errors, equipment failure, or drug interactions.

• Surgical factors: such as emergency procedures, cardiac surgery, caesarean sections, or trauma surgery.

• Patient factors: such as high tolerance to anaesthetics, chronic use of alcohol or drugs, reduced cardiovascular function, or previous history of intraoperative awareness.

The incidence of intraoperative awareness is estimated to be between 0.1% and 0.2% of all general anaesthetics, which means that it affects about 20,000 to 40,000 patients per year in the United States alone. However, this number may be underestimated, as some patients may not report their experience or may not remember it clearly.

There are currently no reliable methods to monitor the depth of anaesthesia and prevent intraoperative awareness.

The most commonly used device is the bispectral index (BIS) monitor, which measures the electrical activity of the brain and provides a numerical score that reflects the level of consciousness. However, the BIS monitor has some limitations and controversies, such as false positives or negatives, inter-individual variability, or lack of specificity.

Therefore, it is important for anaesthetists to be aware of the risk factors and signs of intraoperative awareness and to take preventive measures to reduce its occurrence and impact. Some of these measures include:

• Preoperative assessment: to identify high-risk patients and inform them about the possibility and consequences of intraoperative awareness.

• Intraoperative management: to use adequate doses of anaesthetic agents and avoid complete muscle relaxation, to monitor vital signs and end-tidal anaesthetic concentration (ETAC), and to use verbal or auditory stimuli to test for responsiveness.

• Postoperative evaluation: to ask patients about their experience and use a standardised questionnaire, such as the modified Brice interview, to detect any signs of intraoperative awareness.

• Postoperative support: to provide psychological counselling and treatment for patients who have suffered from intraoperative awareness and refer them to specialised services if needed.

Intraoperative awareness can have a devastating effect on patients' well-being and quality of life. By being aware of its risk factors and signs, anaesthetists can prevent or minimise its occurrence and impact and provide optimal care for their patients.

What is clear is that an anaesthetist has to be on top of their game during every procedure.

They have to anaesthetise the patient, give pain relief, monitor vital signs, check for intraoperative awareness, and keep the patient safe. EyePro and NoPress protect the patients’ eyes. BiteMe protects the airway and their teeth. These important products free up much needed time to allow the anaesthetist to focus on the important parts of the job; keeping the patient safe and ensuring the procedure is successful. Why not request your free sample today.  

Refs:

1. Journal of Psychiatry Research. Vol 126. July 2020. P67-72.

2. Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anaesthesia and postoperative behavioural outcomes. Anesth Analg. 1999;88:1042–7.

3. Celik, F., Edipoglu, I.S. Evaluation of preoperative anxiety and fear of anaesthesia using APAIS score. Eur J Med Res 23, 41 (2018).

Phobia answers:

1. Anatidaephobia- fear of ducks or other waterfowl.

2. Alektorophobia- fear of chickens or hens.

3. Coulrophobia- fear of clowns

4. Lockiophobia- fear of pregnancy and childbirth.

5. Nomophobia- fear of being without a mobile device, or beyond mobile phone contact.

6. Plutophobia- fear of wealth.

7. Trypanophobia-fear of medical procedures involving injections or hypodermic needles.

8. Trypophobia- fear of clusters of small holes, bumps, or patterns.

Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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