Sizing Up Surgery

Waking to a Nightmare

Although it is rare, some patients have reported "awareness" or experiencing sensations while under anesthesia. Those patients say they recall hearing snatches of conversations, being aware of movement, and feeling pain. But whether this awareness really occurs or is just the subconscious mind playing tricks that come back to haunt the conscious mind has been subject to a lot of debate in the medical community. According to Elting and Isenberg, when the anesthesia is weak, or the depth of unconsciousness is purposely held shallow, the subconscious may provide its own interpretations of what is happening and those interpretations may not necessarily be accurate.

But whether or not awareness is real, anesthesiologists are always on the lookout for indications of "light" anesthesia, such as sweating or involuntary twitching. In these cases, says Brenda Hayden, R.N., an interdisciplinary scientist with FDA's Center for Devices and Radiological Health, the anesthesiologist would increase the anesthesia to put the patient in a deeper state of unconsciousness.

Hospital Infections

According to the national Centers for Disease Control and Prevention, approximately 2 million people a year contract infections during a hospital stay, and nearly 90,000 die as the result. Urinary tract infections, surgical wound infections, pneumonia, and bloodstream infections annually are the most common hospital-acquired infections. Of those, pneumonia and bloodstream infections cause the most deaths (about 34,000 and 25,000 respectively; infections from surgical wounds cause about 11,000 deaths, and urinary tract infections 9,000). Those numbers would be far greater, CDC says, without infection-control programs that have been required for hospital accreditation since 1976. In fact, according to a recent CDC survey of 265 hospitals nationwide, without these programs, there would have been 50 to 70 percent more infections and deaths.

Hand washing is the single most important procedure for preventing hospital-acquired infections, according to CDC. Patients and their families should ask their health-care workers to follow good hand washing practices, and bring it to their attention when they do not. In addition, health-care professionals need to follow CDC guidelines and recommendations on the use of intravenous lines and other medical devices, and the proper use and administration of antibiotics.

Patients should alert their physicians or nurses who are providing them care, or hospital administrators, if they have concerns about their health-care workers' practices. All states have licensing and oversight bodies in their state health departments that respond to concerns and complaints brought by patients.

Patients should always provide their doctors with a complete health history, including:

• other medications (some drugs may increase the risk for infection)
• infections
• recent exposure to people or animals who might have infectious diseases
• travel to areas with high rates of infectious diseases.

If you become more ill after arriving home from a hospital stay and develop unexpected symptoms such as pain, chills, fever, discharge, or increased inflammation of a surgical wound, you should alert your doctor.