- The Washington Times - Thursday, October 27, 2005

ATLANTA — A national doctors group has adopted standards to help prevent patients from awakening during surgery, but the physicians stopped short of embracing the use of new devices that monitor patient awareness.

The American Society of Anesthesiologists (ASA), meeting here this week, approved the group’s first standards on preventing a rare but terrifying situation in which patients wake up during surgery and sometimes feel excruciating pain without being able to cry out.

Such awakenings occur in one or two cases out of every 1,000, the group said.

The phenomenon received press coverage after patients filed lawsuits and after the Joint Commission on Accreditation of Healthcare Organizations last year urged hospitals to better monitor patients for the problem and ask them about it after surgery.

The anesthesiologists society called for doctors to follow a checklist protocol for anesthesia equipment to make sure proper doses are being delivered.

However, the group decided against adopting a new generation of brain-function monitors as a standard of care.

Perhaps the best-known of the machines is the Bispectral Index (BIS) monitor made by Aspect Medical Systems Inc. of Massachusetts. The BIS monitor tracks brain-wave activity and provides doctors with a reading that represents the mathematical probability that the patient is wide awake.

The machine has been on the market since 1996. It retails for about $9,500, but the negotiated purchase price is frequently $5,000 or less, a company spokeswoman said.

Aspect has pushed for its machines to become a standard feature in operating rooms, but some doctors have resisted, saying clinical evidence of BIS monitors’ effectiveness was wanting.

The ASA said doctors can consider the devices on a case-by-case basis — particularly in trauma surgeries and Caesarean sections, two procedures in which deep anesthesia often is avoided and partial awareness is most likely.

Although at least one study has found the devices to be effective, others have reached a different conclusion, society members said.

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