Misconceptions -- AwakeMovieFacts.com

Common Misconceptions About Anesthetic Awareness

SPOILER ALERT: Important plot twists are revealed in this section. If you have not seen the movie, consider yourself warned.

Misconception: The “Awake” movie poster says: “Every year 21 million people go under anesthesia. One in 700 remain awake the entire time….”

Truth: While it is true that an estimated 21 million general anesthetics are administered each year by Certified Registered Nurse Anesthetists (CRNAs) and physician anesthesiologists, the statement that "one in 700 [patients] remain awake the entire time" is outrageous. According to research, awareness occurs once in every 1,000 cases involving general anesthesia, but it is typically fleeting. The patient may recall sounds, conversation, OR activity, pressure, and possibly pain, but only momentarily or for a short duration until the anesthetics are adjusted and the patient is once again unconscious. Patients usually do not suffer residual emotional or psychological effects from the experience.

It is not known how often awareness experiences attain the terrifying and life-changing level depicted in "Awake," but it is believed to be a rare occurrence—far, far less frequent than the 1 in 1,000 cases cited above. Because such occurrences appear to be "statistically insignificant," it is difficult to quantify and study them. However, realistically speaking, if it was true that one patient in every 700 surgeries under general anesthesia was "awake the entire time," the public outrage would have been deafening a long time ago.

Misconception: Operating rooms, particularly during heart transplants, are as empty and unpopulated as the OR scenes in “Awake.”

Truth: The operating room scenes in “Awake” have more than the usual inaccuracies commonly seen with medical themed movies or TV dramas. Realism is severely lacking.

In “Awake” the following deficiencies occur:

The surgical team consists of the transplant surgeon (a friend of the victim), a second physician and a nurse. Another doctor (we later learn he is the anesthesiologist) shows up late. In reality a heart transplant team consists of more than four people, and typically includes residents, at least two nurses, perfusion technicians, etc.
The anesthesiologist would not leave the room unless another anesthesia provider (anesthesiologist or Certified Registered Nurse Anesthetist), or the perfusionist who runs the bypass machine, replaced him. He would not be drinking alcohol out of a flask. The truth is hospitals have policies for reporting workers suspected of drinking. Further, toward the end of the movie when the second transplant team arrives to save the day, it does not appear that an anesthesia provider is part of the team! (In fact, the second transplant team is as skimpy as the first.)
When the Hayden Christensen character is starting to go under anesthesia, monitoring equipment seems to be missing and an IV has mysteriously appeared for a close-up shot of anesthetic drugs being injected into an IV port. However, it does not appear that the character is hooked up to an IV throughout the movie. Further, at the end of the movie when the second transplant team comes in to save the day, it does not appear that the Hayden Christensen character ever receives the anesthesia he so desperately needs!
When the Lena Olin character is rolled into the operating room (OR) to donate her heart, no life support equipment is attached. When a potential donor dies and the heart has stopped beating for a duration of time (as in “Awake”), then the heart is no longer useable.
There is absolutely no adherence to a sterile environment. Masks are taken off, the wife parades into the room and reaches onto the instrument table to handle a syringe. etc. This would be impossible in a real operating room, even if a number of members of the surgical team were involved in a plot to kill the patient!
There are various close-ups of different pieces of equipment arranged along the walls of the room, but nothing appears to be attached to the patient.

Misconception: A patient on a heart donor list who is suffering from cardiomyopathy is able to hold his breath under water in the bathtub for a long period, smoke cigarettes, and have hot, steamy sex, like the Hayden Christensen character in the movie.

Truth: This is highly unlikely. Patients with cardiomyopathy who are awaiting transplant surgery have a hard time breathing, let alone holding their breath under water or breathing heavy during lovemaking.

Misconception: Heart transplant doctors with four malpractice cases pending against them have the run of the hospital, the OR, and are the first choice of most patients awaiting a heart.

Truth: Not likely in any hospital that conducts transplant surgeries. These hospitals are generally top of the line, and such a doctor would be under intense scrutiny, if he was allowed to continue practicing at all.

Misconception: Awareness experiences always involve terrible pain, fear, and panic.

Truth: The duration and severity of anesthesia awareness varies, but most awareness experiences are unremarkable. Patients may hear conversations or activities in the OR. Some patients may feel pressure or pain that doesn't last long. However, awareness experiences as severe as the one depicted in "Awake" are highly unusual.

It is important for patients to know that Certified Registered Nurse Anesthetists (CRNAs) and physician anesthesiologists are highly educated and clinically trained anesthesia professionals, and one or the other will always be with the patient during surgery. Combining their clinical expertise with high-tech monitoring devices, they constantly check the patient's vital signs and adjust the anesthetics accordingly. While equipment malfunctions and human error can occur, with awareness a possible outcome of such events, advancements in the science of anesthesiology have greatly reduced the risk of mortality and increased patient comfort and safety exponentially. However, one patient death or one patient who is awake during surgery is one too many, so anesthesia researchers and providers continue striving to better understand the causes of awareness and eradicate the experience altogether.

Misconception: Awareness can occur during any type of surgical procedure that requires anesthesia.

Truth: This is incorrect. Awareness can occur under general anesthesia, but not with local or regional anesthesia or with conscious sedation. With local and regional anesthesia and conscious sedation, it is intended for the patient to be awake (have some level of consciousness) throughout the procedure.

Awareness can, indeed, occur during any type of surgery involving general anesthesia, but is most likely to occur during certain high-risk procedures, specifically cardiac surgery ("Awake"), emergency C-section, and trauma surgery. This is because the patient is already fragile, and receiving too much anesthesia could be more detrimental than not receiving enough.

Misconception: Patients under general anesthesia are always paralyzed.

Truth: Patients are usually, but not always, rendered incapable of moving while under general anesthesia. The reason for this is obvious: During most surgeries that necessitate the use of general anesthesia, it is in the patient's best interest to eliminate the risk of involuntary movement that could lead to a surgical mishap. This is done through the administration of paralytic drugs.

While it is true that the horror experienced by the Hayden Christensen character in "Awake" is perpetuated by the fact that he is paralyzed and cannot alert anyone to his predicament (cry out, move a finger, etc.), his "awareness" is actually caused by the failure of the medication intended to render him unconscious and prevent him from remembering the surgery.

Patient awareness under general anesthesia (or anesthetic awareness) is a rare condition that occurs when surgical patients can recall their surroundings or an event—sometimes even pressure or pain—related to their surgery while they are under general anesthesia. Severe cases of anesthetic awareness happen infrequently, but research is ongoing to determine the causes of awareness and prevent it from happening

Misconception: Out-of-body experiences are commonly associated with patient awareness under anesthesia.

Truth: It is true that some victims of extreme awareness have reported some form of out-of-body experience as a way of dealing with the horrors of their predicament. The human mind is a powerful and still largely mysterious organ that can accomplish amazing things. Unfortunately, victims of extreme awareness who have shared their stories largely reveal terrible ordeals, a fear of death or desire to die on the operating table, tremendous panic over being unable to move or cry out, etc. Mental distractions such as reliving happy childhood experiences, escaping to an island paradise, or even prayer, are largely ineffectual.

Misconception: Patients should avoid general anesthesia at all costs.

Truth: Often there simply is no choice but to have general anesthesia. A patient's anesthesia provider is best qualified to make this determination, but should always discuss all anesthesia options with the patient before finalizing the care plan.