Martin Wainwright 

Tourniquet technique could end surgical nightmare

Normal bank holiday routines have been abandoned by a small group of doctors and researchers who believe that one of medicine's holy grails may be within reach.
  
  


Normal bank holiday routines have been abandoned by a small group of doctors and researchers who believe that one of medicine's holy grails may be within reach.

Instead of opting for a weekend snooze, anaesthetists from across the world are preparing to discuss how to prevent the exact opposite - everyone's nightmare of waking up in the middle of a hospital operation.

Latest figures estimate that one in every 500 patients put under general anaesthesia recalls experiences during surgery, without any way of letting doctors know at the time. Operating theatre records suggest that a much larger number briefly become conscious but have no subsequent memory of the fact.

The conference at Hull University next week will see live demonstrations of three different anaesthetic monitors, devices to check that patients are still "out" which have been stubbornly difficult to perfect.

Heart and blood-pressure monitors have been generally discarded as guides to a patient's state of consciousness, but practical ways of checking brain activity are still proving a technical challenge.

Speakers include the surgeon Lord Winston and a former flautist from the US, Carol Weihrer, who was conscious throughout a five-hour operation to remove one of her eyes. But one of the potential breakthroughs is a home-grown method tested successfully in Hull which gives patients a simple way of telling surgeons they are awake.

"It's called the 'isolated forearm technique' and it could hardly be simpler as an idea," said Michael Wang, head of Hull's department of clinical psychology. "Instead of trying to monitor consciousness, we have looked for a way round the muscle relaxants which paralyse a patient under general anaesthetic."

The paralysis leads to situations like Ms Weihrer's where, although painkillers prevented her suffering pain, she had to endure the intense pressures exerted during an extraction operation.

Professor Wang said: "Our method involves isolating one forearm with a tourniquet when the muscle relaxants are administered, which leaves the arm, hand and fingers able to move if the patient regains consciousness."

Trial patients have been fitted with earphones which play a taped message during anaesthesia saying: "If you can hear this, clench the fingers of your right (or left) hand." The system has worked so effectively that it will be used to check the performance of brain activity monitors during the conference demonstrations.

"We will be feeding brainwaves into monitors from people who used the technique in trials," said Prof Wang. "We know when they were conscious and when not, and that will be compared with what the monitors tell us."

There was an experiment in London in the 1960s, organised by a trainee doctor who was concerned that medics' jokes made during operations were processed by patients' brains.

He staged a fake crisis during 10 operations where one doctor told another "the patient's turning blue". Under hypnosis, four of the 10 repeated the words verbatim and another four became distressed, suggesting they had some awareness of the incident.

 

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