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    New Technique Allows Patients to Respond Under General Anesthesia

    By Jennifer Huddleston, staff writer     

    Italian researchers have devised a way for patients to communicate with anesthesiologists and surgeons while under general anesthesia during surgery.

    In a study led by Sergio Bevilacqua, M.D., of Ospedaliera Universitaria Careggi in Florence, Italy, researchers employed a technique called cooperative patient general anesthesia in 181 adult patients undergoing carotid endarterectomy (carotid artery surgery) to prevent stroke.

    Patients initially were anesthetized with a total intravenous anesthesia technique. When the carotid artery was clamped, anesthesia was reduced and patients were given remifentanil, a drug which suppressed pain while allowing the patients to remain conscious and respond to simple verbal commands like opening their eyes or squeezing an object in their hands. The patient feedback enabled the surgeon to ensure that adequate blood flow to the brain remained during the procedure.

    The cooperative patient general anesthesia technique was effective for 179 of the 181 patients included in the study. In about 12 percent of the operations, the patient’s responses during the operation made it possible for the surgeon to take further action to preserve blood flow to the brain.

    Almost all patients (99 percent) said the experience was not stressful; rather, they reported it was even pleasant at times. While most patients characterized the experience as dreamlike, some reported more vivid memories. The majority of patients (81 percent) said the operation was brief, while approximately 19 percent accurately identified the length of time they were conscious during the operation. None reported any pain or trauma, and researchers reported that no postoperative neurological events were observed in any patients.

    Patients and surgeons reported high levels of satisfaction with the cooperative patient general anesthesia technique. While researchers concluded that it is a safe technique for both the patient and the surgeon, further studies are necessary to determine the advantages of this technique as compared to typical general and local anesthesia.

    Carotid artery surgery is a common operation to prevent stroke in patients with hardening of the carotid arteries (atherosclerosis), which supply the brain with blood. Local anesthesia can be used in order to keep the patient conscious for monitoring during the procedure, but many surgeons and patients do not feel comfortable doing so.

    The findings of the study are published in the June 2009 edition of Anesthesia & Analgesia.

    [1] “New Anaesthesia Lets Patients Talk During Surgery.” The Times of India. June 6, 2009.
    [2] “New Anesthesia Technique Lets Patients Cooperate During Carotid Surgery.” Medical News Today. June 6, 2009. 

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