Open heart surgery. I cant take this im going crazy a constant bedside thats what i was thinking and i kept hoping we have to lose consciousness and then not noticing why arent they noticing the make up for. This coming its difficult to describe the kind of pain you have. Nots and it shoots through your whole body or scare it or you can soko. Venit the wrestler tried desperately to get someones attention. But he couldnt move. Virtually every general anesthetic contains substances that paralyze our muscles. With islamists it was horrible the doctors just carried on and chanted no one noticed the state i was in. After a long while i suddenly heard a voice. I think somethings not right the anesthesia is lifting the patient is breathing himself on my ok lets wait a minute. Lets give him a bit more. Then there was this hissing and i was out. Then if thats low on scored its in saxony is one of the around 16000. 00 people who wake up during general anesthesia every year in germany accidentally. It was a traumatic experience. And he still haunted by nightmares years later. Why he had experienced anesthesia awareness was never explained bennett the wrestler asked the doctors. They said this kind of thing shouldnt happen and they cant imagine what its like and i hoped he would never happen again but they also said theres no point in my taking legal action because i wouldnt get anywhere if the doctors admitted fault id have to cover the costs. Around 16000000 medical procedures requiring general anesthesia are carried out every year in germany during which one patient in a 1000 experiences unintended intra operative awareness has managed to rest why did. Many believe consciousness has an on off switch yet scientists dont even truly understand why we need normal sleep and why we dream. We know even less about artificial sleep. Vienna general hospital. Where weve been allowed to film a general anesthesia procedure from beginning to end. Unit she for is an anesthesiologist general anesthesia is part of her daily routine. Every patient gets deeper raped before surgery. I stop the Alcohol Consumption regular occasionally twice a week wait age illnesses medications you to chief needs to know as much as possible about her patients to be able to decide which anesthetics to use and with what dose. And what about your teeth all good. Yes. You have and how did you tell the right your last i missed it and i felt nauseous after. You felt noisiest did you vomit as well i also vomited. The conversation isnt only for gathering Necessary Health data its also intended to assure patients. For fear of unintended interoperate of awareness fear of waking during surgery of being paralyzed and aware but without being able to speak. So thats the fear of patients talk about most often. At the. Distant tissue was scheduled for uterine surgery the next day yeah. Before my whole body resisted the anesthesia and i felt really bad and then collapsed that was really unpleasant this time im putting that aside and telling myself these people will look after me and nothing will happen so no im not really afraid anymore. The word anesthesia comes from greek for without sensation its development was a blessing for patients who until the 19th century were operated on without anesthesia. There were attempts to relieve pain through hypnosis alcohol or opium. But the doses were administered haphazardly. And often even when operations had been successful the patients died. Anesthesia was 1st demonstrated in boston and 846 dentist William Morton put the patients into an artificial sleep with ether and then removed the tumor and the operation was a success that made headlines worldwide. Years later anaesthesia with artificial mechanical respiration was introduced by the turn of the century spinal anesthesia which specifically blocks the sensation of pain in the lower half of the body had also been invented. New and better anesthetics rapidly developed from 950 onward. Numerous hospitals open anesthesiology departments which are today indispensable in modern medicine. The following morning at the Vienna University general hospital. Patient kiersten tissues ready for surgery. We also have e. C. G. Electrodes Blood Pressure cuffs oxygen saturation. General anesthesia always consists of 3 parts 1st there is a strong painkiller. For them for that you may be getting a little time a little dazed. Just take nice deep breaths and think of something pleasant. Could i commence is the way the more you think about what she doing the scarier it feels to. Have this is. The 2nd step. Is the next step is the medication that makes you fall asleep. Until. The sleep inducing drugs used are hypnotics that switch off consciousness just keep breathing in and out take a deep breath. Since it are you feeling sleepy already. The most commonly used anesthesia inducer is propofol. And injection works within a few seconds. The last step is muscle relaxants substances that relax muscles and immobilize the patient. Without these the bodys protective reflexes could cause involuntary twitching even while under. The can do that you place. And press. Patients would suffocate without artificial ventilation. Once anesthesia has been induced patients must be kept under. As just in tissues prone to nausea shes receiving propofol as this causes nausea less frequently than volatile gaseous anesthetics. Protocol can have other side effects such as drops in Blood Pressure or apnea. Kiersten tishs now unresponsive. But what does that actually mean she asleep is she unconscious. A study in munich is trying to find answers to these questions head of anesthesiology care hard schneider is testing what happens in the brain when consciousness is lost under anesthesia. So far we know very little about the brain mechanisms involved in this process. Magnetic resonance imaging provides brain scans of test persons while they are awake and under general anesthesia. So where is consciousness located. Yeah we anesthesiologists have a very simplistic idea of consciousness. For us patients are unconscious when theyre unresponsible or an react or. What i call a consciousness component is basically reaction to stimulus. Or conscious reaction to stimuli. But for psychologists or social scientists this has nothing to do with consciousness as. Scientists long believed anesthesia switched off the entire brain like a light switch but as snyder has observed in fact only certain brain regions marked red here are less active under anesthesia. These regions are part of the brains functional network where several brain areas Work Together to achieve efficient connectivity. These networks are responsible for processing incoming stimuli such as sound or pressure and interpret in them to form conscious perceptions and as the zia disrupts these networks. During reduced consciousness the primary sensory areas the parts of the brain responsible for the 1st stage of stimuli processing. Are completely active. Partially theyre even more active than when were awake but the next step the interpretation of higher order processing does not happen that final stage of consciousness is disrupted by anaesthesia. Exactly how anaesthesia it disrupts the brains functional networks is what basic Research Scientists and. Doing it or hoping to find out. The. Band is investigating how anaesthetics work on a molecular level. The challenge is that there are dozens of them. And their molecular structure alone suggests each is very different. From a. Whole bunch when they work they all lead to the same effect on consciousness its just you know how can that me. We have identified proteins that are absolutely essential for anaesthesia but identifying these small Building Blocks alone doesnt come close to explaining how consciousness is lost on the org. The researchers are using mouse brains to try to better understand how different substances used in anesthesia work. For many decades scientists thought all anesthetics essentially blocked information from reaching neurons by causing a malfunction and their lip it membranes. However this lifted theory has since been abandoned today researchers know that every anesthetic has a different way of causing a consciousness of. Brain tissue cultures taken from areas of the brain involved in loss of consciousness are put into a nutrient solution for several weeks during which time they grow into many brains which can be used for experiments. And. This is what researchers have discovered so far. Central nervous systems receive and process stimuli from the external world individual neurons communicate with each other across gaps called synapses. Synaptic communication or transmission works like this. Neuron a emits messenger substances called neurotransmitters which bind to receptor in neuron b. Anesthetic such as. Mainly act on the neurotransmitter gaba which dampens the signals. Of all reinforces this dampening effect and thus prevents the neuron from sending out a signal. The damping occurs at several locations in the Central Nervous system. Precisely which are responsible for a patient losing consciousness is not yet clear. And most likely also depends on the ennis that accused. There are anesthetics that do not act on the messenger but on the other neurotransmitters that tuning and researchers are investigating these differences with a micro e. G. That measures signal transmission in the many brains of neurons. So all anesthetic drugs have been found by trial and error doctors know that they work but not exactly how they work. However understanding the how is an important prerequisite for reducing side effects. We should really be looking at patients individual needs and attributes and choosing the substances they get accordingly we need a rational approach and not just a trial and error approach to see if it works and if it does thats good enough the. Trial and error right. Why in order to minimize and reduce errors perspective anesthesiologists at the height of burke anesthesia and emergency medicine Simulation Center artists on dogs were. Left director at anesthesiologist christopher annoyed house. Explains the simulation of. A 45 year old man was hit by a car in the city while walking on he still awake as spontaneous breathing and his circulation is stable system the rest youll see going to moment. The instructors control the dog from the next room. Doc i missed a good im the an ether test could you open your mouth place what. You know yes can you stretch your neck. Yes good friends a bit of a could you please do something for the pain my stomach hurts so much yes well give you something now mystically going to begin the anesthesia the 1st truck will make you a bit fuzzy were going to take good care of you this is. Its interesting to see how quickly you forget that its only a plastic doll with a bunch of telltale sign else once participants get used to the situation they dont just speak to the dog they show it real empathy and stroke its cheek and reassure it before the honest these are kicks in it shows how quickly you can forget its not real and yet snit the purpose of this exercise is to train Team Communication in stressful situations approximately 60 to 80 percent of problems during anesthesia are due to human failure. If youre just kind of says its was i wouldnt exactly call it failure because its a value judgment of the Technology Used in this area so good that its not the problem and its the easier machines dont just suddenly explode in devices dont suddenly fail which leaves communication and teamwork where misunderstandings do occur that can lead to mistakes happening have a misfortune is off to it and be done this instead inference is a friend to consider. The trainers simulate the worst Case Scenario cardiac arrest and we dont have any circulation anymore so we need to press. Today. It is all. Because the pressure rising. With the. National congress to try to figure. Out a pause for a moment circulation is picking up thats the truth. Of the. Thanks very much lets stop here for no take a deep breath i want to think how was it for you. On my side i think i could have called the attending physician earlier before i started the anesthesia but i think overall we got through it well. The seminar is not a test participants actions are a value weighted but no marks given busy also everything here is strictly confidential. Each day over 40000. 00 general anaesthetic sort ministered in germany lots of them at the clinic th often. Mark ober is preparing for a very special anesthesia an operation with xenon. Xenon is a noble gas used in fluorescent tubes or car headlights and it can also be used in the operating theatre. Seen on has been called the miracle anesthetic drug because its proven to be well tolerated even by sensitive patients or people in very poor health. In contrast to other anesthetics. It puts hardly any strain on circulation. The effect begins quickly and also disappears quickly so that patients regain alertness soon after surgery. But on this is the paper not as the 0 just wants to end the anesthesia that they can make a patient up very quickly this is the fastest drug we have and that is the user in terms of coronary Flow Dynamics the affected. As on Blood Pressure is very stable and patients Blood Pressure remains approximately what it was at the beginning which is much better for them and that was it to go. Coburn was researching how well elderly patients recovered after hip surgery he found that xenon anesthesia leads to significantly less complications and mortality is also lower. Seen on has been approved as an anesthetic gas since 2005. Lab tests have shown that the noble gas has Neuroprotective Properties meaning it protects the brain from damage. But today its only rarely used the reason for it is its cost. A one hour long anaesthesia with xenon costs between 20300 euros other anesthetics are only about 50 euros. It would be great if we could generate more money. To be able to carry out large trials and to further research what weve found so far. But there are many factors at play here. And at the moment its uncertain whether xenon will even still be on the market in a few years time. Because its so expensive. And one corporations are deciding whether or not to continue this Research Highlight of. A Research Project can cost between 20 and 30000000 euros the money for this comes from industry. Back in vienna. At the University Hospital the operation we have been given permission to observe is underway. Anesthesiologist who did she feel monitors the patients by the function Blood Pressure heartbeat and oxygen saturation. That. Weve been going to look. In addition and e. G. Monitor measures brain waves which helps determine the depth of anesthesia. To see me i missed out in a heavy sea the stage is a to f. The focused on the lets say basically means being away from the b. And c. Can be read as lies in this these. As a kind of dozing them of. Stages d. And e. Show us thats like she has no as a patient has a good depth of anesthesia and. There are no numbers on how often anesthesia is monitored with e. G. Experts estimate the technique is part of routine procedure and less than half of all hospitals in germany. You did she for uses e. G. Often but not exclusively is kind and so she didnt and various parameters can indicate that a patient is awakening or experiencing pain. In our line of work we also keep an eye on whether the patient is sweating or whether theres an increase in heart rate hike or an increase in Blood Pressure stick. And pupil which can also be a sign. As well as tears. Up its tween. A study on intra operative alertness is currently underway in munich. Patient nina have now is being prepared for new surgery. This cap measures brain waves even more precisely than the standard 3 electrodes on the forehead. The researchers have developed a method for communicating with the patient in case she wakes up during surgery. A Blood Pressure cuff keeps the muscle relaxing medication from getting into her forearm. This ensures that if the patient is conscious while under anesthesia she can move her hand. Squeeze my hand. Menace fish if there are fish in the sea squeeze my hand. And if a stone floats in the worlds head squeeze my hand. And if you have pains him a squeeze my hands twice miss head. In the most recent study like this one almost by percent of patients did clench their hands. Patients who take opioids regularly have a higher risk of regaining consciousness while still under anesthesia as do drug and alcohol addicts people who are often extremely scared of surgery. I have not been as have not pressed my hand twice if everythings fine its the in me told me that moment that we currently cannot rule out consciousness with 100 percent certainty using the methods of e. G. Analysis we have now thats one problem the other problem is that the e. G. Only react when wakefulness has already occurred meaning that by the time the calculator to e. G. Index value detect something the event already took place before. The study in munich is also examining subconscious memory can patients remember things in spite of anaesthesia. Or often cluck. Cluck. Into the industry factory factory. Only one word in each pair was mentioned during the operation the patient has to choose which feels more familiar. Within the council we are really still at the very beginning so we cant really predict the outcome yet but we have been surprised a few times on the one hand there are patients who clench their hand when asked to do so. And on the other hand there are also patients who even if they arent consciously remembering. Are able to recall lists that we played with a high level of success. Anesthesiologists at University Hospital had developed a new device for monitoring anesthesia the risk of waking up during an operation is particularly high when drugs are administered intravenously. One possible reason for this is that propofol concentration in the body cannot be measured yet. But in inhalation anesthetics the socalled blood gas partition coefficient describes this. The fact that the concentration of volatile anesthetics can be measured a measure of the concentration which i didnt have until now with propofol which is why the probability of over and under dosing is higher than with gas anesthetics. For. This new device is intended to remedy the situation the measures the concentration of prop