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business. because it is not. the 1st looks. waking up when an artificial sleep is supposed to keep you safe from fear and pain . this nightmare scenario happened to bennett the best during open heart surgery. i just i can't take this i'm going crazy a constant basis that's what i was thinking and i kept hoping we have to lose consciousness and then not noticing why aren't they noticing something is a microphone. that's come or gets difficult to describe the kind of pain you have. it shoots through your whole body or scare. bennett

that's the tried desperately to get someone's attention. but he couldn't move. virtually every general anesthetic contains substances that paralyze our muscles. 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 something's not right the anesthesia is lifting the patient is breathing himself right ok let's wait a minute. let's give him a bit more. with this then there was this hissing and i was our.

manifesto from scott it's 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 best asked the doctors. they said this kind of thing shouldn't happen and they conti matcham wanted slike and i hoped he would never happen again but they also said there's no point in my taking legal action because i wouldn't get anywhere else if the doctors that made it felt i'd 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 been addressed it. many

believe consciousness has an on and off switch. yet scientists don't even truly understand why we need normal sleep and why we dream. we know even less about artificial sleep. vienna general hospital where we've been allowed to film a general anesthesia procedure from beginning to end. and you to chief is an anesthesiologist general anesthesia is part of her daily routine. every patient gets steeper effect before surgery. alcohol consumption regular occasional twice a week. 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 to write your last. after. you felt noisiest did you vomit as well i also vomited. the conversation isn't only for gathering necessary health data it's also intended to assure patients. here of unintended intra operative awareness fear of waking during surgery of being paralyzed and aware but without being able to speak. that's the fee of patients talk about most often. i kissed and tissue was scheduled for uterine surgery the next day. before my whole body resisted the anesthesia and i felt really bad and then collapsed that was really unpleasant this time and putting that aside and telling myself these people

will look after me and nothing will happen so no i'm not really afraid anymore as a thing which was. 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 $846.00 dentist william morton but the patient into an artificial sleep with ether and then removed the tumor. 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 anaesthesia

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 1950 onward. numerous hospitals open anesthesiology departments which are today indispensable in modern medicine. the following morning that the vienna university general hospital. patient kissed in 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. see them feel that you may be getting a little toy it a little dazed. just take nice deep breaths and think of something pleasant.

commences the way the more you think about what she doing this scarier it feels thinking about how this is. the 2nd step as nick says the next step is the medication that makes you fall asleep and stuff in. the sleep inducing drugs used or hypnotics that switch off consciousness just keep breathing in and out take a deep breath. since that 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 body's protective reflexes could cause involuntary twitching even while under. under that you please. and press. patients would suffocate without artificial ventilation. once anesthesia has been induced patients must be kept under. as just an tissues prone to nausea she's 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. testing tissues now unresponsive. but what does that actually mean she asleep if she unconscious.

the 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 they're unresponsive boren react or. what i call a consciousness component is basically a reaction to stimulus. or conscious reaction to stimuli. but for psychologists or social scientists this has nothing to do with consciousness this

sense of. scientists long believed anesthesia switched off the entire brain like a light switch but as schneider has observed in fact only certain brain regions marked red here are less active under anesthesia. these regions are part of the brain's 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 it's 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 inactive.

partially they're even more active than when we 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 anesthesia disrupts the brain's functional networks is what basic research scientists and. tubingen are hoping to find out. all the. band. is investigating how anaesthetics work on a molecular level. the challenge is that there are dozens of them. with you and their molecular structure alone suggests each is very different. but when they work they all lead to the same effect on consciousness which is you know how can that me. we have identified proteins that are absolutely essential for anaesthesia but identifying the small building blocks alone doesn't

come close to explaining how consciousness is lost on a dog. the researchers are using mouse brains to try to better understand how different substances used in anesthesia who work. for many decades scientists thought all anesthetics essentially blocked information from reaching neurons by causing a malfunction and their lips at membranes. however this limited 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. this is what researchers have discovered so far. central nervous systems received and processed 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 anesthetic used. there are

aesthetics that do not act on the messenger but on the other neurotransmitters the tuning and researchers are at best to getting these differences with a micro e.g. that measures signal transmission in the mini brains neurons. so far all anesthetic drugs have been found by trial and error doctors know that they were not exactly how they work. however understanding the how is an important prerequisite for reducing side effects. we should really be looking at patient's 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 that's good enough the . trial and error write.

one in order to minimize and reduce errors perspective anesthesiologists at heidelberg anesthesia and emergency medicine simulation center back to some dollars were. left director and anesthesiologist christopher annoyed house. explains the simulation of. a 45 year old man who was hit by a car in the city while walking he still away as spontaneous breathing and his circulation is stable most of the rest you'll see in a moment. the instructors control the dog from the next room. i'm the an ether test could you open your mouth please. 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 we'll

give you something now mr click making to begin the anesthesia. the 1st drug will make you a bit fuzzy we're going to take good care of you is this is it to some it's interesting to see how quickly you forget that it's only a plastic doll with a bunch of telltale signs anyway once participants get used to the situation they don't just speak to the dog they show it real empathy and stroke its cheek and reassure it before the honest these are kicks in. which shows how quickly you can forget it's 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 you're just going to says that's was i wouldn't exactly call it failure because it's a value judgment that the technology used in this area is so good that it's not the problem and it's these your machines don't just suddenly exploded devices don't

suddenly fail which leaves communication and teamwork where misunderstandings do occur that can lead to mistakes happening obsession is often done this instead inference is a very good see. the trainers simulate the worst case scenario cardiac arrest and we don't have any circulation anymore so we need to press. today. is the pressure rising. with the ruler for the longest you don't. want to pause for a moment circulation is picking up the phone. on. thanks very much let's stop here for no take a deep breath i want to think how was it for you. from 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 while. the seminar is not

a test participants actions are evaluated but no marks given also everything here is strictly confidential. each day over 40000 general anaesthetic sort ministered in germany lots of them at the clinic are w t h often. mark ober is preparing for a very special anesthesia an operation with scene on. scene and 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 it's 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. this is the paper not just the 0 i just want to end the anesthesia they can make a patient up very quickly this is the fastest drug we have and that is these are in terms of coronary flow dynamics the affected. as on blood pressure is very stable and patient's blood pressure remains approximately what it was at the beginning which is much better for them and that was it to. 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 it's only rarely used the reason for it is its cost. a one hour long anesthesia with xenon costs between 20300 euros other anesthetics are only about 50 euros. it would be great if we could generate more money. to carry out large trials and to further research what we've found so far. but there are many factors at play here. and at the moment it's uncertain whether xenon will even still be on the market in a few years time. because it's so expensive. and corporations are deciding whether or not to continue this research. even. 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 only one of them. 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 if the focused on the let's say basically means being awake from the be and see can be read as long as and is these. as a kind of dozing them of self. stages d. and e.

so i was that's 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. she for uses e.g. often but not exclusively is kind and so she didn't 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 there's an increase in heart rate hike or an increase in blood pressure stick to group books and pupil which can also be a sign. as well as tears. tween. a study on interoperate of alertness is currently underway in munich. patients need

to have now is being prepared for need 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. if

a stone floats in the words here squeeze my hand. and smash if you have pain in my 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. or have not made have not pressed my hand twice if everything's fine it's then 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 that's one problem the other problem is that the e.g. only reacts 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 industry factory factory. only one word in each pair was mentioned during the operation the patient has to choose which feels more familiar. listen we're really still at the very beginning we can't really predict the outcome yet but we have been surprised a few times on the one hand there are patients who clench their hands when asked to do so. and on the other hand there are also patients who even if they aren't consciously remembering. are able to recall lists that we played with a high level of success.

anesthesiologists at the 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 like propofol. one possible reason for this is that propofol concentration in the body cannot be measured yet. but in inhalation anesthetics the so-called blood gas partition coefficient describes this. the fact that the concentration of volatile anesthetics can be measured a measure of the concentration which i didn't have until now with propofol which is why the probability of over and under dosing is higher than with gas anesthetics. this new device is intended to remedy the situation the edmund measures the concentration of propofol in the patient's body by his breath. says

propofol is almost always used during general anesthesia induction but to maintain the artificial sleep in only around 20 percent of operations. he says that percentage is likely to rise significantly with the new at mt device. after the operation the researchers compare the values measured by the edmund with the propofol concentration in the blood. each patient processes the anaesthetic differently. confusion anxiety hallucinations these are the symptoms of post operative delirium . condition that more than a 3rd of patients over 60 experience. your

mom had such a delirium in 2016 he suffered organ failure and was kept in an artificial coma for 4 weeks a long term general anaesthetic. the waking up basis lasted several days afterwards he was completely disoriented and had vivid hallucinations. it was an intense phase when i couldn't tell if something was real. or if i was falling back into a dream i'd had before i really struggled to distinguish the 2. is still in touch with. the doctor who treated him back then. he would again and again have these phases where he was very agitated and that's typical for a delirium. we call them function trajectories us where

a patient moves between being very absent very subdued to being severely agitated and plagued by fear. but delirium will frequently damage a patient's brain permanently york naaman managed to recover fully. if you or someone who was pretty active before. and then you have to learn to walk again from wheelchair to walk or to a crutch can be frustrating. i think having my family really helped me because i wanted to get home again as quickly as possible. it's not yet clear what exactly triggers a delirium after a general anaesthetic. noise. trends commotion studies show that conditions in intensive care units promote the development of delirium.

this room and there will be a show clinic in berlin has been designed in a way intended to reduce deliriums and be able to treat them better. the most important strategy used in this intensive care unit of the future is providing patients with important so they don't feel lost for example light panels simulate the day night rhythm. secondly commotion a noise or avoided. nurses only enter the rooms when necessary otherwise they keep an eye on patients from a surveillance room. still talking all i think you can hear that it's much quieter in this room than in the other rooms in these normally intensive care rooms of noise levels of 80 decibels whereas here we're trying to reduce it to 35. we're also trying to take all the devices that scare patients out of their direct line of vision. which is why we positioned the breathing machine and syringe drivers behind

to partition the splits and form. the 3rd part of the concept is to have alert active patients in the past long term sedation or even artificial comas were popular methods in intensive care units. today anesthesia has to be kept as brief as possible. if you just didn't give us every delirium we can avoid every damaged organ we can avoid reduces the risk of cognitive impairment 25 percent of patients have cognitive damage after intensive care with an impairment level similar to all timers. and that means they can't return to living alone at home just like they used to they can't return to the job market or their profession and that's why i think we have to keep on top of. the new intensive care concept has reduced the number of delirium cases by

a 3rd. but researchers at the shari take a want to begin their efforts earlier during surgery and. it keeps running the deeper the anesthesia the more likely it is a delirium will occur so general anesthesia has to be deep enough for a patient to have no memories and no unpleasant sensations but not so deep that too much medication has to be administered to feel. that. the doctors at the sharia taint. len show us how this can be achieved using the example of a prostate removal. they combine general anesthesia with regional anesthesia. pain killers are injected directly into the abdomen to switch off any feelings of pain there. when general anesthesia is accompanied by regional anesthesia

a smaller dose of anesthetic suffices. i mean it's here and there here we have a general anesthesia with a very low concentration of inhalation and aesthetics we giving the patient so little the machines are sounding the alarm to say you're using too little medication your patient will wake up because machines and he is too us watching and reading the igi line but it shows us that he's under far enough of the city from the actually it. dept the dentist t.c.m. dosage of medication duration of anesthesia details on all 3 factors during the operation are collected in say. these details are subsequently combined with data on the patient's health and postoperative recovery for the bio cox study at the shari today. the aim of this study is to give researchers a measure of whether their efforts can successfully prevent

a delirium after the operation anesthesiologist on a camilla helps the patient get his bearings at the earliest possible time. it's 20 to 6 pm the operation is over you are in the recovery room you can now take your time to wake and your wife already know it was from this a checklist is used to ascertain whether a delirium is happening. but is everything ok. there are. some you know some delirium patients are hyperactive or aggressive others apathetic and absent at the latter it's especially hard to detect a delirium. you've said you see and hear me well. and we can also talk to each other well. that's. the study on delirium risk factors involved 1200 patients between 65 and 80 years old.

their physical and mental conditions before and after the operation are tested and compared. if you want to oppose a test at any point just let me know and i'll stop. the studies participants will be accompanied for 3 years. early results already indicate several risk factors. these include cardiovascular diseases metabolic disorders such as diabetes and infections in the body. researchers concluded that especially higher risk patients should be closely monitored for signs of delirium. they also suggest caregivers and relatives should take particular care of them. back in vienna. utero surgery is over and everything went fine. anaesthesiologist you did she for

has turned off the sleeping drug during the final phase of the operation. all that's left now is to wait. she's too far far away. to waking up base is critical. both the sleep inducing drugs and the muscle relaxants should stop working at the same time. because it is in fight and man hits in the high if the effect of the muscle relaxant hasn't worn off the patient could find themselves in a situation where they want to breathe but cons because their muscle function isn't fully restored yet most kids who are on myspace to let's me to have a steady. that's what the. 10 mark good morning. good morning and deep breaths in the end out take a deep breath in one eye open your mouth why it's grounds take your time yeah come

on yes we can take it out yeah come on open your mouth half a perfect good morning. oh god it hurts. the patient is in pain this shouldn't be the case. in the deep breaths in and out in the big gray eyes this. q did he for and checks some more painkillers. so. i listen i'm still not cool so quick but only know the anesthesia went well and the stupid however in the end the patient needed a higher dose of painkillers than we initially thought but it does take me through this has to do with pain pills section varying between people so it's hard to

previous s. it. seems. every person's perception of pain is different researchers make use of this in their search for alternatives to general anesthesia. for example in the end. there's fresh clean air. coming in through the window. hypnosis instead of anesthesia and sounds a bit like a joke. but neurosurgeon. is building on a long tradition. during the early days of surgery practically every operation was performed with the use of hypnosis. but with the development of modern drugs this is been completely forgotten and. at the university hospital of vienna hypnosis is used for brain surgery. this

patient has parkinson's disease ok deep brain stimulation is supposed to reduce the strong tremor. this also slows breathing and decelerates the heartbeat. but in contrast to anesthesia here the patient is fully conscious. even when a hole is drilled in his skull the hypnotist incorporates the sounds into the hypnosis. but the construction workers won't stop the even start drilling with a pneumatic hammer or maybe you can open your mouth and it's not so bad or exactly . pain perception is used in hypnosis as in the patient feels the pain but this can be incorporated into other experiences and rebuilding so that it's positive and not so unpleasant. that. this is the patient only receives pain

killers but no sleep inducing drugs. in order to check whether the electrodes for deep brain stimulation are correctly positioned by the patient is taken out of had no success. on the count of 3 open your eyes wide and take a good breath ok they're all here and there. if you know what organization is as much in your ologists it's important to be able to test patients during the operation to see the effect on the trauma so for that the patient needs to be awake and alert or general anesthesia sometimes doesn't clear up straight away or patients are tired so they can do the tasks promptly that's different with hypnosis patients are awake and can participate well which helps improve the surgery outcome ignace though so when an officer. took notice has many advantages patients are less scared their blood circulation is more stable bleeding happens less often less pain medication gets used and patients who are hypnotised stay in

hospitals for less time than those who received general anesthesia. medicine has made huge leaps forward and only one in 136000 operations has a patient died from the effects of anesthesia. going under and as these are 30 years ago was very different to our it is today in terms of tolerance effectiveness maintenance side effects loss. but there's still room for improvement using e.g. to monitor anaesthesia depth is not yet standard everywhere. i still don't understand why anesthesiologist measure everything blood pressure heart rate saturation but the brain where things are happening isn't monitored the. basic research will continue developing and perhaps someday lift the mystery of anesthesia. we need personalized on a c.c.i.

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