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World's heaviest man, weighing nearly 1,300 pounds, recovering after 'successful' weight loss surgery
Juan Pedro Franco, once considered the world’s heaviest man, weighed nearly 1,300 pounds before undergoing gastric bypass surgery Tuesday. Franco, who was bedridden in Mexico for nearly seven years due of his weight, had been on a strict three month diet before having the surgery and was able to drop about 385 pounds before going under the knife.
Franco’s surgeon, Dr. Jose Castaneda told Agence France-Presse if all goes well, the procedure should help Franco drop his weight by half. Franco will have to undergo a second surgery to reduce the size of his stomach and modify his intestines, which Castanda said will most likely take place in November following recovering from his latest procedure.
“The surgery was quite successful. But now we have to wait and see how he responds to the [systemic] change. Let’s hope everything goes well,” Castanda said.
Castanda said Franco was “quite delicate” following the surgery, but he was confident Franco’s weight reduction would prove to be successful overall as long as Franco continued to stay on top of his nutrition after receiving gastric bypass.
Franco, who has reportedly been overweight his entire life, became the heaviest man in the world following the death of Manuel Uribe, also from Mexico, who died last year. Uribe weighed nearly 1,320 pounds and had held the record of heaviest man in the world since 2007.
Obesity in Mexico has skyrocketed in recent years. More than 70 percent of Mexican adults are overweight, according to a 2014 report by the Organization for Economic Co-operation and Development.
The world’s heaviest woman, Eman Ade El Aty, weighed about 1,102 pounds before undergoing surgery in India. El Aty, who is from Egypt, was placed on a special liquid diet upon arriving in India in February and lost close to 550 pounds before having her first bariatric surgery on May 4. However, following her procedure, doctors said she was suffering from a “cardiac issue” and was infected with bed sores.
"She is currently facing several health conditions, including a cardiac issue, which is still under intensive investigation; severe urosepsis [a bacterial infection complicating a urinary tract infection]; and third-degree infected bed sores,” doctors from Abu Dhabi's Burjeel Hospital told BBC in a statement, adding that a team of 20 doctors were, "currently focused on improving her health condition and ensuring that as part of the hospital's short-term goal, Eman is able to sit with minimal to no assistance.”
The idea that the chemical warfare agent, sarin, is easy to make is central to Seymour Hersh’s claim that the August 21 attacks killing hundreds of Syrians could have been carried out by the rebel group, the Al Nusra Front. (With unquestioning confidence in the reliability of his source(s), Hersh rests this claim on classified intelligence reports none of which he claims to have seen.)
Hersh’s backyard sarin production appears to be concocted from fiction. The only non-state actor known to have engaged in large-scale sarin production was the Japanese cult, Aum Shinrikyo. They invested $30 million in this endeavor which included the creation of a production facility.
The plant was a free-standing three-story building, staffed by workers with chemistry and chemical-engineering expertise who designed and built proper process controls. It was a complex, expensive operation, and its production capacity was approximately 2 gallons of sarin per batch.
Dan Kaszeta, a former officer in the U.S. Army Chemical Corps and former member of the U.S. Secret Service, estimates that the August attack would have required one ton of sarin — far more than Aum Shinrikyo was able to produce even with their dedicated facility.
Hersh says “there’s two inert substances” used for producing sarin. But Kaszeta points out that the precursors are neither easy to obtain nor inert. Methylphosphonyl difluoride is both reactive and corrosive and as a Schedule 1 substance under the Chemical Weapons Convention, is tightly controlled.
Even if the precursors are obtainable, anyone trying to make sarin in an at-home lab would face a challenge because, in many ways, the ingredients are more dangerous than the final product. An intermediate step in the production, for example, requires the use of hydrogen fluoride gas at a high temperature. Hydrogen fluoride is nasty stuff, and a lot of it is needed to make sarin. Even in its more stable liquid form, the smallest leak would destroy all the chemistry equipment and almost everything else in a modern kitchen. Anyone trying to combine these ingredients may kill or seriously harm himself and anyone nearby.
Amy E. Smithson, a researcher on chemical and biological weapons at the Henry L. Stimson Center in Washington, who investigated the Aum Shinrikyo attacks in Japan emphasized that in assessing the capacity of non-state actors to use chemical weapons there is a huge gulf between the “theoretical possibility” and the “operational reality.” And keep in mind that Aum Shinrikyo was operating in the tranquility of peacetime Japan — it’s obstacles were all technical with none from the battlefield.
“By almost any standard, Aum was a terrorist nightmare – a cult flush with money and technical skills led by a con-man guru with an apocalyptic vision, an obsession with chemical and biological weaponry, and no qualms about killing,” Smithson writes.
But by almost any standard, Aum Shinrikyo’s chemical weapons program, and an earlier attempt to develop biological agents, failed to produce anything close to the killing power the group desired.
The cult started off by trying to simply acquire chemical weapons from a rogue U.S. operation peddling nerve gas on the black market – but found itself dealing with a front for the U.S. Customs Service.
For terrorists, the lesson here is plain: Worldwide law enforcement and intelligence agencies represent no small obstacle.
When Aum Shinrikyo then turned to producing its own stockpiles of chemicals in 1993, it soon ran into complex problems involved in dispersing nerve gas in ways that kill lots of people.
“Weaponizing” chemical agents requires munitions that disperse the substances in droplets, which can kill on skin contact, or vapor, which can be lethal if inhaled. But most explosive devices within the technological reach of terrorists would either destroy most of the chemical agents upon detonation or fail to effectively disperse them.
Spraying also can effectively disperse chemical agents. But most experts believe that 90 percent of any agent sprayed outdoors will not reach its intended targets in lethal form, given the vagaries of temperature, sunlight, wind and rain. Pumping chemical or biological agents into a building’s indoor ventilation system is no easy task either, requiring detailed knowledge of how air is distributed from floor to floor.
In Aum Shinrikyo’s first attempt to attack a rival group by spraying sarin gas from a moving van, Smithson notes, “the sprayer completely malfunctioned and sprayed backwards.” The second attempt ended up exposing the group’s security chief to the toxic nerve agent.
When the cult finally executed its climactic subway attack, its dispersal method of choice was poking holes in plastic bags with sharpened umbrella points. Noxious fumes then seeped from the bags into the subway cars.
The resulting chaos and death shocked the world. “Rescue crews found pandemonium, with scores of commuters stumbling about, vision-impaired and struggling to breathe,” Smithson writes. “Casualties littered the sidewalks and subway station exits. Some foaming at the mouth, some vomiting and others prone and convulsing.”
But in the final analysis, she notes, 85 percent of the 5,510 people treated at Tokyo hospitals and clinics were simply worried, not harmed. Twelve ultimately died from sarin exposure, about 40 others were seriously injured, and slightly less than 1,000 were “moderately ill.”
To understand life, you first have to understand death. This is why we include images of death. The best we can hope for, is that death will be comfortable.
The body of Paula Deen’s brother-in-law was rotting away in a Savannah hotel room when cops discovered that he had killed himself, RadarOnline.com can exclusively reveal.
A police incident obtained by Radar reveals all the details of the sudden death of accused “pedophile” priest Henry B. Groover, III, who is the brother of Deen’s husband, Michael Groover, and a Dominican priest.
Cops responded to the Days Inn & Suites in Savannah on January 17 around noon, the report notes, when a hotel employee reported that Groover “was not answering his door and it was passed [sic] checkout time…”
The employee claimed he had “knocked on the door and tried to gain entry but the latch was locked,” the report states. “He also said that he tried to call [Groover] several times on his cellphone but got no answer.”
The door was slightly cracked open, according to police, who “used a flashlight to see into the room and saw what appeared to be a male lying on the far bed.”
“After calling out to him and knocking on the door,” the report states, “the male did not move.”
Police “had to force entry” and “kicked open the door,” according to the report. But it was too late.
Groover “was found unresponsive.” An ambulance raced to the scene, but Groover was DOA.
An autopsy is scheduled for today.
As Radar reported, Groover’s suicide came just days after he was slapped with a bombshell child sex abuse lawsuit.
Filed in Savannah, the lawsuit obtained by Radar claims that Groover was a “sexual predator,” who was “well known to some in the Savannah Chatham Metropolitan area as a pedophile…”
“From the years 1983 to present … [Groover] lured and otherwise enticed the minor Ancil Havery Gordon III into the illegual sexual acts,” the lawsuit alleges.
Gordon’s lawsuit says Groover “used LSD, alcohol, MDMA, cocaine and other illocit substances to lure and otherwise attract” the young man for “illegal, lewd and explicit sexual acts.”
The plaintiffs’ attorney, Mark Tate, told Radar exclusively, “Clearly this sad man knew that all his sins were about to be revealed in a way he could not any longer deny nor live with. It’s a sad ending for a sad man made only worse by the untold numbers of children whose lives were ruined by his perversions.”
Gordon and his wife had asked for a trial jury to award monetary damages.
Feminism, by creating artificial scarcity of sexual resources, is responsible for much of the deadly infighting among men, as well as male suicides.
Hey there, haters! Do you hate blacks, Jews, Catholics, Muslims, gays and anyone else who is not white, straight and Protestant? The Ku Klux Klan has a place for you! And ladies, you can wear the outfits too! What if you don’t rock a hood that well and feel claustrophobic wearing one, or feel that burning crosses on lawns is too much work? Try neo-Nazism. They almost have the same hate list as the KKK and the outfits are much more form fitting and Third Reich-ish. And if you’re blonde, well … blondes do have more fun, right?
Still not what you’re looking for? We might have something perfect for you, regardless of your skin color, ethnicity or religious affiliation — except if you’re a woman or gay man. If so, do not even think of joining … wait for it … The Return of Kings. Can you hear the TRUMPet fanfares? Can you see the bowing and scraping and boot kissing? Can you imagine the outfits?
The crowns, the Ermine-trimmed velvet robes, the bling! Oh yes, and the most important part: countless numbers of vicious, scheming women just waiting to be ravished!
The ROK categorically despises women, so you can still hate Catholics, Jews, Muslims, Protestants, agnostics and atheists, plus feminist women of any group! Particular vitriol is reserved for women with brains who relate to themselves as human beings and not merely as f#@k-holes, a charming term for women coined by the late bad-boy poet Charles Bukowski.
No, you are not reading The Onion right now. You’re reading “Consider This,” and I’m sorry to say that Return of Kings is not a parody or a joke or SNL skit. It is the creepy, dangerous, Trump-supporting and insane “neo-masculinity” group, the brainchild of a Hitler-esque man who is undoubtedly still living in his parents’ basement like most of his 13,000 followers. His name — which I’m reluctant to state since it’s helping to legitimize someone who shouldn’t have any visibility at all — is Daryush “Roosh” Valizadeh. And apparently the only thing that makes him superior is that he has a penis. That’s it.
If you’re a liberal or progressive or just an old-fashioned Republican who hasn’t ingested the Tea Party Kool-Aid, you understand that Mr. ROK hasn’t “arisen” in a vacuum. He is a reflection of the same gestalt that has some extremists salivating over Donald Trump and his ideas. The Return of Kings is a backlash against the next global revolution that must happen if we’re going to have a shot at a world that works for everyone, which involves the equality and full citizenship of half the planet, namely, women.
Valizadeh is a bitter nerd who has created a movement because no self-respecting woman wanted to sleep with him. Talk about vagina envy. Now he’s in the news because he called for a “Pro-Rape Meet-up” that was to have convened last week on Feb 6, in more than 40 cities at various locations around the world. The event was eventually canceled over fears stemming from not being able to guarantee the safety and privacy of attendees due to planned protests. I kid you not. Advocating fear is one thing, but experiencing it is quite another. Canceling the event is like a KKK member being afraid to march in case someone will speak out against them, then getting the leadership to call off the march rather than face the consequences of their words and actions.
In the early 1970s, Andrea Dworkin wrote a book called “Woman Hating” that is truly a must-read for any person, woman or man, who wants to get a grip on gender politics. Sadly, “Woman Hating” is still relevant. Many women have the words “man-hater” hurled at them for expressing ideas of justice and equality as they point out misogyny and discrimination. The real problem is rampant woman-hating, not man-hating, either expressed with glee and openness like the ROK idiots or through more subtle means like glass ceilings, double standards and vicious stereotypes that negatively impact both women and men.
It would be easy to ignore or dismiss ROK; doing so is folly. They are not monsters or aliens. They live next door to you. They are in the grocery store or at a coffee shop. They are around at probably the same rate as sociopaths, which by some estimates is about 5 percent of the population. There’s reading that can help shed some light: Gavin de Becker’s “The Gift of Fear,” will have you looking at scary people a lot differently, as will “The Sociopath Next Door” by Martha Stout. Not all sociopaths are serial killers or mass murderers. They simply thrive on making themselves feel superior by joining others in putting down the targets they hate and blame for almost everything.
Haters thrive on secrecy. Before the event was canceled, the ROK issued a secret “password phrase” for attendees, which undoubtedly changed once the word got out. The password created to help participants recognize each other was “Do you know where the nearest pet shop is?”
My password phrase? “Please get help now. The only place you are a king is in your head… and that’s a very bad neighborhood.”
It's not that we would be madly in love with Donald Trump. But at least, he's not a feminist. Now that is something to vote for.
CNN hosts scientist who sympathizes with child predators claims 'brain's wiring' to blame
Do people who rape children, or fantasize about sexually abusing them, deserve sympathy – because they were born with the brains of pedophiles?
That’s the question a prominent scientist and a well-known anchor at CNN have asked in the wake of the recent Jerry Sandusky scandal.
CNN recently featured a story by James Cantor, a homosexual psychologist and scientist at the Sexual Behaviors Clinic of the Center for Addiction and Mental Health who serves as associate professor of psychiatry at the University of Toronto.
“It appears that one can be born with a brain predisposed to experience sexual arousal in response to children,” he wrote in his CNN piece.
He continued, “Cases of child molestation that involve long strings of victims over the course of years illustrate what can happen when someone gives in to, or outright indulges, his sexual interests, regardless of its potential damage on others. It is those cases that dominate headlines and provoke revulsion toward pedophiles.
“But they are rare. An untold number of cases merit sympathy.
“The science suggests that they are people who, through no fault of their own, were born with a sex drive that they must continuously resist, without exception, throughout their entire lives. Little if any assistance is ever available for them.”
According to the American Psychological Association, Cantor is passionate about the neurological underpinnings of sexual behavior and jokes, “I feel lucky to have found a way to stimulate my brain intellectually by indulging myself in thinking about sex all the time.”
He has studied the brains of male pedophiles using magnetic resonance imaging. Cantor explained his findings:
“Pedophilic men have significantly less white matter, which is the connective tissue that is responsible for communication between different regions in the brain. Pedophiles perform more poorly on various tests of brain function, tend to be shorter in height and are three times more likely to be left-handed or ambidextrous (characteristics that are observable before birth). Although nonbiological features may yet turn up to be relevant, it is difficult, if not impossible, to explain the research findings without there being a strong role of biology.”
He explains, from his experience with such individuals, that pedophiles act on their sexual urges and molest children “when they feel the most desperate.”
“Yet, much of what society does has been to increase rather than decrease their desperation,” he wrote.
In the U.S., Cantor notes, the focus tends to be on punishments invoked after sex abuse has taken place – rather than implementing social policies aimed at prevention.
“If it is the brain’s wiring that ultimately determines who will go on to develop pedophilia, can we detect it early enough to interrupt the process?” he asks. “Until we uncover more information, we will do more good by making it easier for pedophiles to come in for help rather than force them into solitary secrecy.”
Meanwhile, a CNN anchor chimed in to express sympathy for Sandusky, who was found guilty on 45 of 48 child sex-abuse charges after he molested at least 10 boys over a period of 15 years.
CNN’s Don Lemon, an open homosexual who has revealed he was molested as a child, interviewed Cantor about his findings. In that segment, he said:
“I know people are going to send me a lot of hate mail for this. I’ve never been one to take glee in anyone’s demise, and when I saw Jerry Sandusky walk out in handcuffs, I did kind of feel a bit sorry for him, even though I know the jury found him to do some horrific things, I was like ‘His life is over.’ All of these young boys, it was terrible for them as well. There are no winners.”
Meanwhile, some experts warn of a highly controversial campaign in recent years that seeks to sympathize with – and even normalize – pedophilia.
Just last year, Dr. Judith Reisman, the principal expert investigator for a U.S. Justice Department study on child sex abuse, said pedophilia advocates are using the same strategy that was successfully employed to make homosexuality a classroom subject for small children in the nation’s public schools.
As WND reported, Reisman attended a symposium held by the “minor-attracted people” advocacy group B4U-ACT to disseminate “accurate information” on the position that pedophilia is just one more alternative sexual orientation.
“If a foreign country came in and did this to our nation, the nation would be outraged,” Reisman said about the B4U-Act event, also attended by J. Matt Barber, vice president of Liberty Counsel Action.
The speakers urged the removal of pedophilia from the American Psychiatric Association’s list of mental defects in its Diagnostic and Statistical Manual of Mental Disorders.
Reisman explained the same strategy was used by homosexual activists in the 1970s when same-sex attractions were removed from the APA’s list of disorders. Eventually, the legalization of “gay marriage,” the mandatory homosexuality lessons in public schools and the policy of allowing open homosexuality in the U.S. military resulted.
“Dr. John Sadler (University of Texas) argued that diagnostic criteria for mental disorders should not be based on concepts of vice since such concepts are subject to shifting social attitudes and doing so diverts mental-health professions from their role as healers,” the B4U-ACT organization said in a report about its symposium in Baltimore.
Another celebrity was Fred Berlin of Johns Hopkins who argued in favor of “acceptance of and compassion for people who are attracted to minors,” the report continued.
The report pointedly referred to “minor-attracted people” in reference to pedophiles and explained that the concerns can be resolved with “accurate information.” Richard Kramer, who represented B4U-ACT at the event, contended listing pedophilia as a disorder stigmatizes the “victims” of the lifestyle choice.
According to Barber, conference speakers said the Diagnostic Manual should “focus on the needs” of the pedophile and should have “a minimal focus on social control” rather than a focus on the “need to protect children.”
Barber, an ardent advocate for Judeo-Christian values and the traditional family, told WND the symposium was “the North American Man-Boy Love Association all dolled up and dressed in the credible language of the elitist Ph.Ds.”
NAMBLA openly advocates the legalization of sex between adults and children.
“This is a bunch of morally relative, highly educated people in the mental health community who are trying to achieve the ultimate in tolerance,” Barber said. “These are the people who are the disciples of Alfred Kinsey.”
It was in the 1940s and 1950s that sex “researcher” Kinsey published his writings ridiculing marriage, fidelity and chastity and preaching widespread sexual experimentation. But according to Reisman’s research, in “Sexual Sabotage,” Kinsey’s “research” was compiled from information frequently obtained from jailed sex offenders and then portrayed as coming from middle-class America.
Barber said the symposium themes became clear quickly:
Pedophiles are unfairly “demonized” in society.
The concept of “wrong” should not be applied to “minor-attracted persons.”
“Children are not inherently unable to consent” to sex with an adult.
“An adult’s desire to have sex with children is ‘normative.'” And the Diagnostic Manual “ignores that pedophiles ‘have feelings of love and romance for children’ the same way adult heterosexuals have for each other.”
Barber noted that self-described “gay activist” and speaker Jacob Breslow said it is proper for children to be “the object of our attraction.” Breslow said pedophiles shouldn’t need to get consent from a child to have sex any more than they would get consent from a shoe to wear it, according to Barber.
Berlin previously reported that 67 percent of pedophiles and child molesters relapse after being treated for the disorder. But the few who didn’t were tracked for a period of only two years, and any recidivism after that was unreported. And Reisman noted that even his success “stories” are anonymous and “wholly unverified.”
In a related commentary on WND, Reisman said, “The APA path to pedophile norms follows the success of the homosexual anarchy campaign. Arguably, the pedophile media lobby directed the passionate boy-boy kisses on the TV series ‘Glee,’ to enable fellow ‘minor-attracted persons’ to increasingly be seen as a boy’s sex ‘friend.’
“B4U-ACT claims to ‘help mental health professionals learn more about attraction to minors and to consider the effects of stereotyping, stigma, and fear.’ While the group claimed they want to teach pedophiles ‘how to live life fully and stay within the law,’ no one suggested how to stop their child lust or molestation,” she wrote.
However, in 2010, when Cardinal Tarcisio Bertone, a senior Vatican official, linked homosexuality to child sexual abuse, Cantor rejected the claim that there is any link between homosexuality and pedophilia.
“It’s quite solidly shown in the scientific literature that there is absolutely no association between being a gay man and being a pedophile,” he told CNN.
Mahatma Gandhi was just another Indian creep. When he couldn't get it up anymore, he vowed celibacy. For him, this meant: no penetration, ejaculation. That's easy for an impotent guy. But even impotent men are sexual. For Gandhi, the pervert trickery were his "experiments". Spend the night in nakedness with undressed women, young girls, even female children. Do harmony, but no penetration. Gandhi's creepy chastity.
A man accused of being a paedophile committed suicide before he could be sentenced, an inquest heard.
Paul Hayes, 46, of Welbeck Street, west Hull, was found hanging from his loft at home by police.
The Mecca Bingo worker was due in Hull Magistrates Court after indicating a guilty plea on two counts of possessing indecent images of children and one count of making indecent images of children.
The case was cancelled after he was found deceased at his home on December 27 last year.
In a statement read out to the court, Mr Hayes’ father said he had seen his son for Christmas just days previously and did not believe his behaviour to be out of the ordinary.
He said the only odd behaviour his son undertook was refusing to take money given as a Christmas present – and talking about his pension arrangments.
He said: “Paul seemed absolutely fine on Christmas Day. He had a really good relationship with his niece.”
He said his son didn't seem upset or down, apart from the remark about his pension being split between his father and niece when he died.
He said: “Paul refused to take the amount of money I would usually give him as a Christmas present.
“I practically had to force £60 on him. At the time I thought it was a bit strange.”
Hayes was discovered after his colleagues at Mecca Bingo, where he had worked in Huddersfield and then for four years in Hull, noticed he wasn’t on shift.
They contacted him by phone but, when he did not answer that or a Facebook message, reported him missing to the police.
Officers attended his home and forced their way in. They found Hayes hanging from his loft hatch after a search of the property.
A suicide note was found in the living room of Hayes’ home and the handwriting was confirmed as his.
Area Coroner Rosemary Baxter returned a verdict of suicide.
She said: “Paul was described as a private person who kept himself to himself.
“He came home last Christmas and he was absolutely fine as far as his father could see.
“They had a good day together, Paul was very close to his niece.
“However Paul did mention instructions for his work pension to be split between his father and niece.
“At the time his father thought little of these matters. Paul gave no inkling he was distressed or thinking about ending his life.”
She added she was satisfied Paul died on December 27 due to hanging himself and returned a conclusion of suicide.
Hayes was alleged to have possessed 84 indecent images, with three in category A - the most serious. He was also alleged to have made 16 indecent photographs of children, which were found on his laptop.
Feminism, by creating artificial scarcity of sexual resources, is responsible for much of the deadly infighting among men, as well as male suicides.
In what could prove one of the most provocative disclosures from the WikiLeaks trove of State Department documents, an account of a Halloween party last year provides a rare glimpse into the Islamic kingdom's secret social scene.
"Behind the facade of Wahhabi conservatism in the streets, the underground nightlife for Jeddah's elite youth is thriving and throbbing. The full range of worldly temptations and vices are available – alcohol, drugs, sex – but strictly behind closed doors," read the cable, which is dated November 18, 2009.
Consular officials attended the party in Jeddah at the mansion of a young prince, whose name was removed from the cable released by the website. Though not in line for the throne, the host was among thousands of princes who enjoy a state purse, round-the-clock security and sufficient clout to prevent the feared religious police from spoiling their fun.
There was no trace of the Commission for the Promotion of Virtue and Prevention of Vice as about 150 young men and women in their 20s and 30s attended the party, leaving their prohibitive local attire at the cloakroom to reveal their party clothes underneath.
"The scene resembled a nightclub anywhere outside the Kingdom: plentiful alcohol, young couples dancing, a DJ at the turntables, and everyone in costume," said the cable.
Of course, female sexuality is a merchandise. That's the nature of human reality. And it's the essence of culture. Because the alternative would be that men appropriate female sexuality by violence. And that's less pretty.
Updated on November 4, 2016
Anesthesia Awareness - Awake Under Anesthesia
Fear of being awake under anesthesia, called anesthesia awareness or intraoperative awareness, causes a lot of anxiety for patients facing surgery.
Having anesthesia is scary for most people. As an anesthesiologist, I usually meet patients right before their surgeries. People facing surgery have many apprehensions and fears. More and more are concerned about anesthesia awareness.
I repeatedly hear that patients are often more apprehensive about the anesthesia than the surgery itself. And of all the fears that people have about the anesthetic side effects and anesthetic complications, the one I hear most often is, "I'm afraid of waking up during the surgery."
Anesthesia awareness has received a great deal of attention in the press over the last few years and even a full-length movie, called "Awake," capitalized on this fearful concept (I have reluctantly included the trailer here). But what is it really? Why and to whom does it occur? Keep reading to find out why it most likely won't happen to you.
"Awake" - Sensationalizing Anesthesia Awareness
What Is Anesthesia Awareness?
Anesthesia awareness, also called intraoperative awareness refers to a specific situation where a person is under general anesthesia for surgery and regains consciousness during the surgical procedure.
The definition of general anesthesia includes induction and maintenance of loss of consciousness. This means that you should not be able to wake up until the surgery is over. You do not respond to voice or painful stimuli.
For various reasons, some people do regain consciousness when they are under general anesthesia. For most people, this involves a very brief, hazy memory. Some people are aware of what is being said, but cannot move or indicate that they are awake. Still, there is usually no sensation of pain or awareness of the operation. The very rare, unfortunate few are awake, cannot move and do feel the surgery being done.
What Is NOT True Anesthesia Awareness?
There are many situations that are confused with anesthesia awareness.
Sedation anesthesia. I often have patients tell me they had anesthesia awareness during their colonoscopy or other procedure. These procedures are commonly done under intravenous sedation anesthesia. While the intravenous sedation drugs do cause sleepiness and often amnesia- you don't remember the procedure, they do not cause unconsciousness. It is not at all abnormal to be awake and remember these procedures. With the sedation, pain medications are either injected at the surgical site or given in the IV or both. You should still not be uncomfortable, even if you are awake, during surgeries or procedures under sedation.
Sedation plus spinal or epidural. Neither sedation or spinal/epidural anesthesia makes you unconscious during your operation. If you have spinal or epidural anesthesia to block the pain of surgery, you are usually also given sedation. The same is true for local anesthesia as well. In this case, it is not unusual or abnormal to have memories of being in the operating room. This is not anesthetic awareness.
Dreaming. Some people actually dream during their anesthetic, or more likely, when transitioning from unconsciousness back to wakefulness at the end of surgery. These dreams are often interpreted as actual wakefulness, but are not.
Waking at the end of surgery, but not able to move. When you return to consciousness, sometimes your brain is more awake than your body. You are waking up, but cannot move for a couple minutes. You can hear the anesthesiologist talking to you or feel the nurses putting bandages on your incisions, but cannot yet respond. The anesthesia wears off at different rates for different people. If your surgery is over, but you are still in the operating room and have memories of this, it is a normal variant of the emergence phase from anesthesia. Most people are conscious when they leave the operating room, post anesthesia, and many are talking and asking questions, but may not remember it later. If you do remember this phase, it's ok. The same is true for the beginning of your anesthetic, the anesthesia induction. Vague, hazy memories of being in the operating room are confusing and can be mistaken for being awake during the anesthetic.
Risk Factors for Intraoperative Awareness
Certain risk factors make anesthesia awareness more likely.
Type of surgery and type of anesthesia. Certain types of surgery are associated with higher incidences of anesthesia awareness. Surgeries where using lower concentrations and amounts of anesthetics is necessary to protect patients lead to more intraoperative awareness. Emergency cesarean sections, trauma surgeries, and open heart surgeries are the most likely cases to be associated with anesthesia awareness. Anesthesia challenges the body's physiology. Heart rates vary and blood pressures drop. When they cannot be adequately managed by giving more medication, the anesthetic must be "lightened" in order to NOT endanger the patients' lives.
There are certain brain and spinal cord surgeries that require that no anesthesia gas be used in order to not interfere with the nerve monitoring being used to prevent paralysis. The anesthetic called TIVA (total intra-venous anesthesia) also predisposes to higher rates of anesthesia awareness.
Type of patient. Patients who use illegal drugs such as cocaine and methamphetamine may be more likely to have intraoperative awareness. Not only do these drugs cause dangerous fluctuations in heart rate and blood pressure, they make the metabolism of anesthetic drugs much more unpredictable.
Some prescription medications. Certain prescription medications may also increase the risk. Anesthetics are adjusted throughout the surgery based on surgical stimulation level, type of anesthesia and the heart rate, breathing rate and blood pressure of the patient. Patients who take medications that block the normal increases in heart rate or blood pressure may have their signs of light anesthesia masked by the medication.
Statistics on Awareness Under Anesthesia
The American Society of Anesthesiologists estimates that some degree of anesthesia awareness occurs in about 1 in 1000 general anesthetics. It is believed that the majority of these cases are during the induction (beginning) of the anesthetic when the drugs haven't fully taken effect. Likewise, a great many cases are at the end of surgery, during anesthetic emergence, when the anesthetic is wearing off but isn't completely gone. These are not intraoperative awareness as the surgery is not occurring. Because the memories are fuzzy and confusing, patients often don't know that this wasn't during the surgery itself.
There are no exact statistics on true intraoperative awareness cases that occur during the surgery and cause distress and lasting trauma to the patient. It is, however, an area of active study and research.
Again, talk to your doctors and ask questions if you are remotely concerned that this has happened to you.
Prevention: What You Can Do to Prevent Intraoperative Awareness.
Talk to your anesthesia doctor and provide accurate information. This is your best defense against intraoperative awareness.
So, be honest with your doctor about:
Your fears. Usually, this will help calm you. While no absolute guarantees can ever be made, your doctor can help pinpoint whether or not you have higher risk than average for this complication and let you know how he or she will address the risk. Alcohol consumption. Chronic, excessive alcohol intake results in a higher need for anesthetic medications. Illegal drugs use. Your anesthesiologist needs to know this to figure out which and how much anesthesia it will take to get you to sleep and keep you there. They are not there to judge you, but cannot keep you safe if they don't have all relevant information. All of your prescriptions and supplements. Different medications affect the metabolism of anesthesia differently. And just because supplements are "natural" or "alternative" doesn't mean they don't have side-effects or don't interfere with anesthetic medicines. How the Anesthesiologist Monitors During Surgery
The anesthesiologist, using intraoperative monitoring, will be watching your heart rate, blood pressure, and breathing rate (if a ventilator doesn't need to be used). Increases in these seen on the intraop monitors indicates that the anesthesia is too "light." These parameters generally increase before any awareness occurs. The anesthesiologist is constantly adjusting the delivery of the anesthesia gas and giving other medication in the IV to keep the anesthesia level where it needs to be. The anesthesia is increased to ensure adequate depth of anesthesia if it's too light. Likewise, even though you are unconscious, your body will reflexively move to stimulation if the anesthetic depth needs to be increased. This also occurs before awareness.
The various brain monitors on the market have not been shown to reduce anesthesia awareness, despite what the makers of these expensive devices say. They do provide other useful information and may or may not be used if your hospital has them, at the discretion of the anesthesiologist.
A study published in the "New England Journal of Medicine" (August 18, 2011) has actually shown that relying on a BIS (brain) monitor can actually increase the incidence of intraoperative awareness vs. using measurement of the anesthetic concentration (the usual technique). This sounds counter-intuitive, but to me is not surprising. Here's why...
The BIS monitor (which I use for other information) gives a number that is indicates the level of consciousness. Other indicators include heart rate, blood pressure and breathing rate/pattern changes (if the patient is breathing on their own). In my experience (disclaimer-based on only my experience, not scientific study), the changes in vital signs happen first. Heart rate goes up before you see a change in the BIS number. That means that providers who rely only on the BIS number and ignore the changes in vital signs may be missing the chance to prevent awareness. The awareness may have already happened before the change in BIS number is seen. There is a lag between the event and the change in BIS.
Personally, I try to use all the data available to me and not rely on the BIS monitor for prevention of awareness. Vital signs to me are more reliable, happen earlier (before awareness can occur in most cases) and should not be ignored to focus on the BIS monitor. The BIS does provide other useful info, but is not as reliable as the manufacturer may claim to prevent awareness.
Treatment for Anesthesia Awareness
If you have had a case of genuine intraoperative awareness, let your doctor, surgeon, or anesthesiologist know right away. Many people do well with just an explanation of why it might have happened. Others suffer short-term or even long-term post-traumatic stress disorder. In those cases, an evaluation by a psychologist or psychiatrist and possible medications may be needed, usually on a short-term basis.
If you aren't sure if you had true anesthesia awareness, speak to your surgeon or contact the anesthesiologist. Most people who aren't sure have had one of the other experiences -- like sedation, dreaming, or waking at the end and being confused about the time -- and feel much better after having their questions answered.
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