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Under the Knife and Completely Aware

A Case of Intraoperative Awareness



Co Authors:

Patrick R. Field
Department of Biological Sciences
Kean University
pfield@cougar.kean.edu

Gabrielle Gangemi
Department of Biological Sciences
Kean University

Taylor Kinsley
Department of Biological Sciences
Kean University

Abstract:

This case study is based on a newspaper article about the suicide of Sherman Sizemore shortly after he underwent an exploratory laparotomy (abdominal surgery).  After his surgery, Sherman experienced symptoms similar to post-traumatic stress disorder (PTSD) including nightmares, paranoia, depression, insomnia, and dramatic mood swings. Sherman's family later discovered that he had been awake during the first part of the surgery; although given a muscle relaxer, he was never administered an anesthetic. Sherman was never told that he had been awake during surgery or that he had been given an amnesic to suppress memory of the traumatic event.  The condition that Sherman experienced is variously called intraoperative awareness (IOA) or anesthesia awareness. This case study explores the moral, ethical, and biological issues relevant to IOA by using role play and the device of a fictional mediation between three stakeholder groups: Sherman's family, the anesthesiologist group that administered the anesthetic, and the hospital and lead surgeon who conducted the surgery. The case is suitable for use in a wide variety of courses including medical ethics, psychology, abnormal psychology, introductory biology, anatomy, and physiology.

Objectives:
  • Research and discuss the condition of intra-operative awareness (IOA), including the symptoms that patients experience during and after surgery; the types of surgeries where IOA is most likely to occur; and the frequency of cases in the U.S.
  • Apply the typical protocol for delivery of anesthesia to this case study to discover the failure that resulted in IOA.
  • Apply the protocol of managing intraoperative awareness to this case study to determine the failure that resulted in PTSD-like symptoms.
  • Synthesize solutions to correct the failures in delivery of anesthesia and management of IOA observed in the case study.
Keywords: Intra-operative awareness; anesthestic awareness; anesthesia; post-traumatic shock disorder; PTSD; surgery; suicide; medical malpractice; litigation; mediation; medical ethics; bioethics
Topical Area: Ethics, Legal issues, Social justice issues
Educational Level: High school, Undergraduate lower division, Undergraduate upper division, Clinical education
Formats: PDF
Type/Method: Debate, Dilemma/Decision, Role-Play, Trial
Language: English
Subject Headings: Biology (General)   Medicine (General)   Public Health   Psychology   Physiology   Anatomy  
Date Posted: 7/16/2013
Date Modified: N/A
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

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