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By JOE GROSSMAN, UPI Science News

BOSTON, Aug. 29 (UPI) -- You know the dream where you want to move or talk but you can't? Well imagine that's really happening while you're in surgery and your anaesthesia isn't working. This happens to at least 20,000 patients in the U.S. each year.

Most of these patients experience pain during surgery, often excruciating, along with terror and helplessness, according to a new study appearing in this month's journal General Hospital Psychiatry. In these cases, the anaesthesia doesn't kill the pain but leaves the patient conscious, paralyzed and unable to communicate their plight. A small number of hospitals have started using equipment to detect the situation as it occurs.

A big part of the problem is that awareness during surgery leaves about half the patients very severely traumatized psychologically. While this phenomena has been known for 40 years, the study shows that more than half the patents who were aware of their surgery developed post-traumatic stress disorder.

People with post-traumatic stress disorder experience flashbacks of the trauma in which the re-experience the event. Other symptoms include avoiding situations similar to the one that caused the trauma and sleep disturbances. People with PTSD tend to have intrusive thoughts about the trauma and often react strongly to anything that reminds them of the event. They may be jumpy and startle easily.

According to the study's lead author, Janet Osterman, most post awareness subjects reported lapsing in and out of consciousness, picking up fragments of the surgery, conversations and bodily sensations while struggling to move, escape and communicate. These memories re-appeared later as vivid images, sensations, isolated thoughts, intense emotions that are characteristic of PTSD.

Osterman, who is director of residency training in psychiatry at Boston University School of Medicine told UPI, "We know that post traumatic stress disorder is a potential outcome of such an horrific experience. We also know from our treatment of post traumatic stress disorder that there are things that can help, such as early recognition, support and treatment. And there are very effective treatments for post-traumatic stress disorder, so people do not have to suffer for long periods of time. They can get into treatment."

"Typically, our population experienced intrusive thoughts of their surgery. they had flash backs. Re-feeling sensory experiences, feeling pain, feeling fair, seeing things, hearing things around the surgery, machines beeping, conversations. And they had nightmares," Osterman said.

A televison program about a hospital could cause PTSD suffers to experience rapid heartbeat. One subject threw out everything blue they owned because the color reminded them of the surgical gowns worn during their operation. Victims could have a numbed experience of life, feeling they had no future. Avoidance of hospitals was very common.

The study characterizes the PTSD better than some of the other studies and points to development of chronic post traumatic stress disorder in these patients, according to Peter Sebel, professor of anesthesiology at Emory University School of Medicine who has done research on monitoring the depth of anaesthesia.

Sebel, who is a consultant for Aspect Medical Systems, a company developing and marketing devises that detect if anesthesia is working to produce unconsciousness, said such devises are being used in a very small percent of hospitals. Some devises monitor brain waves while others make a clicking sound in the patients ear and then detect is there is a central nervous system response. Such devises are effective, Sebel said.

Although in percentage terms it’s a low incidence phenomenon, it is actually relatively high when you consider that the denominator is the number of anesthetics done in the United States, Sebel told UPI. About 20 million patients received general anesthesia a year in the U.S. While studies show between 0.2 to 0.7 percent remain aware during surgery and experience the operation, often with pain, Sebel believes the number is close to 0.2 percent, meaning that 40,000 people a year would experience awareness during surgery, leading to about 20,000 cases of post traumatic stress disorder, if Osterman’s small sample of 16 patients is representative.