Tucson Region

Anesthesia can give rise to sex illusion

Doctors are being warned about a bizarre but threatening phenomenon - that patients under anesthesia can experience vivid sexual dreams they believe are real. Although rare, the strange effect has been documented since the discovery of anesthetizing drugs more than 150 years ago. But in today's lawsuit-happy society, doctors and dentists have found themselves falsely accused of sexually assaulting patients under the hallucinogenic influence of these drugs. A physician presenting his research at a meeting of the American Society of Anesthesiologists is warning anesthesiologists, surgeons, dentists and nurse anesthetists to take care to avoid such such suits. "Most physicians are not aware of this potential aspect of sedating drugs and anesthetics," said Dr. Robert Strickland, anesthesiologist at Wake Forest University in North Carolina. "In the patient's mind, such hallucinations can seem very real upon waking from sedation. In several recent, well-documented cases, physicians have been accused by patients of sexual misconduct, even though witnesses were present throughout the entire procedure." Although it is almost impossible to verify how often sexual hallucinations occur, some studies indicate it happens in 1 percent to 3 percent of anesthetized patients, Strickland said. With some anesthetic drugs - such as ketamine or propofol - the incidence is up to 5 percent. Just why it happens is not well understood. But the risk is higher under lighter, sedating anesthesia than under deep anesthesia, doctors have found. "In that situation, the drugs seem to lower inhibitions much the way alcohol does," Strickland said. Several Tucson physicians say anesthetized patients have expressed graphic, erotic fantasies during and after surgical procedures, but none has resulted in a legal accusation of assault. However, in Phoenix several years ago, a dentist lost his license after using a drug known to trigger sexual dreams to assault patients. He claimed the patients were hallucinating the sex. "This is real and it is a concern, especially with certain anesthetic agents," said Dr. Steven Barker, head of anesthesiology at University Medical Center here. "If we are using a drug prone to causing this reaction, we tell patients they may see and experience things that are not really true. "I understand the concern," Barker said. "We live in such a litigious world. But the fact is, I cannot imagine a setting when these drugs are being used that someone else is not in the room with the physician." To protect themselves while undergoing anesthesia, whether in a hospital or an office setting, both doctors and patients should always have someone else in the room, he said. Barker was not alone the day he put a female patient under moderate anesthesia for a minor surgical procedure. He wanted her deeply sedated, but not completely out, so he could maintain verbal contact to check her breathing and other signs. "At one point, I asked her if there was anything I could get for her, and she said, 'Yeah, a man,'" Barker said. "She then proceeded to describe the sexual characteristics of what she wanted, in a pretty direct way. "I knew it was the drug, so I just sort of tried to change the subject. We all know these things can happen." The patient later had no memory of saying anything out of line, and that was the end of it, Barker said. But in the case of a Tucson oral surgeon, an upset husband called the day after his wife underwent a surgical dental procedure, thinking she may have been molested. "He said his wife told him some kind of inappropriate touching had happened," said Dr. Daniel Klemmedson, a Tucson oral surgeon and president of the Arizona Dental Association. "We described the phenomenon of what the drugs can do, and assured the husband that we are never alone with the patient under these circumstances," he said. The couple never pursued charges. Case reports indicate accusations of sexual assault under anesthesia are almost always made by female patients against male health care workers - nearly 90 percent - but the hallucinations apparently affect both sexes. After anesthetizing a male patient with the drug ketamine - a potent hallucinogen sometimes trafficked illegally on the street as "Special K" - a Tucson plastic surgeon recalls the patient waking up terrified. "He described what he said was a terrifying dream - that he was being chased by a bunch of naked women," said Dr. Boyd Burkhardt. "That didn't sound so bad to me, but he just seemed very frightened by it, and told me never to do that to him again." Some doctors have used their knowledge of such reactions to take sexual advantage of their patients. Throughout the 1990s, Phoenix dentist Shidan Dahnad repeatedly was accused of sexually molesting female patients in his office. But he was acquitted of six molestation charges in two trials after persuading juries his victims only dreamed the assaults while drugged by nitrous oxide, a common dental anesthetic. Finally, after yet another young woman complained he'd assaulted her during a job interview after asking her to inhale nitrous oxide, the state Board of Dental Examiners revoked his license permanently three years ago. He since has been arrested in connection with the molestations of two girls. Longtime local surgeon Dr. William Neubauer, now retired, said he never saw these side effects in more than 30,000 operations, and he is baffled by the need for a warning. "What I would hate to see is patients who are afraid of going under light anesthesia for fear they'll spill their guts in some strange way," he said. "I'm very concerned that will be the effect of this warning - about something that is very, very uncommon."