Waking up during surgery | Hacker News Reader

Waking up during surgery

mosaicscience.com

44 pointscatfacedlady43 comments

As an anaesthesiologist (well, senior trainee), I hesitate to comment on this, but here goes nothing...

I think it’s important to remember that the vast majority of anaesthesia delivered does not involve ‘general anaesthesia’ nor neuromuscular blocking drugs. Most patient’s experience of anaesthesia is sedation, where the aim is comfort, not absence of recall.

There is a bit of a movement to reduce our reliance on neuromuscular junction blocking drugs, which will hopefully lead to a decrease in the incidence of awareness under general anaesthesia.

In my institution, even of general anaesthetics, less than 30% would involve neuromuscular blockade.

Neuromuscular blockade only affects your skeletal muscle, not muscles like your heart or those in your gut.

Very interesting. I cannot recall having sedation outside of dental practices, but I have had several colonoscopies which involved counting down from 10, getting to about 8 and waking up hours later in recovery.

Interesting to see I'm sort of an outlier.

You probably (depending on your location) had so-called ‘deep sedation’ for your colonoscopies, which usually involves reasonable doses of anaesthetic drugs, likely leading to complete amnesia. The crucial point is that we don’t necessarily promise no recall, that’s a side effect of maintain comfort and facilitating the procedure.

I've woken up during surgery (for appendix removal). It was uncomfortable but not especially painful. I didn't feel panicky or disoriented, but then I've always been OK with medical situations. The anaesthetist looked pretty horrified though.

I’ve also woken up during surgery to remove a hematoma. I was so high off the anesthesia that it was less fear/pain and more of a disassociation/dreamlike state. I was comprehending what was going on around me but didn’t have full control over my faculties.

I expect that kind of thing happens pretty regularly because once the anesthesiologist realized it they re-dosed me pretty quickly and I was back out again. They didn’t seem alarmed at all. The whole situation, while it felt like a decent amount of time, probably lasted less than 30 seconds and only felt more stretched because of the drugs.

Tangentially I do remember the doctors and nurses having some sort of conversation that seemed ridiculously mismatched to the current situation but I am guessing more mundane talk happens during people’s surgeries than a normal person would expect.

My spinal analgesia for an unplanned c-section utterly failed. My anesthesiologist thankfully kept it together and immediately went to our discussed plan B, but I felt so bad about it that I sent her a gift basket. I wonder how common that all is.

Are you a redhead by any chance? Red hair is linked to anesthesia resistance, requiring about a 20% higher dose to get the same effect as other people.

Wouldn't your heart rate increase to alarming levels?

If you were awake & in pain during surgery, you would (of course) freak out. Even if you were paralyzed, your heart rate would increase and the doctors would know. This is what a doctor once told me when I asked.

I'm not sure how to contrast that with what the article says.

Especially in the case of an intubated patient with neuromuscular blockade, I don’t think an EKG would be useful. You’re already going to have all kinds of fluctuations from the anesthesia, muscle relaxants, analgesics and just from the intubation. I’ve read about the use of EEG [1] as a way to detect awareness, but it has serious limitations. Most of all though, many anesthetic agents have a profound effect on the autonomic nervous system, and I don’t think your body would react as it would if you were conscious. You probably wouldn’t have a significant increase in heart rate, you’re already not breathing on your own, you probably wouldn’t sweat or cry either.

[1] https://twin.sci-hub.se/5746/9679b963c5859d4991d906fef74c0b7...

Paralytics used in surgery impact voluntary muscle control only, they have very little in the way of effect on things like heart rate.

Heart rate is absolutely monitored closely during surgery (precisely because it can be an indication of inadequate sedation).

Paralytics primarily effect voluntary muscles (and spontaneous respiration), but GA impacts the autonomic system to varying degrees. The blockade will keep you from moving (or breathing), the GA will depress your autonomic functioning. Now it’s true that the anesthesiologist will monitor your heart, but they have to interpret the cause of any change. If they don’t realize that the change in heart rate is due to awareness, you’re screwed.

Yes. The anesthetist is monitoring the patient's vital signs, and one of the things they are watching for are elevations of the heart rate, indicating inadequate sedation.

This isn't foolproof though. Not everyone will have the same physiological response, and over the course of an hours long procedure (during which nothing happens in the "routine" case), it's easy to lose focus and perhaps not notice a change for a little while...

Just my experience, but I didn't wake up during the surgery; I had a surgery with half of my body paralyzed. My vital signs remained stable (in particular, heart rate <= 60 and blood pressure 120/80). I was exceptionally fit at that time, I am sure that helped somewhat.

I was watching the whole surgery live, so to say, but I was also a little bit sedated. Felt no pain, though.

I was informed I would be waken up during brain tumour surgery. They did wake me up to test motor skills (and vision I think) but thankfully I have no recollection of the event (which they also told me would be most likely).

I can't fathom being awake during surgery. Having sleep paralysis once or twice in my calm bedroom was traumatizing enough.

Many comments here mention waking up during wisdom tooth extraction. I've had two surgical wisdom tooth removals under local anesthesia. General anesthesia was never suggested to me, and frankly I can't see why you'd even want that when local anesthesia works just fine and is safer.

Is it common to have general anesthesia for wisdom tooth surgery somewhere in the world, maybe USA? I live in Finland.

One of my operations turned out problematic and slightly traumatic. No one wants stressful situations like that, of course. I'd still rather remember what happened and try to come to terms with it.

More links/excerpts: https://www.lesswrong.com/posts/wzj6WkudtrXQFqL8e/inverse-p-...

I've got to wonder if it's as big an issue if patients don't remember the pain. It seems to be like the tree-falling-in-the-woods problem: if a patient feels pain but never remembers, as far as he's concerned, did it really happen?

I have very hazy memories of wisdom tooth extraction. No pain, but very hazy. It doesn't bother me.

when I was a kid, I used to bike to school. I had a type of thought experiment. Biking uphill was difficult for me. I would have liked to teleport to the top of the hill and be over with it. What I would do was before starting the hill, I would say to myself that I'm going to teleport. Then I would try hard not to think. Then when I got to the top of the hill, I would snap back to it and pretend that I teleported to the top of the hill.

I would always wonder if I could use the same logic for surgery

Even if you don’t wake up during surgery, it feels like there’s an imprint of the trauma. I had a very long operation and by the time I came round I was in pieces emotionally, with no clear idea of what had happened but still a deep sense of dread. On some level it felt like my body knew what had just happened.

It's common for people to be disoriented and emotionally unstable after surgery.

But should we take that observation as evidence against, or for...?

How long for?

6 hours

Are you sure that isn’t just the comedown from the anesthesia?

Could be! It’s an emotional moment and not a particularly nice place to wake up. But there’s definitely something at the back of your mind telling you something fairly awful happened. Of course your mind knows this anyway - you know you had surgery and have the scars - so it could all be an illusion.

They just woke me up during a colonoscopy due to sleep apnea (I did warn them and even bring my CPAP, which they chose not to use.) Highly reminiscent of the “I’m going to go medieval on your ass” scene in Pulp Fiction.

Understandable, but not fun at all.

I recently had a foot injury. In the ER they put me under and the (fantastic) surgeon "twisted" the foot back into place.

I don't remember anything, however other people said I was moaning in pain while under anesthesia. Pretty weird.

Ever since I’ve been a little kid this one thing has stuck with me; if you can’t remember it, is it like it never happened? I used to wonder that about nightmares, but I tended to go with the view that a version of you did suffer, and on some level the impact is there. Like a person with anteretrograde amnesia who can’t remember learning to work a specific maze, but still realizes the gains of the previous attempts.

I still don’t know if it’s even a realistic question, but I still wonder.

It's realistic, I vaguely remember one story from someone who dislocated his shoulder in his teens and had to have a doctor pop it back into place. Apparently they didn't have regular pain killers, so they gave him something that induced amnesia and just had clinic staff hold him down. He doesn't remember any of it at all.

Granted this happened ~50 years ago so I don't know how embellished the story became over the years, or how pain science changed since then.

There’s a lot of study going on about that very issue right now. A lot of surgery is done with the patient conscious or semi-conscious, but on an amnesiac medication that’s supposed to suppress memories. It’s not clear whether memories retained at a deeper sub-conscious level can trigger PTSD.

As recently as the 1980s, they would do heart surgery on newborns because the surgeons felt that the babies wouldn’t remember anything about it. It sounds monstrous to me, however.

That's not why they did it. They did it because anesthesia wasn't as good then, and there were significant risks to the infants.

When the risk of pain outweighed the risk of anesthesia the practice stopped.

I'm pretty sure using these amnesia type drugs is the standard for endoscopies and colonoscopies (versed aka midazolam). You can find horror stories about them online. You can have those procedures done with just propofol or without any sedation but I'm pretty sure they give you versed by default.

I'm sure you can find horror stories for propofol and other drugs, but I'm vastly more uncomfortable with the idea behind intentionally inducing amnesia.

Apparently patients do experience pain under certain anaesthesics, but that they do not remember upon awaking. Pretty disturbing to me.

https://www.theatlantic.com/health/archive/2017/12/surgical-...

When I got my wisdom teeth removed, I regained conscience in the middle of sobbing. I remember feeling a strange disassociation because I didn't feel any pain or know why I was intensely crying.

During the procedure they split the roof of my mouth from stem to stern and had to stitch it back together.

When I got home I looked at myself in the mirror and realized I had a bad black eye.

I wish I could have reviewed footage of whatever cage match I was involved in!

As disturbing as it is, when you consider how surgeries used to be performed before anesthetics we're still pretty lucky to have them. Even if it just paralyzed you it would still probably be an improvement just because the surgeon would be able to work without you moving.

It could well have been that you got a dissociative agent. This is not uncommon in the ED. I remember using etomidate when I was a resident to deal with a kid who lacerated their tongue. After the shot a screaming kid who wouldn't let anyone near his bleeding mouth was totally compliant and willingly stuck out his tongue so I could throw a couple stitches in it.

Anesthesia and analgesia are two different things. There are also different types of anesthetics. For "procedural sedation" (the sort of thing you would do in the ER), it's common to simply use a dissociative agent (like Ketamine), so you aren't really "out", you just aren't "in" either.

Wow! Fascinating, thanks.

I woke up during my wisdom teeth surgery.

Actually, I'm not even sure I did, but I remember doing it. The doctors never told me anything about it.

I remember waking up and seeing something covering my eye, and moving my hands to do thumb ups and peace signs (I knew there were students in the room watching the surgery), and then I remember hands trying to immobilize me, and me trying to start thumb wars, then blacking out.

I don't remember pain, just that it was fun to fuck around with them.

I also woke up during my wisdom teeth extraction. Likewise don't remember any pain, just being shaken as they tried to extract one of the teeth.

Contrast that to my first eye surgery, for which I was completely awake, and the local anaesthesia wore off. That was hell. Excruciating pain while the doc had various instruments in my eye. I voluntarily stopped breathing as I clenched against the pain. Set off all sorts of monitors. The whole stress of it and the swelling in the eye had me blind in that eye for nearly 3 weeks. First week was total blackness. Slowly started fading back in as the swelling went down. Very disconcerting.

Second eye surgery, made clear what happened and the doctor was far more liberal with the anaesthetic both before amd during surgery and I had no pain and minimal swelling and near perfect vision immediately out of the OR.

I also woke up after a wisdom teeth extraction, while still intubated, choking, and remember the nurse pulling out the tube quite painfully (for me) while I was gagging.

The asshole anesthetist denied it happened.

That happened to me too. I thought that was normal procedure?

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