I had a colon resectional several years ago due to a large and suddenly growing cancerous tumor. I remember thinking as they were giving me the initial happy drug that I had a joke I wanted to tell the surgeon that only he'd get (relevant to something where we'd each served in the military together some time before). Some time into the surgery (I didn't realize it was when I was wide open and the Doc, literally, had his hands full) I came "fully" (I didn't feel any pain) awake and said clearly "Hey Doc, blah blah blah". Talk about silencing a room. To his credit, the Doc looked at me and clearly said the punch line I was looking for, and told me he was busy and to relax. I laid my head back down and heard him say to the anesthesiologist "Put him under, now!", with the response "He's under, look at the readings!". I couldn't help myself, and said, "No I'm not." I heard several colorful words from the Doc, followed by "intubate", followed by "get the paddles", and then "clear" - apparently it was real balancing act as they tried to get me under again while the Doc tried to hurry to complete his act. I awoke again right as they finished and found myself strapped down and intubated. The Doc was watching me this time and told me I was dreaming and to relax. Of course, they then had a hell of a time waking me in recovery. I have a beautiful scar now as the Doc said he decided he'd better hurry for his problem child, and did a record time surgery.
Just for curiosity's sake, do you mind clearing up a few things for me? Why weren't you already intubated when you woke up the first time, if they'd already opened you up? Were you not supposed to be under general anesthesia by that point? And what on Earth were they doing with the paddles? You can't have been in cardiac fibrillation if you were awake.
You don't always intubate when someone's under general anaesthesia - it depends on the person, the level of anaesthesia needed, the anaesthesiologist's judgement call of the risks of intubating vs not intubating, the type of surgery and length of surgery. For example, I've been under GA three times, but all for oral operations (Adenoids removed, problems with a tooth not coming down properly and needing to be pulled down and forward from the roof of my mouth, and having all my wisdom teeth removed at the same time) all of which clearly can't be done with intubation! It ultimately comes down to balancing two different sets of risks against each other, and alternatives like CPAP (continuous positive air pressure, aka an oxygen mask) are often used instead.
It's also entirely possible to have a cardiac arrhythmia while fully conscious - if you've had an orgasm, there's a good chance you've had a brief, though mild, period of arrhythmia in the form of skipping a heartbeat periodically until orgasm subsides. In the case of more severe cardiac fibrillation, it will take a period of time before you actually lose consciousness depending on the severity.
In the case above, where more anaesthesia was being admitted, it would seem posible that fibrillation would have been caused by lowered blood oxygen to the heart in the period between the extra anaesthesia being used and it's taking enough of an effect for intubation to be done. In that case, a quick shock might be needed to restore normal heart rhythms subsequently.
Source - The other half is an obstetric surgeon and her best friend is an anaesthesiologist. Any errors are my own; I'm not a doctor and don't claim to completely understand even if I do come from a medical family.
I can confirm that you can be fully conscious when the paddles are deployed - get into a strange enough heart rhythm and people call for them. I've been in fast AF, felt normal and been threatened with cardioversion. The threat, combined with flecanide was enough to put me back to normal, no paddles required.
I don't know about the process of non-intubation initially - I don't think it's necessary for general anesthesia (I was youngish and otherwise quite healthy and fit, with no breathing issues, etc.), and I know there's some risk in the process itself - they decided to do it during the surgery to increase control of the process even more in case I quit breathing as they increased the anesthesia. The paddles were because even though the readings said I was under, I was obviously not, and the anesthesiologist and surgeon had to make a rapid decision about what was greater risk - me awakening even more, which the talking indicated was happening, and complicating the surgery, or cranking up the sauce. They went for the latter, and my heart started skipping beats - a few at a time or so, but kept coming back steady. They put the paddles on me three times I was told later, but I was obviously messing with them, as my pulse kept coming back before they'd fire 'em. I suspect there was actually some amount of time between the phrases I heard above due to a lack of temporal awareness and that I was being stubborn about actually going back under.
Anesthesia has never had much effect on me - dental procedures are uncomfortable, but bearable enough, for me as I'm quite aware of what's going on with locals, and having had something more serious for an impacted wisdom tooth removal once, I now prefer the unpleasantness of a little pain rather than the aftereffects of the more serious stuff, and I dislike "being under". After talking about it with the docs afterwards, I believe I simply have a serious fear of dying, and my brain intensely dislikes not knowing what's going on, and fights it. A matter of trust I suppose.
Before putting too much stock in this, break out your copy of _The Myth of Repressed Memory_ by Dr. Elizabeth Loftus. The simple fact is that if you don't remember something that happened to you twenty years ago today, you're not going to remember it better twenty years from now. It will instead become easier and easier for other people to insinuate contrafactual details. It's actually quite easy to implant false memories, especially with the kind of leading questions Ms. Campbell's anesthesiologist friend would be likely to throw at her by trying to reveal his/her specialist knowledge. It's the same phenomenon that led to the big "satanism" scares late last century and it's the same reason normal people who go to "therapists" who specialize in "alien abduction" wind up "remembering" abduction events once in session. Leading questions. In fact, her memory of someone standing over her is a very common phenomenon, usually attended by sleep paralysis, and is also thought to be the basis for alien abduction stories.
The article paints a very clear cause-and-effect relationship between the surgery, trauma, and her life's troubles. I doubt that in reality the effects were so clear cut. We're not seeing the whole story, just the part that makes a coherent narrative. Whatever happened—this, or something else—certainly has produced an emotional trauma which is something Ms. Campbell needs to address in her own life. But I doubt very seriously that the right response is to get everyone worked up about something that may or may not be to blame.
> She explored the possibility of post-traumatic stress disorder with her therapists, but could not identify a triggering event. One clue that did eventually surface, though, hinted at a possibly traumatic experience. During a session with a hypnotherapist, Campbell remembered an image, accompanied by an acute feeling of fear, of a man looming over her.
It is very similar to the histories of false memories recovered after hypnosis that are discussed in the book "Demon-Haunted World" by Carl Sagan in chapter 9.
It discuss tree main branches
* Alien abduction
* Satanic cults kidnapping
* Past lives
* Repressed child abuse
The common pattern is that the subject has unclear symptoms, and after many hypnosis sessions a traumatic "memory" begins to appear and later after a few repetitions it became very clear and detailed. But the details are very difficult to corroborate or refute. (Some people even went to jail because of the supposed abuses.) The "memories" in this article look very similar.
(There is real cases of child abuse, but it is not repressed for decades.)
This seems to be a scare piece rather than a scientific article. For one thing, every mention of a drug inevitably has some irrelevant quip about it, like "... always accomplished with propofol, a drug now famous for killing Michael Jackson. It is milky and viscous, almost like yogurt in a fat syringe." Scary. Drugs should be clear and should not have ever killed anyone even when intentionally misused. (I'm surprised they didn't mention that the doctors drank water before the procedure, a chemical that everyone who has ever died drank until their bodies were three quarters full of it!)
Regarding the anecdote about the dental surgery study, I am personally not surprised by the results. When I was having my wisdom teeth removed, one of my anesthesia options was to be put to sleep for the procedure. The doctor said that the sleep would be like taking a nap, and the purpose of being asleep wasn't to prevent any pain (I would immediately awaken if other anesthesia was not used and they started pulling out the teeth), but rather so that I wouldn't be anxious about the procedure. With this in mind, it seems perfectly reasonable that patients in the study would remember strange occurrences while they were asleep. They probably woke up because of the commotion and went back to sleep after things were back to normal, not remembering much consciously. I would bet that if a study were done where volunteers were asked to sleep on an airline flight until they reached the gate at their destination and were interviewed under hypnosis a bit later, they would probably remember things like the announcement to put away electronic devices. They might not remember that normally, however, kind of like how you forget dreams after you wake up. (Well, I do anyway.)
Ultimately, the subject matter that the article covers is extremely important and interesting, but I thought the negative overtones were not proportional the actual risk of waking up during surgery and experiencing a lifetime of emotional pain as a result. People already irrationally weigh risks when considering surgery, and I don't think this piece will help them make a more rational decision.
Since first learning of this and other odd questions raised by general anesthesia, I try to avoid it at all cost. These days for most operations there are anethetics that keep you conscious, though many of them do affect memory so you're hazy of what happens afterwards. Stories like these show that even if you have no conscious memory, psychological damage can still be done.
I think that technically those are sedatives not anaesthetics, and might be used with numbing agents or nerve blockers just so that you're less aware of what's being done to you in cases where there's no need for a general anaesthetic. For example, my father needed surgery to his hand a few weeks ago - it's minor enough to have no need for general anaesthetics, so they injected a nerve blocking agent into the nerve to that arm under his arm pit and gave him a mild sedative. Or when I once needed a gastroscopy, I was given a sedative and a local numbing agent in my throat.
As it is, doctors and surgeons would generally not put you under general anaesthetics if they have a choice. As soon as you're using general anaesthetics, you've significantly increased the risk to the patient and so it needs to be procedure that justifies the added risks.
Frankly, there's plenty in medicine that we don't fully understand. However, for the risks that there might be some bad side effects the upside often more than make up for it. In this case, for the claimed 0.1% risk of having some level of awareness (a number which is refuted and more recent and wider ranging studies have put closer to 0.005% (or one in twenty thousand)), of which only a tiny percentage claim to have been aware enough to feel pain, the upside is that you can be treated for things which, pre-anaesthesia, you'd die of.
Yeah, that scares me - the brain is so beautifully and profoundly complex, and to say that "This drug prevents memory formation based on our extensive trials!" is to completely ignore the potential that our subconscious being records things, regardless of what we consider to be "memory".
Maybe we should change protocols. The main problem is not the awareness (or even the pain). The problem is the unknown. So if you open your eyes, they should not be taped and there should be some psychologist that just talks to you, explaining what is going on etc ... that is even while you are under just in case you come over. They should also detect and if you are over to have some contingency procedures. Also some psychological training and consultancy before the operation seems like good thing too. And better monitoring after the operation for behavior changes after.
On the top of my head. Although I suppose anyone with medical degree will laugh my suggestions away and with good reasons, but there should be some good ideas over there.
A comment on the article from an anesthesiologist explains that taping the eyes shut is done as, while under, you have no blink reflex, so you will otherwise damage your eyes.
In that case, maybe they can put just enough pressure on the lid to close the eyes, but not too much that you can't force them open. If I lightly touch my lid as it's closed, it stays closed, but I can force it open if I try.
It isn't always done, sometimes a sort of cream is put on the eyelids which seems to make the eyelids stay down (maybe is sort of gently glues the eyelashes). I'd say this, goggles or tape are all equally common where I work.
Yes, we need another $150/hr specialist sitting there to talk you down for the ~30 seconds you'll be awake before the anesthesiologist can put you back under, in the 0.1% chance that you wake up during the procedure. And we wonder why our health care is stupid expensive!
I broke a collar bone a few years ago doing winter sports. It broke very close to the junction with the arm so the doctor decided to put a long screw to hold it into place. Being both young and stupid, I smoke a cigarette before the operation, which is not recommended. I recall the exact moment clearly, it is when they started drilling into my shoulder, I could feel my whole skeleton vibrating with the drill. I suddenly woke up from anesthesia puking all over the place. I remember telling the whole operation crew that I was sorry for making such a mess (yes, I'm Canadian), then some sort of oxygen mask was replaced on my face, I guess they gave my another shot and I soon fell asleep again. I think I slept for over 12 hours straight after that, but I have no other permanent trauma.
What a horrific and brilliant article. I'm only half-way through it – just reached the part about Kant – and fully intend to finish it when I wake up tomorrow (no pun intended)
I wonder what effect a lifetime's meditation practice might have here. As in, if one's trained one's brain through many thousands of hours of focus and deep self-inquiry – to find and become aware of the source of their awareness – whether they might innately be more prepared to deal with become conscious mid-surgery (even if their "personality" isn't conscious, just their I...)
About 15 or so years ago I had an operation on my arm following me breaking it in 3 places on my elbow (I was about 7 and fell off my bike without letting go of the handlebars). While not nearly as severe as a lot of the stories mentioned here, at one point into the operation I became aware. I couldn't feel anything thankfully, but I strongly remember just calmly working out that I couldn't move or sense anything. I probably would have started freaking out, but I suddenly felt myself become incredibly sleepy and I fell back under. I did have a very occational nightmare where I had a similar sensation of complete paralysis for a few years following it, but it took me a while to link that to the operation. I'm just incredibly greatful that I didn't become any more aware.
Did it feel like it lasted a few seconds or more like a few minutes?
There are times when I 'wake up' during the night, but I feel paralysed and unable to move any part of my body. It only lasts a few seconds before I either fall back into a dream where I thought I woke up or I managed to move something and actually wake up.
I think it was about 30 seconds or so, as it was long enough to realise that I was conscious and try everything to realise that I couldn't move. My experience of it in dreams doesn't seem to be sleep paralysis, as it was normally part of a bad scenario (i.e. the old hollywood thing of you being taken to cooking in a pot by canibals) where my paralysis made sense to the situation, but was part of a full dream that had lead to that point. I could be wrong, but that's the way I've interpretted it.
I've gotten the same thing, usually when sleep deprived.
Often, during the paralysis, I experience weird things that are part of the dream-like state I'm in; The feeling of something like a cat thrashing and hissing on top of me, or a strange spider-like leggy thing being on top of me, or the sensation of being watched, surrounded or having something near me.
> Often, during the paralysis, I experience weird things that are part of the dream-like state I'm in; The feeling of something like a cat thrashing and hissing on top of me, or a strange spider-like leggy thing being on top of me, or the sensation of being watched, surrounded or having something near me.
That's probably your primal brain freaking out for being paralyzed in the dark.
When a woman has a Caesarian, it seems pretty typical that the anaesthetic is an epidural which removes feeling from the lower half of the body while the patient retains full consciousness and feeling from the chest upwards. My wife said that operation felt like they were looking for trainers in a sports bag, but it didn't hurt. We couldnt see what was happening because it was behind a green curtain a bit like a table tennis net. I could see that the surgeons had to pull pretty hard to get the baby out. I wonder if there are lots of mothers out there with PTSD? 1 in 3 births was by Caesarian at the hospital we were at although the national average is something like 1/5.
The reasons are related to anatomy of spinal column. In adults the spinal cord ends at lower level of second lumbar vertebra. The sheaths/coverings of spinal cord extend all the way down to cocyx. This creates a hollow tube filled only with cerebrospinal fluid from second lumbar vertebra down to end of spinal column. Most of the epidural anesthesia techniques and all of spinal anesthesia techniques use this space because there is no risk of damage to spinal cord. In epidural anesthesia, the catheter can only be advanced a few vertebra up and down from point of insertion. The regions on which surgery can be performed depend on reach of epidural catheter. So, with an epidural catheter in lumbar region, only lower limbs and lower abdomen can be anesthetized. With epidural cathetr in lower thoracic vertebra , approx. lower 2/3 of abdomen can be anesthetized. For chest surgeries you will need epidural catheter in mid thoracic vertebras. And so on. But the problem with thoracic epidural is risk of puncture of dural sheath and damage to spinal cord which will result in permanent paralysis of that area. Epidural anesthesia can be used for upper abdominal and chest surgeries but the risk will be more. Moreover, for extensive surgeries a lot more is needed just simple loss of sensation. for example, more granular control of heart rate, blood pressure, oxygenation etc ; all these manoeuvres are a lot easier in general anesthesia.
So for lower limbs to lower abdomen , spinal and epidural anesthesia are fine, even better compared to general anesthesia (especially in obstetrics). For the rest, depends on specific circumstances.
Lots of surgeries are done this way- you can do regional blocks for limbs for example, and in high risk patients for knee replacements this is common.
The main reason why it isn't used more often is 2-fold: there is a risk from spinal or epidural anaesthesia of infection or paralysis since it is an invasive procedure; and secondly an awake patient is a risk unto theirselves: they could move, they may talk (?annoying to the doctors)
If you were undergoing a procedure you could very likely elect to have a regional block if you preferred. Just make your preferences known to the doctors
Are you kidding? I just had an epidural for my appendectomy, they had me open and closed in 15 minutes. We even kept cracking jokes during the surgery.
In the case of my sister-in-law, she most assuredly knew since the paralytics still worked but she was awake and could feel pain through the entire procedure (gall bladder removal).
Good question! I assumed that I would remember if it happened, also I did not have any nightmares involving doctors or hospital.
On a separate note it was weird watching youtube video of someone else's appendectomy knowing that all of that was done to me too. You know it's like watching someone eating lemon. :)
