Waking Up During Surgery (2019)

I recall hearing about this phenomenon about a decade ago, and at the time someone theorized that the specific memory may be lost but the effects were still present, and that these effects could cause general anxiety and distress without the person understanding the reasoning. I think it is perhaps more philosophical than rational, but it did give me pause to consider that perhaps not everyone forgets enough of a surgery to escape its effects, even in the best of circumstances.

I wonder if the journalist is asking the wrong people.

Instead of interviewing patients supposed to be under drug-induced amnesia, and finding the few who remembered, ask the doctors and nurses who are being asked to restrain patients in distress. A specialist in a procedure that requires light general anesthesia would, if this was true, have done surgery on thousands of people in various degrees of distress.

To me, that would be a pretty heavy secret to carry, and a 'conspiracy' that large would be impossible to conceal. I do agree, though, that pain without memory is pretty much as good as no pain. When you're conscious but unable to remember being conscious, are you still capable of suffering?

> pain with no memory is pretty much as good as no pain

I can't speak to your specific case, but in general that's not true.

Even if you have no conscious memory of trauma, it can manifest itself in ongoing stress, fear, and general PTSD-like symptoms.

You may have been lucky in waking up but perhaps without pain, but that's not the case with everyone.

Sorry, but there is nothing else to say except that you are extremely wrong. This kind of belief is exactly why male circumcision is not seen for the evil that it is. Please try to consider the possibility that trauma without conscious memory can have disastrous results - as other commenters are trying to get you to understand...

By this argument, living an entire life of suffering and then not remembering it when you’re dead would mean that it doesn’t matter and all suffering can be ignored. I hope that’s not the ethical code we settle on.

>pain with no memory

reverse situation - all the memory and no pain. I had a surgery on my nose done under local, and it was kind of unreal experience when the surgeon stopped cutting and took what looked like a typical woodworking chisel and a small hammer and started to chisel away the bone in my nose - all without any pain, my head is just like a piece of wood - the force would transfer and the back of my head would feel the pressure every time the hammer would fall and the scraping vibrations of the chiseling would just reverberate through the scull. ... More than 20 years later ENT here was genuinely curious where did i get such a nice job done. USSR military surgeon :) And back in the USSR my mother had her appendix removed under local too, and the surgeon was communicating to her various stages of the surgery, like what he is going to do and how that may be felt/perceived.

I wonder about the merits of those different approaches. (very handwavy as IANAD) With the local the pain doesn't seem to reach the central nervous system. With the sedation or general it reaches i suppose, yet the central nervous system has no reaction. If one supposes that the strong pain may be a kind of neuron pathway/connection altering signal ("EEPROM burning"), it would be plausible to expect that that unfelt or felt-and-forgotten at the time pain under sedation or general may still have some effects down the road.

Sedation without going into general anesthesia is not an easy thing at all, and even experienced anesthesia providers will sometimes struggle. However, patients moving or being otherwise disoriented is quite frequent and in itself is a non-event except when trying to reach for the surgical site, as you describe. As for distress, it's often not from pain but rather confusion, which can somtimes devolve into agitation and necessity to deepen the anesthesia. In my experience, true awareness is exceptionally rare. It's true that some procedures, such as cardiac or emergency C-section have an increased risk of event due to the particular context, though.

> It may not be popular to say, but I do feel from my experience that pain with no memory is pretty much as good as no pain, in the grand scheme of things.

If given the choice, I'd choose this over over deeper sedation.

Sedation and Anesthesia are not entirely risk-free. Even routine Anesthesia has been correlated with various subtle cognitive differences in the days and weeks after a procedure in some (though not all) studies.

I'd rather be given the minimum dose necessary to get the job done than have a provider go overboard with medications to avoid the small chance of someone breaking through the sedation.

My wife has actually had both, on separate occasions. About 15 years ago, she smashed her wrist, breaking it into multiple pieces. In the ER, they explained that the wouldn't give her an anesthetic to push things into place for a splint (to hold it together until surgery could be scheduled), but they'd give her meds so she would forget the pain. I was absolutely amazed that it worked. She vaguely remembers telling them "let's git 'er done" and then nothing for about an hour after that.

Fast forward about 5 years or so, she's on the operating table to have titanium plates inserted to hold her ankle together and she apparently wakes up in the middle of the procedure and started trying to rip her IV out while the surgeon and nurses struggle to hold her down (she's pretty strong) while the anesthesiologist puts her back under. She has no memory of this: the only reason we even know about it is that one of the nurses mentioned later that "you caused quite a stir in there."

Training horses is not for the faint of heart :-)

I remember waking up from general anesthesia during removal of my wisdom teeth. The oral surgeon seemed kind of surprised, cursed and asked the assistant to give me more anesthesia. I didn't find it all that traumatic either at the time, but I was only awake for a minute or so.

There is no such thing as ‘light’ general anaesthesia. It’s a terrible term used only by non-anaesthetists. Did you have sedation? Movement with sedation is extremely common and not a concern. With sedation, we aim to provide comfort and relief from the anxiety-inducing parts of the experience, not unresponsiveness to noxious stimuli and lack of recall.

Please don’t bring a recorder. It puts you at risk because when we ask if you have any devices, we expect an honest answer. If it is discovered you will lose the trust of your treating team. You can get electrical burns if certain equipment is used. You could have recorded conversations about other patients, which you are not entitled to do.

Was it true general (full intubation, paralysis, etc.) or "conscious sedation" (falling asleep with no memory and an oxygen tube next to your nose)?

Waking up and trying to move would make sense under conscious sedation. Seems very unlikely under general, given my (non professional) understanding.

I don't believe "light general" is a thing.

That's really the case for medication, as well. I wish doctors would be better in this regard and pay more attention to individual needs. I understand that would be more difficult and would likely increase costs, but still.

The way it's done now is as you said, "take x mg at y interval" based on the tests done during drug development. If you don't respond to the medication the same way as the majority, you're in for a ride. If x drug doesn't work, try something else until something works. It's a pretty terrible approach, tbh.

It's rare to find a doctor who will keep in mind the many individual factors, often they have a lot of experience (to build that database of knowledge, which sadly is not shared) and actual interest in their work, a surprisingly rare thing.

Reminds me of this somewhat relevant post about the mysteries of Anesthesia

https://medium.com/@lukehollomon/anesthesia-works-on-plants-...

That speculation at the end is truly bizzare. I’m sure that, if I suffered such an experience, the first thing I’d do upon waking would be to talk about it!

I've had three general anaesthetics, all as a child or teenager. I only remember "the anaesthetic" for one of them: a large dose of what I now know to be propofol went in a cannula and the (attractive, for a 14-year-old) nurse stroked the cannula on the back of my hand after it was administered. That felt warm and nice. Purple butterflies them started to come up out of my hand, through the back of the venflon, and came around my vision, until I was surrounded by warm, beating wings and a pleasant drifting into unconsciousness (tinged with a feeling of contentment). I woke up -- much to my great chagrin -- in "moderate discomfort" what felt like instantaneously later, although several hours had gone.

None of my hallucinations were real. Everything that I "saw" probably took place in a 1-2s period as I was falling under, and was entirely a figment of my imagination. Were I worried about waking up during my procedure, it's entirely possible that my brain would have hallucinated something far less innocent. These reports are very difficult to substantiate, but a lot of monitoring is done under general anaesthesia: depending on the surgery and the anaesthetic this might range from measuring the inspirational and expirational partial pressures of O2, CO2, other relevant gasses such as N2O and the anaesthetic agent itself, e.g. desflurane or sevoflurane. Heart rate, blood pressure and the like are all routinely monitored. It's therefore possible to compute the effective concentration of agent in the blood stream and directly prove that the concentration is adequate. Sometimes EEGs are taken and can directly show brain activity, or nerve conduction pathways are mapped and can show conscious activation. Waking up during (competent) anaesthesia should never happen, and I think that the 5e-7 chance put above is probably an upper bound. At any rate, it pales in comparison with the complication rate from many surgeries, which, of course are usually several orders of magnitude higher: 1e-3 for death is often considered acceptable, for context.

They went on to describe the forearm experiment which showed a much higher rate of awareness. I don’t see why you’ve chosen to omit that. You seem to casually discard the idea that awareness without memory is irrelevant, but when I’ve informed patients of amnestics they’ve been horrified - maybe needlessly so, but I’m not so arrogant as to think “silly patient, your horror is wrong and therefore irrelevant.”

Many people don’t regard “you’ll be in pain and then forget” as the same as “no pain.”

And the idea that HR and BP are perfect indicators of pain is ridiculous. Anesthetics reduce the responsiveness of both; cardiac parameters don’t respond perfectly, and you don’t need perfect anesthesia to impair them.

In my hospital, at least, we don’t take for granted that we achieve perfect coverage. It’s normal to give patients a bolus of amnestic at the tail end of a procedure to cover any gap in pain/distress while we were bringing them back to consciousness.

Your personal experience has absolutely zero impact on the value of this article. The "it doesn't exist because i never experienced it" mindset is a dangerous one.

I have had several surgeries with everything from a light to general anesthetic. I warn the nurses and doctor beforehand that I have a history of waking and remember previous operations. Most do not believe me. I remember the sound of my wisdom teeth being cracked open and opening my eyes while they were being cut out. I remember scaring the shit out of a nurse and doctor when I woke and started talking mid-procedure. I remember being held down when I kept trying to roll onto my side as if I were asleep. Typically, the reaction is something like "he is awake" followed by a flurry of action, then sleep. I don't know why this happens-- I suspect something makes the anesthesia wear off faster than normal. I also have an issue at the dentist with numbing-- they usually have to hit me twice. If that doesn't work fully, I just tell him to go ahead and I will deal with it.

It should be easy to disprove false memory, I'd think, at least in the case of procedures that are recorded. Ask the patient what they remember happening, and compare with the recording to see if those things did occur or didn't.

I'm not inclined to assume every report of this happening is due to false memory, which is itself a somewhat controversial topic. As the article points out but is not even slightly novel in saying, we don't have a firm understanding of why general anesthesia works, just that it does. That's good enough to be going on with, but not yet understanding the mechanism at work means it's reasonable to expect we also don't yet have perfect knowledge of why and when it doesn't work perfectly, and there is therefore nothing implausible about there being rare outliers such as those under discussion here.

It's a known phenomenon not a mythological creature like bigfoot. Dentists for example often have to re-administer anesthesia mid-procedure when a patient wakes up mid-wisdom tooth extraction for example.

Check out the sibling comment in which lr4444lr recounts taking a secret audio recording device into surgery.

I would guess her actual memory of the up-waking would be very unreliable after thousands of nightmares.

It’s a reasonably common response to traumatic events for people to have regular nightmares for decades afterwards. ~2-3 a night for a decade would be high, but not unheard of.

a study comparing Vietnam Veterans to civilians showed that 52% of combat Veterans with PTSD had nightmares fairly often. Only 3% of the civilians in the study reported that same level of nightmares. https://www.ptsd.va.gov/understand/related/nightmares.asp

My dominant (practically exclusive, actually) nightmare for over 20 years involved forgetting a class schedule or where a classroom was. Initially triggered by the (enormous) middle school I attended for the first half of 6th grade, then it morphed into a whole new set of very-similar nightmares after I started attending college. I'm sure I had thousands of those nightmares. Hell, I so rarely remember any of my dreams on waking these days (used to recall a detailed, ordered history of my dreams each morning, without even trying) that for all I know I'm still having them several times a week without realizing it.

I'd believe thousands of nightmares over the span of a decade, for a traumatic surgery experience.

My idea was that anasthesia switches off consciousness itself. It is like closing your eye when you look at the Sun while using painkillers is like wearing sunglasses.

Potentially relevant research discussing, in part, whether drugs that disrupt memory formation and/or sympathetic nervous system activation can improve outcomes after traumatic events: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620711/

Yes? You think you keep your memories when you die?

Without going into too much spoilers, a horror video game Amnesia: The Dark Descent has some tropes around this topic.

This is known to be kind of true. At least some part of the body remembers the pain. And it can have some long lasting effects (chronic pain, or stress). That's why nowadays during many surgeries they try to suppress the pain as much as possible locally.

So if you get surgery on your leg, it is best if you have additional anaesthesia or pain killers working in this particular leg. So you wouldn't feel all the pain even without general anaesthesia.

That's too bad, it seems like a pretty easy to confirm, but I suspect nobody gave a crap.

Yes, this has happened to me (Ativan wore off) too but I was more disoriented than in pain at that point.

This happened to me when I had teeth removed for braces while under N20. When the wisdom teeth came out I opted for sodium pentothol.