Comment by thrill | Hacker News Reader

Comment by thrill | Hacker News Reader

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.

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.

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.

To be clear, did the doctor confirm afterwards that this all happened? It sounds remarkably like a dream to me.

If this happened, then yikes, I hope I never need general anesthesia....

> "He's under, look at the readings!". I couldn't help myself, and said, "No I'm not."

"I think I'll go for a walk."

...

Did you feel happyyy?

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