
Awakening (during anesthesia) - llambda
http://theatlantic.com/magazine/archive/2013/01/awakening/309188/?single_page=true
======
thrill
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.

~~~
Cass
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.

~~~
elemeno
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.

~~~
lostlogin
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.

------
fusiongyro
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.

~~~
gus_massa
I agree.

A quote from the article:

> _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.)

------
jrockway
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.

------
maaku
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.

~~~
elemeno
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.

------
venomsnake
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.

~~~
saurik
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.

~~~
morsch
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.

~~~
lostlogin
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.

------
Zarathust
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.

------
josscrowcroft
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_...)

~~~
d0mine
I haven't read it to the end but the story seems like classic case of
confabulation

<http://en.wikipedia.org/wiki/False_memory_syndrome>

Luckily it doesn't involve "remembering" a child being abused by a parent.

~~~
gus_massa
In this "awakening" cases nobody would be sent to jail, but I suppose that
they can get a lot of money in a "malpractice" lawsuit.

------
JoshuaRedmond
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.

~~~
meric
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.

~~~
rallison
Sleep paralysis is actually pretty common, affecting around 6% of the
population: <https://en.wikipedia.org/wiki/Sleep_paralysis>

~~~
meric
Yes, I want to see if it felt anything like it.

~~~
JoshuaRedmond
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.

~~~
Chris2048
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.

This feeling disappears as soon as I can move.

~~~
hcarvalhoalves
> 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.

------
willyt
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.

~~~
ars
I've always wondered why they don't do more surgeries this way, an epidural
without anesthesia.

~~~
AmadKamali
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.

------
DanBlake
I thought a older nip/tuck scene was great at showing how scary being awake
during a surgery would be :

<http://www.youtube.com/watch?v=-BHBiSWxa3w>

------
wheaties
Woke up with my stomach open as a child. No pain, I was lucky. Still remember
them telling me it was alright.

I hope they nail this as it will probably lead to the closest thing we can get
to a hands free keyboard.

------
notimetorelax
When I had appendectomy this was the only thing I was afraid of. Glad that I
didn't happen!

~~~
StavrosK
How do you know?

~~~
fallous
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).

