
Waking up during surgery - catfacedlady
https://mosaicscience.com/story/anaesthesia-anesthesia-awake-awareness-surgery-operation-or-paralysed/
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fifteenforty
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.

~~~
ThePadawan
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.

~~~
fifteenforty
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.

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anigbrowl
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.

~~~
silencio
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.

~~~
pmiller2
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.

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zoba
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.

~~~
gotocake
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...](https://twin.sci-
hub.se/5746/9679b963c5859d4991d906fef74c0b7f/serfontein2010.pdf)

~~~
JshWright
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).

~~~
gotocake
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.

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tapland
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.

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dancek
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.

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gwern
More links/excerpts:
[https://www.lesswrong.com/posts/wzj6WkudtrXQFqL8e/inverse-p-...](https://www.lesswrong.com/posts/wzj6WkudtrXQFqL8e/inverse-
p-zombies-the-other-direction-in-the-hard-problem-of)

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mises
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.

~~~
obrisintor
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

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idlemind
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.

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

~~~
afro88
How long for?

~~~
idlemind
6 hours

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tomcam
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.

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winrid
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.

~~~
gotocake
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.

~~~
remote_phone
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.

~~~
ars
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.

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baby
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.

~~~
hermitdev
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.

~~~
emmanuel_1234
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.

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

