May 17, 2010

"Cut deeper, pull harder."

Heard by a woman having her eye surgically removed.
Although normally a patient does not remember anything about surgery that involves general anesthesia, about one or two people in every 1,000 may wake up during general anesthesia, according to the Mayo Clinic. Most of these cases involve the person being aware of the surrounding environment, but some experience severe pain and go on to have psychological problems.
If not remembering is part of the process, do we really know how many people experience awareness during surgery? If you've ever had general anesthesia, are you sure this didn't happen to you? If you somehow, now, could find out that it had happened, but you still could not remember it, it wouldn't bother you as much as it should, would it?


David said...

If you don't remember, does it matter? I've had the "you won't remember" anesthetic a few times and have wondered if the procedure hurt at the time and was just forgotten. Then I wondered why I should care. Not being a NYT columnist of philosophy, I decided to punt the entire issue.

James said...

Alcoholics have much higher tolerance than non-alcoholics for all CNS depressants .

Having had about a dozen surgical procedures involving general anesthesia how many of the docs inquired (prior to the procedure) about my drinking habits ?

One. In our conversation this MD revealed he survived marriage to an alcoholic which did much it explain his awareness.

JAL said...

Is the question about not remembering? Or is it that this particular person,and a small number of others (~.1%) are essentially awake and aware (but paralyzed). That to me is different than "remembering." That is experiencing.

My question is why there seems to be no noticeable effect on the cardiac and respiratory monitor. Normally terror and pain increase heart and respiratory rate. Would that not be a clue re the patient awareness? No change there would add to the puzzle.

If you don't remember it ... I'm not sure it matters, as we cannot remember what pain feels like after the fact anyway. (Interesting physiological quirk.)

We remember that something is "painful" but we cannot feel the pain again.

Is that what you mean? Remembering that the procedure was painful without awareness of experiencing the pain? Or just not remembering. Period.

c3 said...

This does happen but having said that "Cut deeper" and "pull harder" would not be something an ophthalmologist or assistant would say during an enucleation.

There would not likely need to be an assistance but simply the opthalmologist surgeon and a scrub nurse. The cut isn't deep. There's one place to cut and its not "deeper". "Pull harder" implies an elemental view of the eye.

It would be interesting to hear from the OR team as to their recollection of those phrases.

edutcher said...

According to The Blonde, the whole idea of anesthesia is to get you as close to death as possible. Needless to say, there may be some cases where the anesthetist strays a bit too far on the side of caution.

There's also something called 'twilight sleep' where you're a bit more alert, which, from what The Blonde has told me, is getting more popular. No mention of that in the piece, but perhaps she had that and didn't know the difference.

WV "coutchi" What Charo likes better than British TV.

Bobr said...

Wow, that rang a bell. I had bunion surgery about 20 years ago. Half way through the procedure I did wake up and found the doctor talking to two other docters. At that time he was using a hammer and chisal on the bone. I couldn't feel anything because they had put a block on my foot. I opened my eyes and asked how he was doing and it startled the shit out of him. We had a short conversation and he had me put under again. I thought it was funny at the time. I can certainly see where that woman would have been scared to death not being able to let them know she was concious.

save_the_rustbelt said...

I've watched many orthopaedic surgeries and it is a lot like "tool time," nothing you would want to watch or experience (although if you have a knee arthoscopy many surgeons will give you a video on CD).

There are monitors for anesthesia awareness, although the monitors are not fool proof. You should ask at the pre-op appointment.

James - if you filled out your medical history properly it should alert the surgeon and the gas passer to ask about it.

Amy said...

My mom woke up in the middle of her colonoscopy and she DOES remember it. We've all heard the story many times. And she went to a different doctor ever since.

Pogo said...

"Weiher started a campaign called the Anesthesia Awareness Campaign that seeks to educate people about..."

I am hereby announcing the start of my campaign to raise awareness about raising awareness.

There are so many things to be aware of these days, and we may not always be aware of that. It's Raising Awareness Deficit Disorder (RADD).

I am calling on Althouse readers to feel better about making a difference, Raising Awareness About Raising Awareness, by going to expensive dinners, having parties, going on a walkathon, selling t-shirts, going to a concert, wearing a plastic bracelet, gardening, or walking in the park.

Just keep doing what you're doing, but tell people you're Raising Awareness About Raising Awareness.

Thank you for your support.

bagoh20 said...

I'm with C3, I doubt the surgeon would say "cut deeper, pull harder" even if that's what he wanted. It's just not doctorish. Maybe she overheard the home remodeling show on the TV in the recovery room.

Edmund said...

My wife is an anesthesiologist and intraoperative awareness is a major topic of discussion in the profession, as the linked article shows. The rates of intraoperative awareness include everything from total awareness (when the patient is truly awake and paralyzed) all the way down to remembering some lights in the OR. It's not clear that all the reports of awareness are events that really happened. It's hard to measure exactly how common IA is, since there is a certain amount of suggestion built into the questions on the surveys. Nonetheless, it's an active topic of discussion.

The brain monitors alluded to in the article are gaining in popularity simply as a defense against lawsuits, despite the lack of significant effectiveness. The company that has the patent on the machines has done several PR campaigns in the past to make the public aware of their equipment.

One other factor that could be driving reported cases up is that much more surgery is being done under sedation with drugs that keep you calm and prevent long term memories from being formed. Amy's mom was probably sedated in such a fashion, and there is a significant rate of awareness and memory retention during such sedation. (Why is such sedation used? It is cheaper, just as effective, avoids the dangers of general anesthesia, gets you home sooner.)

BTW, anesthesia is at the forefront of doing outcome analysis to increase patient safety. Every closed malpractice claim in the US is scrubbed of personally identifiable info and sent for analysis by researchers. They look for common causes and recommend changes in best practices. As a result, injury and mortality rates in anesthesia have plummeted.

WV: crombin - Where Charles I head ended up.

Pogo said...

Don't be racists, people.
Step up, and Raise Awareness About Raising Awareness.

Only you can prevent RADD.
Raising Awareness means never having to say "I'm sorry; I just didn't know!".
Unawareness is not healthy for children and other living things.

halojones-fan said...

Last night I had an experience where I was awake during surgery. The funny thing is I was lying in my own bed, alone. The doctors must have somehow broken into my house and conducted surgery on me, and then left without a trace before the morning.

I'm filing a malpractice lawsuit anyway, just as my lawyer advises.

(I'm not sure why the doctors would dress up as giant rats with horrible scissor-hands and nightmarish Cronenbergian phallic protrusions. I'm also not sure why they ejaculated into my underpants. I mean, I certainly wouldn't do that!)

Brent Michael Krupp said...

There's a lot of confusion about what kind of anesthesia they're talking about. It's "general anesthesia" as in all the way deeply asleep probably with a breathing tube and probably for major surgery.

You don't get GA for a colonoscopy so remembering that is normal. You don't get GA for dental work so remembering that is normal.

It's also the case that patients are frequently given drugs that block memory formation so even if they are aware during surgery they'll never remember it.

None of this is to say that it isn't a real issue that really happens. It's just that lots of the awareness anecdotes people share in comment sections have nothing to do with it.

Freeman Hunt said...

I don't know that it was general anesthesia, but I woke up while having my wisdom teeth removed. I could feel it, and it really hurt, but the odd thing was that I didn't care. (I have since been told that that anesthesia includes two drugs, one of which does not reduce the pain but makes you not bothered by it, so that one must have been working.)

After a moment, they noticed that I was awake and turned up whatever it was that then knocked me back out.

Freeman Hunt said...

How about the huge number of failed epidurals administered for pain management in childbirth?

I had one of those. There's a form of failed anesthesia that you'll definitely remember.

chuck b. said...

I once had surgery to repair a cut tendon in my finger. It bothered me when I woke up that my memory of the time period before the surgery was gone. Noone said there would be amnesia. It's a creepy feeling. I certainly wasn't going to sue anyone about it, but I do wish someone had told me to expect that. You know, before the period of the amnesia.

knox said...

I woke up while having my wisdom teeth removed

Me too.

Deborah said...

Okay, are we going to talk about child birth and colonoscopies? Because i can keep you entertained all night with those experiences. Twenty two years has not dimmed the memory of my epidural experience, nor in nineteen years has the horror of natural childbirth become less vivid. We won't go into the colonoscopy, so to speak, but let me just say that I did wake up (which I have learned from another poster is common) and watched the procecure on the monitor for a moment before they knocked me out again.

wv:obrogus. That's a procedure I haven't head.

JonesBones said...

I had a colonoscopy two weeks ago and woke up watching the monitor displaying my colon. Suddenly, guess I woke up a little more, I was screaming and writhing in pain. I remember this clearly and the doctor telling me to stay still. I was incapacitated enough to not be able to jump off of the table and clock the doc but, have a clear and horrifying memory of the whole thing. Afterwards all of the nurses were talking about the fully awake patient. Naturally, when I was able to, I told the doctor she was a sadist. She apologised and, in looking over my records from my previous colonoscopy, discovered it had taken almost three times the normal dose of anesthetic to knock me out and keep me out. She was shocked by the amount and noted that she should have checked that before beginning. DUH! She said the next time I'll have to go under general because of my tolerance level.

Skeptical said...

Apparently some anesthesiologists use a touch of amnestic when they think that the patient has come a little too close to consciousness. The amnestic generates retrograde amnesia, so any awareness will not be remembered.

So here is a horrible thought: what if this is the way that ALL general anesthesia really works — you are fully conscious during the procedure, but it causes you to forget it afterward? Man, what a horrorshow that would be.

William said...

This blog is read by many dentists and red haired people. There was a recent NY Times article that said that red heads need more novocaine than others to suppress pain. This is really true. Please spread the word.

Freeman Hunt said...

nor in nineteen years has the horror of natural childbirth become less vivid

Yes. I remember books and articles trying to convince me that natural childbirth was wonderful and so much better than having an epidural. With my second son my epidural did not work.

All those books and articles lied.