January 4, 2013

"Anesthesia awareness is an intrapersonal event..."

"No one else sees it. No one else knows it. You’re the only one."


MadisonMan said...

Fascinating article. Thanks for the link.

Charlie Currie said...

Nightmares ensue...thanks.


Bryan C said...

Interesting. It's perfectly logical that your body and brain would react in abject terror at being paralyzed and sliced open. In the day-to-day world our brains are accustomed to that experience would be fatal.

Still, I wonder how much of the "memory" is actually memory and how much is imaginary horror extrapolated from how it's "supposed" to feel. It's not any less real to the person, of course.

Strelnikov said...

My grandfather always claimed that he was wide awake and felt everything during his many surgeries. I thought he was just crazy, but maybe not.

Mo5m said...

I woke up during a breast biopsy and felt terrible, searing pain. I could not move but they noticed the tears pouring from my eyes and put me back under. I never mentioned it to the surgeon and I'm sure they thought I would not remember.

Shouting Thomas said...

A great article, but the use of "she" as the impersonal pronoun, instead of "he" was a distraction.

All of the researchers referenced in the article were male. I don't know what the actual figures might be, but personal experience in the pharma and medical professions tells me that anesthesiologists are predominantly male. A brief look around the internet confirms this.

There are some good reasons why anesthesiologists are predominantly male. Anesthesiology is less of a personal care profession (in the sense of dealing with sanitation), and thus appeals to men more than, say, nursing. Nursing is a profession which is still somewhat hostile to men.

The use of "she" as an impersonal pronoun in this article was a mistake and a distraction.

madAsHell said...

This is all overwrought.

As a child, I remember having anxiety attacks over colors, and textures.

Yes, your nervous system is trying to protect you.

Eric the Fruit Bat said...

They gave me two spinal thingies for knee surgery. Not a tremendous success, I'd say.

I flinched when they made the incision.

Actually, it was kind of amusing because the surgeons were so alarmed. There were two of them, and they were looking down, and then their heads snapped over, in unison, to look at me, and their faces were hidden by their masks and hats so all I could see were four giant eyeballs, and then their heads snapped back down, in unison, to their work as if nothing had just happened. As I said, it was kind of amusing.

Anyway, I thought it prudent to keep my mouth shut and tough it out.

I felt the entire operation, which I would describe as very painful but not agonizing.

Now that fucking tourniquet! That fucking hurt like a sonofabitch!

It was something of a compensation that I got to glare at the pressure gauge the whole time.

Made it a contest.

Robert Cook said...

Anesthesia is a great boon but also very dangerous and responsible for many of the deaths that occur in surgical procedures each year.

edutcher said...

To be properly anesthetized, you have to be as close to death as possible.


Shouting Thomas said...

Nursing is a profession which is still somewhat hostile to men.

Depends on the nurse IFYKWIM.

Sydney said...

Mitchell the Bat,

When I was in medical school and residency I remember that sort of reaction happening exactly as you described - for both patient and surgeon - when the anesthesia was less than adequate.

Being under anesthesia is very close to death. I've only gone under once and that was because I had no choice (appendix)

William said...

I stopped reading the article. There are some things that it is better not to know.....Just count backwards from a hundred and don't think about the fact that there's a .01% chance that you will undergo pain beyond all human comprehension.

Darleen said...

Shouting Thomas

I don't believe nursing is hostile to men, even if the numbers are low. When my eldest daughter was pinned about 5 years ago (she is a RN in ICU) about a third of her class was male and they had elected one of the men as head of the class.

IMHO male grade school teachers are much rarer and looked upon with great suspicion. Which is most unfortunate.

Darleen said...

And, as an aside to the reductionists in the article that contend the mind doesn't exist beyond the structure of the brain ... I recently read this.

Methadras said...

There are, I believe a couple of medical devices on the market that watch for conscious states during anesthetization. However, I can't fathom the horror of being 'awake' while anesthetized and unable to let anyone know.

Methadras said...

Robert Cook said...

Anesthesia is a great boon but also very dangerous and responsible for many of the deaths that occur in surgical procedures each year.

Which is why anesthesiologists carry some of the heaviest medical insurance burden in the medical industry.

Mark said...

This happened to me, only I didn't find it particularly traumatic. In my mid-30's I had an ACL reconstruction under a light general anesthesia. I actually didn't feel any pain, but I could actually tell what was going on and I said to the Surgeon "I can feel what you're doing."

He didn't seem to find it all that surprising that his patient started talking, and he asked "Really? What am I doing?"

I told him he was pulling something on the right side of my knee down toward the center of my foot. He then told the anesthesiologist to up my dose.

The anesthesiologist was a total babe and I had a great view of her cleavage, so I was a little disappointed that I was going back under.

Don't ask me about my testicular biopsy though.

Polynices said...

Anesthesiology as a profession has worked extremely hard since the 70s to reduce adverse events and it is extremely safe. Anesthesiologists actually have very moderate insurance costs (especially relative to how much they make) because insurers have recognized how diligent the field is about improving care.

Intraoperative awareness does happen and is horrifying and learning to do what can be done to prevent it is very much part of anesthesiology training and practice. If a procedure ever hurts you're not supposed to grit your teeth and endure it -- yell loudly and make the anesthesiologist give you more medicine!

Amartel said...

Mark-surgical scrubs with cleaview? Are you SURE you weren't unconscious at the time?

Mark said...
This comment has been removed by the author.
Mark said...

I'm sure; the curtain was at waist level on me, and they'd talked about doing the procedure under local instead of general. I have a pretty extensive history with local anesthesia (negative - they just don't work, hence my hatred of dentists and reproductive endocrinologists) and I insisted on the general, cleavage notwithstanding.

Michael K said...

"Blogger Methadras said...

Robert Cook said...

"Anesthesia is a great boon but also very dangerous and responsible for many of the deaths that occur in surgical procedures each year.

Which is why anesthesiologists carry some of the heaviest medical insurance burden in the medical industry."

The anesthesia association pushed the use of CO2 monitors on the airway 30 years ago and that eliminated the problem of underventilation, which was the dangerous part. Anesthesia insurance rates are now about the same as surgeons, or less.

Now that the lawyers and psychologists have gotten into it, I expect another "recovered memories" imbroglio. That was only stopped when insurance companies stopped offering coverage for "recovered memory" treatment. The disease disappeared within a year. Amazing.

It is not unusual for patients to remember things said in the OR. For that reason, I always warn the OR crew about what they say. It's unusual for the experience to be painful, partly because paralysis is only used for intubation or for abdominal surgery; big abdominal surgery.

The most notorious case was when Dwight Harkin, a famous heart surgeon in Boston, awoke during a thoracic surgery. The chief of anesthesia was giving his anesthetic, always a dangerous situation. It's like having the commanding general of the hospital in the army do your surgery. When Rockefeller's wife, when he was VP, had her mastectomy, the CG of Walter Reed did the surgery and took seven hours. When LBJ had his gallbladder done, he went to the top surgeon at Mayo to do it. Much smarter.

Anyway, Harkin woke up and was in terrible pain. He told the story later, saying that he was sure his blood pressure must be going through the roof and figured Beecher, the anesthesiologist, would notice and put him back to sleep. Then he heard Beecher say, "Harkin's blood pressure is high. He'd better have that checked when this is over." He was awake through the rest of it. He told the story as an anecdote.

We once replaced the valve in a woman who had had a previous heart surgery awake. She had had a lot of post op psychiatric problem and was terrified of another anesthetic. It went well, however.

I woke up in the recovery room after my 14 hour spine fusion. They had left me intubated and on a respirator. I figured out what was going on and went back to sleep.

Versed, midazolam, is used much of the time and it causes amnesia. I once did a bowel resection on a woman in deep shock we couldn't get her out of. We did the surgery awake with her paralyzed and then have her versed at the end when he BP had recovered. She didn't remember anything and was talking to me before she left the OR. In fact, the anesthesiologist was showing off and had her sit up and say, "Doctor Kennedy, I am four plus." She was in septic shock and we had no choice. I wouldn't do it in other circumstances.

I did a hernia under local one time and then the patient got versed. He was mad at me postop when I saw him in the office. He said I had never come in to see him after the surgery. I had to get his wife to swear I was there.

Brew Master said...

When I was 20 years old I had all 4 of my wisdom teeth removed in one surgery. They put me under, not sure with what, doesn't really matter.

I was not 'awake' during the procedure, but I distinctly recall the sensation of pressure at each extraction site, akin the the pressure of someone pressing on you with their thumb. This rememberance occured immediately upon waking up in recovery, and I can still recall it to this day. It was not painful at all, nor was it traumatic, the memory is more of a curiosity than anything else.

One aspect of that memory is the time dilation, each sensastion of pressure was short, and immediately proceeded from one point to the next. The surgery itself was much longer than the dim 5 seconds or so of the memory.

This was over 20 years ago now, and I've not been put under for any other type of event since that time. It is a useful article to read, and now if I ever do undergo a surgical procedure I'll be sure to mention it to the staff.

Coincidentally, locals used for dental work, or stiches seem only about 75% effective on me.

jr565 said...

I had a colonoscopy and woke up in the middle and talked to the nurse for about fifteen seconds before being knocked out. My experience at the time was OWWWW.

And another time I had an operation and as it was over the doctor was talking to another doctor and I responded to them.

But I can't say that I was awake the whole time. I woke up just enough to be momentarily aware.

Crunchy Frog said...

Darkness imprisoning me
All that I see
Absolute horror
I cannot live
I cannot die
Trapped in myself
Body my holding cell

Astro said...

A long but really interesting article. Thanks for the link.

My wife became dimly aware of what was going on during a C-section when our son was born. This was in the early 80s. She said she remembered the pressure as the doctor pressed on the interior of her uterus to sop up the blood and embryotic fluid. She was not in pain but was scared that she would start to feel pain. She remembered a few moments panic, not being able to tell the doctor she was awake. Then she drifted asleep.

My own experience was after a colonoscopy. I remember counting backwards... then suddenly I was awake struggling to pull up my underwear in the recovery room. When I finally got my clothes back on I told my wife I badly needed to pee and blow out some gas. The nurse led us to a restroom where I went in and sat down to pee and fart (too wobbly to stand). A half hour later my wife was pounding on the door to see if I was OK. I thought I'd only just sat down, but she informed me I'd been in there for a half an hour.