[nightingale]

My pt. cam back from OR, after having had a lap appy, stating he felt the entire procedure but could not move. When he awoke in PACU and told them that, they tried dosing him with Versed to cause a little amnesia and it did not work.

I have never heard of this. Does this happen rarely? Apparently, the Anesthesiologist does not use the brain activiy monitor and goes by v/s; she stated that he actually had quite a lot of pain med during the procedure and she had been medicating him.

I can not imagine having a surgical procedure and feeling "everything" and be paralyzed and not able to express what I needed.

I would love to know your thoughts on how this can happen and be prevented. Could this pt. has simply be dreaming? Of course everyone, especially the Anesthesiologist, felt terrible.

[Katnip]

It has happened. There are a couple of threads here that posted articles about such things. Once a pt is paralyzed and intubated there's no way for them to tell you they're in pain.

I have a friend who had surgery and afterwords she said she felt it, the doc said that was ridiculous. A couple of years later it was discovered that he anasthesiologist was diverting the drugs from patients for his own use and many people had gone through procedures without proper pain management. Last I heard there was a huge class action suit going against him.

[LeesieBug]

I watched a very interesting documentary on this once...pretty gruesome stories, some of the people had.....

In the documentary, they mentioned that they are working on different types of technology to prevent this. I think I recall something they were working on (or already have) that monitored brain waves to know if a person is in pain and assess their level of consciousness???? Don't remember the details, and as I know NOTHING about anesthesia, maybe someone else can fill us in on that. It's pretty interesting.

[UCDSICURN]

I've never gone under general anesthesia but had a severed extensor ligament on my hand repaired. I was given a choice of general or a block. I went with the block. My arm was completely dead, couldn't move it, couldn't feel it and was given some good old "Vitamin V" and couldn't say anything coherently. The surgery started and my vitals went through the roof. I felt the intial superficial cutting which was quickly resolved with some lidocaine. It wasn't just pressure either, it felt like he was cutting my finger off. After the lido I felt some tugging and dull pressure, but no pain.

So, yeah, it's possible and has been documented thoroughly like the others have already stated. Just thought you'd like a first hand experience.

Donn C.

[Jolie]

I have read accounts of this happening. Just another reason I have a healthy fear of surgery and general anesthesia.

I know this is a little different, but I was in a C-section once with a patient who had an epidural. The anesthesiologist carefully checked her level of anesthesia before the case started, and all seemed well. As the OB reached the deeper layers of muscle, the patient began to c/o sharp pain. The OB waited while the anesthesiologist dosed up her epidural, but to no avail. After multiple attempts to numb her up, the anesthesiologist offered her the option of a general vs. an injection of local into the troublesome spot. She chose the latter, and it worked fine. Thank goodness it was an elective case, and the OB and anesthesiologist had the luxury of time to work things out.

[June55Baby]

During my STAT C-Section 25+ years ago, I had a general anesthetic and felt the initial incision. It was a firey hot pain just like when you cut yourself with a knife! I remember thinking Oh, My Goodness, I can feel this ! ! ! I also heard my babies cry and the pediatrician's pager go off and him telling someone that he had received a page to ER. Then, I was out...

When I awoke in recovery and related my experience, hospital staff were amazed at what I had heard and felt. The pediatrician had received a page to ER and had told the nursery staff about it!

[KiKi05]

Isn't this called surgical awareness?

[AmyRNin06]

Originally Posted by nightngale1998

I would love to know your thoughts on how this can happen and be prevented. Could this pt. has simply be dreaming? Of course everyone, especially the Anesthesiologist, felt terrible.

Hi,
I had oral surgery performed in a dental office when I was 15. The roof of my mouth was cut open and two extra teeth were removed (I had primary, permanent, and an extra set of front teeth). I was under general anesthesia but I could feel everything from the first cut to the pulling out of the teeth to the stitches, and I could hear the dentist and assistants talking. I tried to move a hand or open my eyes or SOMETHING and was unable to do anything. I remember crying during the procedure...do patients often cry during surgery, even under general? I've often wondered if they should have noticed that.
I am positive it wasn't a dream. I could tell you the exact procedure they performed and that the dentist was talking about taking a trip to Hawaii. My mother verified this with the dentist after she heard my story.

I am the most paranoid person about needing surgery now. If I had to have any procedure, I would plead for a spinal or epidural. Heck, I think I'd rather feel the pain and at least be able to TELL someone rather than go through that again.
Amy

[loisane]

There a couple different issues involved here.

It has been recognized for a long time that there is a rare, but possible complication of general anesthesia in which the patient is conscious when they should otherwise be unconscious. This has been historically referred to as "awareness".

Sometimes it is a consequence of provider or equipment error. While still unfortunate for the involved person, at least these cases are easily explained, once the source of error is identified.

Very rarely, no cause can be identified. The numbers are so low, it is hard to study, so we really don't even have a good picture of how often this occurs. It is so rare, most anesthesia providers have never encountered it, and have a difficult time believing it is even possible.

Three populations are at particular risk for awareness. One is cardiac surgery, because of the type of anesthesia that was used for these cases in the past (high dose narcotics). There is a trend now to use other anesthetic agents for these cases, so this may not be as much of a problem in these cases as it was in the past.

Second are trauma patients. It is easy to understand how a patient might form memories during a surgery, if they are so hemodynamically unstable the only anesthesia one can give them is oxygen and muscle relaxants (which is of course, no anesthesia at all.) If they are lucky enough to survive the experience, they might be at risk for subsequent awareness.

Third is usually the most problematic. Emergency c-section. If you ever see one of these done, you can see how it can happen. Time is of the utmost essence to save the baby, so often the OB is cutting before the induction injection is even complete. There is no time to prepare mom (emotionally) for this possibility. Couple this with the fact that things didn't go the way she had hoped, she got cheated out of the birth experience she had planned, and she can be pretty angry. Hopefully, when she realizes the prioritization that had to occur to try and maximize her outcome, she will be OK with it.


If the patient is NOT receiving a general anesthetic, then this is an entirely different issue. (Teeth extraction in the office is usually not full general anesthesia, even though they tell you you'll be "asleep") Some of the experiences reported here sound like situations of inadequate block. Regional and local techniques sometimes need supplementation for inadequate level. And we are always ready to provide a complete general, if it becomes needed.

There are two new brain wave technologies that have become available to help assess anesthestic depth. The manufacturers are marketing them as an indispensible tool to help prevent awareness. Although there is some evidence they help with this, the entire anesthesia community is not convinced they are as effective as the manufacturer would have you believe. In fact, some of these horror stories that keep getting circulated can be traced back to these companies. Now, I'm not saying they are untrue. Just that the manufacturers may be making more out of them, for their own agenda, IMHO. These monitors are not standard of care, and no provider would be guilty of negligence for not using them. And remember, inadequate depth is just part of it. There have been cases of awareness when the patient had a perfectly adequate level of anesthesia.

Obviously, these are complicated issues. Anesthesia providers are constantly monitoring every aspect of patient condition. We are experienced in recognizing changes in level of anesthesia, and responding appropriately. Awareness is one of the many things we are watching for, and taking measures toward. Most of the time, things go so well, that people outside of anesthesia don't even realize how much goes into maintaining this balance. But nothing is 100%, and despite our best efforts, awareness occurs once in awhile.

loisane crna

[amandita]

Assuming that the anesthesia was appropriately monitored and administered, are there any legal ramifications if a patient becomes aware or experiences pain during surgery?