I woke up during surgery, Have you?

[GatorRN]

I was responding to another thread the other day and made mention of the fact that I woke up DURING my last surgery. I got to wondering if this had ever happened to anybody else, so I thought I'd ask.

It happened to me last year. I had a vague memory of waking up and seeing the overhead operating room lights, and being in excruciating pain. I thought I had imagined it, until two different anesthesioligists (teaching hospital) came up to my room, on separate occasions, and asked me if I had any memory of waking up during my surgery. I was shocked to find out that it actually did happen. :uhoh21:

I later requested a copy of both my hospital records and my surgeons records for my own file, and amazingly enough, it wasn't mentioned anywhere in my records. I wooooonder why...Hmmmmm? Of course, my surgeon downplayed the whole incident at my follow up appt.

Has anybody else ever had this experience before? If so, what do you remember, and did your surgeon own up to it?

[Rose_Queen, BSN, MSN, RN]

I know this is an old thread, but this just happened to me yesterday. I was put under sedation (not general anesthesia) for a lipoma removal off my back. I was told that I would be put under sedation and the surgeon would use local anesthetics to stop me from feeling pain. I remember getting the sedation, feeling very sleepy and closing my eyes. The next thing I know I can feel a knife in my back cutting repetitively. For some reason I was unable to speak (I was not on any paralyzing agents, so I'm not sure why I couldn't talk) but tried to flinch and began to cry. The surgeon heard me crying and I heard him say "Is she crying?" The anesthesiologist then looked at me and asked if I was in pain. I was able to nod my head yes and then I guess they gave me more sedation because the next thing I knew I was waking up in the PACU. I woke up in a terrible panic and began crying again. It was very scary and I'm still feeling upset about it. The nurse in the PACU flagged down the anesthesiologist to talk to me. He acted insulted that I wanted to ask what happened. I told him what I experienced and his response was just, "Well we were only using light sedation, you were never completely out." I understand that it was just sedation, but it would have been nice to hear "I'm sorry you had that experience."

If I ever have surgery again I will make sure that Anesthesiologist comes nowhere near me!

Sounds almost like they didn't completely explain to you what to expect. All of our docs will tell our light sedation patients that it wouldn't be uncommon for them to hear the staff talking/feel pressure (but not pain), that sort of thing. Maybe the surgeon didn't wait long enough for the local to take effect before starting. Either way, sounds like that anesthesiologist needs an attitude adjustment.

[lamazeteacher]

are they now calling "conscious" sedation, "light"? i agree with the possibility that the local anaesthetic hadn't taken effect, and/or it could have been long acting, which takes longer to work.... most surgeons will test the operative area with a sharp, to see if that's felt, before they excise something.....

a lot of anaesthesiologists are jerks when talking to patients. they didn't hone their communication skills, as they were supposed to be working with unconscious people. however, communication skills are necessary when working with others, and function as part of a team. it sounds to me like he/she could have asked the surgeon about doing the test, if he/she didn't do it before beginning to cut! i just hate it when anaesthesiologists pay attention to anything other than their patient during surgery. they should be on the alert for changes in muscle tone and facial expressions, etc. i'll bet that you were very contracted, and your facial expression must have been horror stricken, before you started to cry. i'm so sorry that it happened to you.

you've done all of us a favor by bringing your event to our attention. i consider the anaesthesiologist the most important care provider during surgery, and want to meet whoever's "passing the gas" (as we used to call it eons ago), before the surgery, no matter how small. i don't think that any preparatory explanations would have adequately pacified you during your experience. no onbe would have told you that the incision would feel painful, as it isn't supposed to hurt. that reminds me of ob patients who are told the contractions will feel like "pressure".

when i taught prenatal lamaze classes for 35 years before retiring, i was quite specific about the pain, and explained that the purpose of breathing in specific patterns, was to take their attention away from the pain, diverting laboring women so she "stayed above" the pain, and could control their perception of it, if they practiced enough to become "conditioned" (a la pavlov).

of course you will probably desire an anaesthesiologist if/when you have surgery in the future, and for colonoscopy (although people can do without it for that). that is, unless hypnosis and acupuncture become available..... they work!

please tell us what the anaesthesiologist said about your aphasia! that was scary!

[Bobbkat]

I've had concious sedation fail. I was (supposedly) given versed pre colonoscopy, wheeled into the procedure room, and turned on my side. I watched the whole thing on the screen that the doctor was watching. He never noticed that I was awake until I made a comment about my intestines. He offered to give me some more versed, but I declined since it was kinda nifty to see my insides. Luckily, it wasn't painful at all. It was also very comforting to know that even though the people in the room thought I was sedated, they were very respectful and professoinal towards me the whole time.

It's odd, because the other times I've been given the drug, it worked like a charm, which leads me to believe I was never actually given the dose that I was told I had received.

[GadgetRN71, ASN, RN]

I'm not a CRNA. I'm an OR nurse with some questions for those that are. I see a fair amount of patients who are less than truthful in their pre-op interview, either with their weight, or drug/alcohol use. I had a patient 2 weeks ago that was claiming she was 165 lbs when she was at least 250.

I would think this could really affect the anesthesia to some point. Or you guys pretty good at eyeballing someone and adusting the anesthesia accordingly. I mean, in the above situation, we're not talking about a small difference. Do you just use your judgement in a case like that? I have had surgeries and I am always truthful with my CRNA or anesthesiologist...knock wood, I've never woken up under general anesthesia..I did during my EGD and colonoscopy but that happens..if people only knew what they said during colonoscopies...

[SillyPinkBunny]

I had a colonoscopy 4 years ago, and they didn't give me anything to sedate me. they gave me an IV, but the nurse said that the vein collapsed? It was a horrible experieince....

It started with the medication they gave me to clean me out the day before....it came with Reglan for the nausea caused by the laxatives, but I can't take Reglan due to that weird side effect it causes (feels like I'm climbing the walls, and I know it can be stopped with benadryl, but sometimes it doesnt help so I stay away from Reglan, PERIOD) and they didn't give me anything else to help with the nausea.

Well on the day of my appointment, the hospital/dr. office was a three hour drive, and we where an hour late cause my aunt had to keep pulling over so I could vomit every half a mile.

Then they started an IV and offered Reglan to help my Vomiting, but I reminded them again that I will NOT allow them to give me Reglan, I rather vomit. So they said the IV fluids may be enough to help stop the vomiting.

Well the take me to the procedure room, and the doctor asked if I was ready, I said sure, and the next thing I know, he's shoving a camera in my backend, and I'm screaming the whole time. They never injected anything into my IV, and the nurse just held my hand, while I litterally screamed louder then when I gave birth to my big headed son with no epidural or drugs. I could feel every twist and turn, I was crying, then I started vomiting again. And when I begged him to stop, he just made it hurt more. He wouldn't stop no matter how much I pleaded.

And what made me more upset, was that my aunt wanted to stay during the procedure with me, she said she had a bad feeling about this, but the doctor absoutly refused, saying that most people can't handle it, but she told him that she's watch her husband's and mother's colonoscopies, and it didn't freak her out at all, but he wouldn't budge.

Then afterwards, I'm vomiting even more, actually by then I'm dry heaving, and the doctor comes in to explain what he found, and he got mad at me cause I wouldn't look at him while he spoke to me...I was vomiting!!!! I couldn't even stop heaving for 5 seconds, no joke....so he just said "forget it" and walked out...

Then I didn't want to leave cause I couldn't stop dry heaving 3 hours after the procedure, so they tried to get the doctor to order something for the ride home since it was a long drive for me, and they couldnt get a hold of my doctor, so they had to have another doctor order some phenergan.

Well the nurse comes back with a shot, and I asked her what it was,and she got snippy at me and said "it's phenergan, what do you usually get", and I told her that phenergan was fine, I just couldn't handle Reglan or Compazine as they both cause horrible side effects, and she said "well this is all your getting!!", but in a very rude way...But I had to ask cause I've had alot of nurse try to sneak Reglan or compazine in thinking that I'm lying for some odd reason in the past. I was just hurting so much and confused....I'm seeing other people coming out of the procedure room still asleep....what happened to me?? I'm only allergic to penicillin and sensitive to Reglan and Compazine, it's not like I have reactions to the medications they use to sedate you. And I know they don't always completly put you out during colonoscopies, but why didn't they give me anything??

It took me 3 months to recover from this, I lost alot of weight cause nothing would stay put in my stomach, and it caused me so much stress, I had nonstop migraines, alot of my hair fell out, couldn't sleep, deep depression, it was traumatizing, the most painful thing I've ever experienced....

Also once I woke up during an ERCP, and remember gagging from the tube, and I remember them saying that I was waking up, and quickly I was back asleep, then I woke up towards the end when they where pulling out some tube thing, and I remember throwing up some whiteish colored stuff, but I quickly fell back asleep again...

-bunny

[lamazeteacher]

Quote from SqirrelRN71: ".........if people only knew what they said during colonoscopies..."

Better that they're innocent of their own proclivity to saying antisocial things. I guess there's a patient benefit reason for HIPPA, after all.....

SillyPink Bunny: It is regretful both that Reglan is not suitable for you, and especially your sense that nurses have "slipped it" into injections you've had before. That is adequate reason for them to lose their licenses. If you could only get the antinausea med that was given in the early '60s, thalidamide. However the possibility of it being misused by someone who was pregnant, and causing teratogenic malformations of the fetus, have caused it to be banned by the FDA.

It is unconscionable that you have been treated by overtly hostile health care providers. I don't think I'd travel 3 hours for that kind of thing..... Is there another facility closer to you, where you would have more patient oriented providers? There is no place for rudeness or hidden agendae in patient care, and I'd let those individuals who display their hostility, suffer in their pocketbooks.

Reglan's synergistic effect with the sedation received for "conscious" sedation, is probably why you're wide awake when others recovering from their "anaesthesia" are blissfully unconscious after their procedures. It would serve you well, to have a consultation with a specialist (still not formalized) in allergies to medications. Lately I've noticed that people who are allergic to things like dye used in diagnostic radiological studies, are given Benadryl to alter their allergy, before they're given it. Even blood transfusion recipients are given that to allay possible antagonistic reactions.

As a RN educated in the late '50s, that seems almost heretical to me, and I refused Benadry prior to a blood transfusion I was given. I wanted to know if I was allergic to it! Yet I appreciate that the antiallergic effect of Benadryl needs to be on board, before the possible allergen is administered, for optimal effect. I guess the good effects of having it, out weigh the possible bad effects.... but I saw the blood cells of antagonistic blood types clumping during class, and have that fixed in my brain, because of that. Mind-body connection being what it is, I could very well bring on an anaphylactic reaction.....

However, the Benadryl in combination with Reglan could sedate you further, meaning that you'd need a lowered dose of Versed or whatever else is used to sedate you for your procedure. I'd think a period of testing for optimal results would be indicated, which only an unusually dedicated anaesthesiologist, in consultation with an allergist, could be provided. It would be wise to find out from an allergist what and how that can be done, before you actually need "conscious sedation" again.... to be thoroughly prepared for any event. Colonoscopies need to be repeated every 5-6 years.

[NurseKitten, MSN, RN]

Discovery Health did a whole documentary on Anesthesia awareness.

It turned out later that the tank that contained the drug that puts you to sleep was empty.

Empty vaporizers are the number one cause of anesthesia awareness. It is part of every machine check, every time before it is used, to check the fill level of vaporizers. Even if I don't have time to fill the vaporizers, I will take the bottle of agent out of the Pyxis, and set it on my work station so I remember to do it once the case is started and my patient is stable.

I can (thankfully) say that to my knowledge, I've never had a case of awareness. Versed prior to surgery is a key component to that cocktail. The other component is understanding what level your gas must be at to maintain amnesia. I usually run at least double that level.