I woke up during surgery, Have you? - page 7

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... Read More

  1. by   sirI
    You are welcome, GatorRN
  2. by   analee23
    I work in the ER and do conscious sedations. I had a patient the other day that was a difficult fracture reduction. He woke up in the middle of the procedure, looked right at the ER attending and said "F*** YOU!" Then went right back out as I was pushing more meds right at that time. He had absolutely no memory of it, and kept asking if they had "fixed his arm" during recovery. Makes ya happy for the versed!!!

    I remember briefly waking up at the end of my foot surgery, but it was when they were dressing my foot at the tail end, and then I don't remember anything for the rest of the day.... until waking up on the couch in my dad's office. Have had 3 surgeries since and never woken up, or remember anything until I'm back in my hospital room, don't remember recovery AT ALL!!
  3. by   louloubell1
    This thread is interesting, and to me the thing that makes it most interesting are the continued reports of "I woke up during surgery" despite several posts trying to explain some things from anesthesia providers.

    Folks, if you "woke up" from your conscious sedation, if you "woke up" from your spinal or epidural or other regional block, if you "woke up" at the end of surgery as they were putting on the dressings, if you "woke up" hearing the anesthetist say to you "breathe, breathe," if you "woke up" from what you are wrongly assuming to be general anesthesia and actually "spoke" to your anesthetist quickly before "being back out", then you did not "wake up" inappropriately. I just am trying to help you all clear up some misconceptions here so that the people who have truly suffered awareness under anesthesia can have some suitable support and maybe other people can understand their post-traumatic feelings a bit better.

    Conscious sedation is a realm of depressed consciousness sufficient to provide comfort while still the patient maintains the ability to respond. Sometimes people won't remember anything when they've had conscious sedation, but sometimes they will. That is ok. It is not expected that you will be unconscious for your procedure, hence the term conscious sedation. You may have heard conversations in the room, you may recall sounds & lights. If you recall something or "awakened" from a procedure you had done with conscious sedation, you did not suffer from awareness under general anesthesia.

    Regional blockade, including spinals and epidurals, are not general anesthesia. Spinals are often done for many lower extremity and some abdominal surgeries. Sometimes, a patient who has had one of these forms of anesthesia is provided with some sedation as well during their procedure: Sedation, not general anesthesia (although regional blockade may indeed be combined with general anesthesia but not usually). Again, let me stress, sedation is not general anesthesia. If you awoke from your sedation, you did not suffer from awareness under general anesthesia. You may have heard conversations in the room, you may recall sounds & lights. You did not suffer awareness under anesthesia.

    If you awoke and actually "talked" to your anesthesia provider before quickly being "put back out" you were likely receiving some sedation, not general anesthesia. General anesthesia involves the placement of an ETT or an LMA, or much less frequently, a very tight fitting mask. You won't be talking with any of those contraptions in your throat I can guarentee.

    If you awakened hearing your anesthetist or anesthesiologist saying "breathe, breathe" you were likely being awakened at the end of the procedure. There comes a time when all general anesthetics must end, obviously, and we do indeed wake you up. And sometimes we wake you up fully with the ETT still in because we may deem it to be the safest (as opposed to extubating deep under anesthesia). Likewise, if you woke up and dressings were being applied, your procedure was over, and you were being awakened on purpose. You did not suffer awareness under general anesthesia.

    Also, to answer a couple of other questions which have been posed: First, the BIS monitor is not utilized by every facility. BIS continues to be under study and its use is not standard of care. Mistersister posted that a BIS reading under 30 is unconscious, however, the true number range that correlates with general anesthesia is 40-60. The lower the number, the deeper the state of anesthesia. It is not desirable to run a patient too deep just as it is not desirable to run a patient too light, & I think you should know that some studies utilizing the BIS monitor to gauge depth of anesthesia have shown that anesthesia providers have a tendency to run their patients too deep, rather than too light. Many anesthesia professionals question the usefulness and accuracy of this tool, and so its use is not universal. Also, I must tell you that many anesthesia providers blame the makers of BIS for aggressive ad campaigning that has falsely led to people believing they have experienced awareness under anesthesia or believing that the incidence is astronomical. This thread is largely an example of that, of people who truly believe they had awareness under anesthesia, when they in fact were not receiving a general anesthetic.

    Another question: Yes, drugs with amnestic properties are utilized often for general anesthesia. Versed is probably the most common. It is a benzodiazepine with can provide anterograde amnesia. However, not all patients experience amnesia with versed. In addition, versed is not appropriate for all patients. The other drugs utilized during general anesthesia also provide for amnesia and unawareness.

    Another misconception that I have read so far on this thread involves pt movement under anesthesia. There are many, many procedures in which no muscle relaxation (paralysis) is necessary. Movement does not necessarily mean that a patient is not adequately anesthetized. The dose of inhalation agent necessary to prevent recall in a patient is about half that necessary to prevent movement to surgical stimulus, and the dose needed to prevent autonomic response (tachycardia, increased BP, etc) is even higher than that necessary to prevent movement. OR nurses who see a patient move under general anesthesia should be aware that it doesn't mean the patient is not unconscious.

    Anyway, what this longwinded response amounts to is that people who have really suffered awareness under general anesthesia have endured a traumatic experience, and need support from professionals and others who have suffered similar events. Likewise, anesthesia providers maybe need to be doing more education with the public on what awareness under anesthesia really is, and what the different kinds of anesthesia are. There is obviously, even amongst this group of health care professionals, great misunderstanding of this.

    Lou
    Last edit by louloubell1 on Dec 14, '06 : Reason: typo
  4. by   ewattsjt
    Thanks Lou,

    Great post! Hopefully people will read your post and have a better understanding of anesthesia.
  5. by   crackerjack
    Working in the OR I've seen more than I care to of patients waking/moving on the table. For a patient to suddenly be moving and trying to come off the table, out of stirrups or whatever while the surgeon is trying to work and is nowhere near the beginning or end of the case (not like the patient wasn't fully under or in preparation for the end of a case that didnt' come quite as soon as anticipated) that's just a bit too light to be 'light' and it always happens with the same anesthetists. Over and over and over....soooo predictable. Let's just say I know who I would and wouldn't have for my anesthetist.
    Last edit by crackerjack on Dec 15, '06
  6. by   ewattsjt
    That is one of the nice perks to working surgery! I know who I would choose too.
  7. by   meme_911
    i woke up in the middel of surgery and i remember feeling the cold tube passing through my esophegus :smiletea2: it was soOoOo cold and weired an i felt like couphing
  8. by   nurscee
    2 separate procedures for the same thing I woke up (?) and vaguely remember hearing someone hollering. I then realized it was me! And then I was put under again. Another time I woke up with a sore, swollen chin and injured hand after a colonoscopy. All 3 times I was put under with Versed. Never again will I let them use Versed on me.
  9. by   subee
    Quote from 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?

    How could they record the incident if they didn't know it happened until you were seen post-op? Awareness during surgery is very rare, but it does happen. Usually, the patient hears noises in the room but does not feel pain. That is because you (usually) have enough narcotics and gas in your system to block pain impulses but have not received enough amnesiac medications. If you read the entire thread, you will discover the type of surgeries and patients most prone to recall. However, you were kept too "light" and should have had both more narcotics and amnesiacs in your system. Avoiding amnesia involves more art than merely providing pain relief and if you had a resident or new practitioner, you got assigned someone at the bottom of the learning curve. You may have given no visible signs of being aware (we don't have reliable monitors for awareness) and there's no reason for your surgeon to suspect that you experienced awareness unless you told him or her. It must be traumatic for you - sorry someone failed you.
  10. by   neveragain
    I had a bad experience with Versed as well. I was aware, but curiously unable to move unless the nurses told me to. They proceeded to give me a general anesthetic that I had told them would be completely unacceptable for my particular surgery. We had no talk ahead of time like it says for "informed consent." Since I had said no to the general and accepted the risk for an axillery block, I thought the subject was finished. How was I to know that the CRNA had a drug like Versed? Anyway, I had to listen to his (CRNA) crude comments about me, and actually PARTICIPATE in the general anesthesia prep, even though I wanted to jump off the table and RUN AWAY AS FAST AS I COULD! It was so upsetting, that months later I can't get a good night's sleep, have PTSD and am afraid to take the Prozac my gp wants me to take, etc. This was caused by VERSED, let alone awakening during the procedure paralyzed! I wanted to be awake and aware, and watch the operation, not be given a zombie drug, have a tailpipe shoved down my throat and a given a general! Not to mention the staggering hospital bill for all the procedures involving anesthesia! I want to have the sloppily installed hardware taken back OUT of my arm, but am too terrified to go back to a hospital. I swear if the things weren't screwed in I would get a scalpel and slice them out myself! The OR nurses were the only people that were kind and considerate to me even though they all thought that I would have amnesia. Without them I would be in a mental hospital. Big thank you to all of you OR nurses who are sweet to patients even if they believe the patient won't remember.
  11. by   subee
    Quote from neveragain
    I had a bad experience with Versed as well. I was aware, but curiously unable to move unless the nurses told me to. They proceeded to give me a general anesthetic that I had told them would be completely unacceptable for my particular surgery. We had no talk ahead of time like it says for "informed consent." Since I had said no to the general and accepted the risk for an axillery block, I thought the subject was finished. How was I to know that the CRNA had a drug like Versed? Anyway, I had to listen to his (CRNA) crude comments about me, and actually PARTICIPATE in the general anesthesia prep, even though I wanted to jump off the table and RUN AWAY AS FAST AS I COULD! It was so upsetting, that months later I can't get a good night's sleep, have PTSD and am afraid to take the Prozac my gp wants me to take, etc. This was caused by VERSED, let alone awakening during the procedure paralyzed! I wanted to be awake and aware, and watch the operation, not be given a zombie drug, have a tailpipe shoved down my throat and a given a general! Not to mention the staggering hospital bill for all the procedures involving anesthesia! I want to have the sloppily installed hardware taken back OUT of my arm, but am too terrified to go back to a hospital. I swear if the things weren't screwed in I would get a scalpel and slice them out myself! The OR nurses were the only people that were kind and considerate to me even though they all thought that I would have amnesia. Without them I would be in a mental hospital. Big thank you to all of you OR nurses who are sweet to patients even if they believe the patient won't remember.
    Neveragain: You need to obtain a copy of your anesthesia record because its impossible to know what happened (except for a sloppy anesthetic!). In case you ever have to have surgery again, anesthesia needs to know what failed with you before. It will also give you some power over something that still terrifies you. Do you think you could arouse up enough anger to contact the head of the department where you had your surgery and file a formal complaint with a cc. to the hospital administrator? You can never begin to heal from this until you find out the facts and take some action. I'm sure there's someone in that department that cares very much about what happened to you and wants to follow through. Please don't let this incident continue to fester. By the way, axillary blocks frequently are inadequate for surgery because of poor spread of the anesthetic or a rush by the team to get the case going. Versed is linked to catonia (short-lived) in patient who don't get general anesthesia. (I know you said you were intubated - this is just an FYI for others). Good luck to you. Feel free to pm me.
  12. by   danissa
    :icon_rolleyes: Horror stories! I have never experienced this, thank him above!, as I've only had one GA in my life! this was for tooth extraction at the dentist when I was a child, but I went the opposite way! Obviously I was not aware, but they could not get me out of the anasthetic, I just would not wake up! Dentist all panicky, just about to call for ambulance, when I started to come around. i was sent home, with no follow up !! Now when I think about it, how negligent was his practice? It was a while ago, ( well, a wee bit longer than a while ago! ) but makes me shudder all the same! Thankfully, never needed a GA since, but would make them aware of my past history.
    My Mam blames it on me being a "lazy baby!" Born sleeping, couldn't be bothered to make the effort to wake up! still sleep at the drop of a hat, even sitting at the computer! ( or in the cinema, or worse in the lecture theatre at a Neonatal Perinatal Mortality meeting! Did I mention that SNORING LOUDLY is what I do as soon as my eyes close? Imagine the shame- Consultants etc, all turned towards the jet engine in the back row, the junior doctor having to wake you up???:zzzzz :imbar Know this is a bit off topic, but just shows , things can go the other way!
    MERRY CHRISTMAS AND ALL THE BEST FOR 2007!!!
    Last edit by danissa on Dec 23, '06
  13. by   BertinaRN
    RNLou,
    Wonderful information. I too am a pt that woke during my foot surgery, after reading your information I now understand why. I will say even though conscious sedation( based on your writing and the fact I had no ET tube) is what I was under the anesthesiologist was still surprised when I woke and asked if I could watch what they were doing...needless to say, they put me back out quick after that. The Dr. also told me that I would need to tell any future anesthesiologists what happened, which I have done, I have a had a few more surgeries, and that has never happened to me again.
    Have a Great Day,
    Bertina (SN second semester)

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