I woke up during surgery, Have you? - page 6
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
Dec 7, '06Specialty: med/surg, telemetry, IV therapy, mgmt ; Joined: May '05; Posts: 15,027; Likes: 8,983Quote from SMARTY_RNIt may not be due to "bad anesthesia", but when I woke up during a major surgery that was being performed on me it was extremely painful, very emotional and something that I've never been able to forget. I KNOW I woke up during the surgery. I felt the doctor working in the incision and heard what was going on in the room. I hope your post wasn't to say that those of us that this happened to were dreaming from the drugs because that just isn't so!I work in surgery and it is not bad anesthesia if the patient briefly awakens. I have only seen that happen once and it was because the patient was very sick so the anesthesiologist was very careful with the amount of drugs given, all he did was give more to solve the problem. The patient did not completely awaken and sit up on the table, he just started slightly moving. Some patients remember seeing the surgical lights after they wake up and they believe that they woke up during surgery............
Dec 7, '06Occupation: med-surg faculty Specialty: icu, neuro icu, nursing ed ; Joined: Apr '06; Posts: 69; Likes: 4i woke up during surgery. was intubated. unable to move (probably pavulon), eyes open just a slit and covered with ointment -- so everything was blurry but i was aware of light. could hear every word of their conversation. tried to take a breath and couldn't. tried to move fingers and hand but couldn't. being an RN, i figured out what was happening -- but i'm not sure i would want to be a lay person experiencing that!
Dec 8, '06Joined: Mar '03; Posts: 161; Likes: 12Quote from SMARTY_RNJust because you've only seen it once doesn't mean that it doesn't happen more frequently, as the 60+ ppl that have posted here can attest to. No, perhaps not all occurences happened during a general, as in my case, but still happened all the same. I was not sick to where the anesthesiologist would have perhaps been inclined to give me a lighter dosage. I remember seeing the surgical lights because I woke up DURING my surgery. I don't "believe" I woke up during surgery, I DID wake up! My anesthesiologists confirmed that it happened. They were the ones, in fact, who told me I was trying to get up off the table, and trying to pull on things, which I did not recall. The surgical lights I seen, the excrutiating pain I felt, the sounds I heard, and the traumatic aftermath were/are also very real!I work in surgery and it is not bad anesthesia if the patient briefly awakens. I have only seen that happen once and it was because the patient was very sick so the anesthesiologist was very careful with the amount of drugs given, all he did was give more to solve the problem. The patient did not completely awaken and sit up on the table, he just started slightly moving. Some patients remember seeing the surgical lights after they wake up and they believe that they woke up during surgery............
Dec 8, '06Occupation: RN Specialty: 14 year(s) of experience in Medical ; Joined: Sep '06; Posts: 15; Likes: 5A very old Aunty of mine (now passed) had a GA for a knee arthroscopy. She was fit and healthy, a real bright spark. After her surgery she complained that she felt pain and could hear the Dr's and Nurse's talking during the surgery. She tried to tell them what was going on but she couldn't move. She said the Dr was talking about his overseas holiday that was coming up. To be honest no one really belived her (I was about 10 years old at the time and didn't really understand what she was talking about) and the family kind of brushed it off telling her she just had a dream. Imagine the families suprise when they found out she would have to see another Dr for follow up as her's was on an oversees holiday. She talked about other things she had heard and one of her daughters tried to get some answers but she was brushed off. She was told 'your Mums getting old and confused, she neither heard nor felt anything'.
She lost her spark after that and never fully recovered from the surgery. I was only young but I was terrified of having surgery in case I woke up or felt pain. I can't imagine the horror of realising what was happening to you during surgery. Nor can I imagine going thru that and having no one believe you.
Aunty died a year or so after the surgery, but she was never the same person again. She became a very frail and frightened old lady.
I hope that anyone who has been thru something like this has been able to get good counselling, that they feel like they have been listened to and that someone validates what they have gone thru. Nothing anyone says can erase the experience some of you have had, but I hope you have been able to work thru it with love and support from your family and friends.
Dec 8, '06Occupation: RN Specialty: 2 year(s) of experience in ICU ; Joined: Sep '06; Posts: 1I woke up during rhinoplasty and chin augmentation when I was 16 years old. I did not feel a thing I remember forcing my eyes open and asking how it looked then it was lights out!
Dec 8, '06Occupation: RN Specialty: 3 year(s) of experience in Critical Care ; Joined: Jul '06; Posts: 7; Likes: 3I am one of the fortunate ones who have woken up during surgery, but it was no big deal. I was under conscious sedation (propofol and I don't know what else) versus GA for a bunionectomy. I remember kind of sitting up and saying "That hurts!". The anesthetist asked what and I said "my foot!". Then boom, I was gone again.
That was my left foot. I told the anesthetist about it prior to getting the R foot done and it did not happen again. Sounds like CS is the route to go whenever possible (obviously not during CABG or such!!)
ps - i was also awake during tooth extraction as a child (10yo, in 1978). i have no idea what i was under with then. that was terrifying. i was told i'd be out.
Dec 8, '06Joined: Nov '06; Posts: 15Some people are just so noisy! LoL
No seriously that is scary.
Dec 10, '06Occupation: RN - Currently ICU Specialty: Anaesthetics/PACU/Perioperative/ICU ; Joined: Apr '06; Posts: 3; Likes: 1Hello all.
This is my first post on allnurses though been reading for awhile. I've been an anaesthetic nurse (now in ICU for awhile) for several years (in Oz it's not the same as a CRNA, but we're like the scrub nurse is to the surgeon - and then some).
The incidence of awareness under anaesthetic is actually fairly high (something like 1 in 25000) but mostly (and admittedly not exclusively) limited to three types of surgery - trauma (loss of blood due to massive haemorrhage takes the drugs into third space loss and disrupts first pass metabolism, in addition to all the other metabolic disturbances), general anaesthetic cesaerean sections (gotta keep the doses light so you don't anaesthetise the baby as most drugs cross the placenta - usually ok from breast milk if surgery post delivery as long as first feed is expressed
post GA) and cardiac surgery (due to most of the surgery being run on something like a high dose larazepam (long acting benzodiazepine like a souped up midazolam) premed and fentanyl (synthetic opioid narcotic 1000 times stronger than morphine - not sure what its called in the US). Cardiac surgery is done this way because the other maintenance drugs we use (both inhalational and IV) are useless in the face of the cardioperfusion bypass machine - sort of ventilator/heart pump/metabolic dialysis machine.
Now the good news - the chances of have awareness in any other surgery is, nowadays, pretty low. We've got a new monitor that measures the pt's level of consciousness - something we just couldn't do until recently. We could infer by other parameters, but as has been pointed out - we're giving you drugs to cease (or sometimes just lower) respiration, lower heart rate and BP, so how much of that is actually lowering you're consciousness? There's the problem. We also based doses for inhalational agents on MAC, (mean alvoeolar concentration) which essentially is the concentration of the agent at the alveolus (also inferred) and based on the idea that 50% of patients had no reaction to surgical stimuli (in studies) therfore, at this dose the pt is probably asleep.
Strangely, one of the main drivers for the use of this monitor is to reduce the cost of drugs administered to pt's under anaesthesia. It was found that a goodly percentage of practitioners actually gave higher doses than they needed to - this increased drug costs, PACU time and ultimately length of stay.
'Course, any reason to institute widespread practice of this monitor is a good one, given its obvious benefits at reducing the incidence of this traumatic experience. The tip is it'll probably be compulsary in a few years, a bit like those pulse oximeters everyone said couldn't be trusted or wouldn't last.
Won't take up much more time because it's a big subject, and this is only an insight into some of the issues involved - how does it happen, should we admit it (yes we should), when is it negligence, etc.
Thanks for reading.
Dec 10, '06Joined: Dec '05; Posts: 1,375; Likes: 248Meistersister- Thank you for your very imformative response. Has the manufacturer of the consciousness monitor shared how they determine the levels? I am a first year student and was observing in the OR Friday and the CRNA was explaining that the manufacturer does not divulge just how this monitor works, just what the numbers are supposed to mean. She also stated that she has had pts sit bolt upright at 30 at times so it is not completely accurate.
Dec 10, '06Occupation: RN - Currently ICU Specialty: Anaesthetics/PACU/Perioperative/ICU ; Joined: Apr '06; Posts: 3; Likes: 1Hey there.
As I wrote in my post I'm not a CRNA either (we don't have them in Australia) so I envy you your career choice - it's the next step for me but I'd have to move overseas, so I've moved sideways instead.
My understanding of the BiS (stands for BiSpectral Index according to the manufacturer Aspect) monitor is that they took EEG recordings of a huge (76000 was one figure I've heard used) number of US marines undergoing surgery. They then analysed these with to find common elements or complexes in particular waves at certain points in the anaesthesia (there are textbooks that will still demonstrate the "planes" of anaesthesia - it used to be a recognised thing clinically, by now is more idealised as the drug the planes are based on was thiopentone (?or halothane) neither of which is used anymore. (You'll still find thiopentone in rare circumstances - propofol is the thing now).
Anyway, the planes deliniate certain characteristics of an anaesthetised pt. and as such if they could identify and design an algorithm to cheaply and easily sort out the mess of an EEG into a usuable graded number, well, that'd be worth something.
That's essentially the story, it does exactly that and since it Aspect put it on the market Datex Ohmeda have come up with a simpler and cheaper (no liscence fees for the algorithm) version that uses mathematics (chaos theory) to do the same thing (their's is called entropy).
Both use a four sensor arrangement to capture a simplified EEG and conduction of impulses along the facial nerve.
The end result is a number between 1 and 100, under 40 is unconscious, 100 is fully awake, and 0 is deceased, though I've seen a few 0's in my time that aren't, so reliability can still be an issue. Remember with all monitors, treat the patient, not the number.
Hope this helps
Dec 10, '06Specialty: OB, HH, ADMIN, IC, ED, QI ; From: US ; Joined: Jun '06; Posts: 2,340; Likes: 2,045In 1974, during my breast lump biopsy (in those days, a frozen section of tissue was done quickly while the patient was anaesthetized. I'd told my surgeon before surgery and signed to go ahead with the modified radical mastectomy if cancer cells were seen).
However, I really couldn't conceive of having a mastectomy in that small community hospital where the biopsy was done, and remember my, and my surgeon's surprise when he exclaimed "It is!", while I was on the table. I felt no pain, however, or any emotional reaction like sadness.
When I awoke in the Recovery Room and felt the big bandage, I realized that it had happened. When I told my surgeon the above, he said, "You could hear that?" confirming my recall.
Of course, hearing is the sense that is lost last at death, and being anaesthetized is as close to that as you can come, and live. I saw the movie "The Doctor" after that, and recommended that it become required on all medical school curricula, as it outlines patients' need to have medical professionals use their knowledge of patients' awareness while unconscious, of what is said. Hopefully it curbed the crass telling of "dirty" jokes and nasty comments, thrown instruments, etc. that occurred in O.R.s when I worked there.
Lois Klein, R.N., P.H.N.
Dec 10, '06Occupation: Staff RN Specialty: 5 year(s) of experience in Telemetry, Med/Surg, Infusion ; From: US ; Joined: May '06; Posts: 254; Likes: 164As a first semester student, we recently had our perioperative lectures. Isn't one of the meds given in a general anesthetic mixture an amnesiac? Wouldn't this be important in cases as another poster suggested PTSD?
Myself, the GI doc who did both my colonoscopy forgot the amnesiac. It wasn't painful or anything, but kinda cool to watch! The EGD was another story, where's halcion when you want it! He kept saying, "No, don't cough."
Dec 14, '06Joined: Mar '03; Posts: 161; Likes: 12siri - i wanted to thank you for the article/links that you posted. i finally had the chance to read through all of them. they were all great articles, i found them very informative.
mistersister - i wanted to thank you as well. the information you gave was also very informative. i appreciate you sharing your knowledge.
i am definately now more informed about what to discuss with my anesthesiologists for future surgeries that i may need. i had no idea that there was such a thing as the consciousness monitor. i have written out a list of questions that i gathered from the resources provided. i will certainly utilize it in the future to better inform myself preop, and hopefully calm the anxieties that i'm sure i'll have. you can learn something new here everyday, that's what i love about this site! thanks again
as i said before, i am amazed to find out just how many ppl have experienced this type of thing. it can be very traumatizing. some of you had experiences much worse than mine. i truly hope that you have been able to work through everything and will have no lasting effects. thanks for sharing your stories.
go gators!! sec champions!!
national championship bowl bound!!Last edit by GatorRN on Dec 14, '06