Waking up in the OR

[Kidrn911]

When my daughter was 5 years old, she had a T&A. From the time of her surgery to now (8 years later) she insists she woke up during the procedure. I always tried to pass it off as nothing. I would tell her it was probably the very beginning of the surgery when they would roll you in the OR and then start sedation.

Now that she is older she adamantly insists that she was asleep and when she woke up she seen them in their garb and scalpels in hand, They told her it was okay and to go back to sleep.

They never told me after the surgery she woke up. I never asked, really thinking my daughter was confused. It doesn't appear she suffered any mental anguish or anything. She just states it as fact. I believe her now, because she has been so consistent with her story for such a long time.

However, if she did wake up, shouldn't they had said something? I know that getting the right med combination can be tricky, I have done conscience sedation in pediatrics alot in the ER. However, for any future surgery this would be good to know and report off, so that it can be handled better in a more invasive case.

[MunoRN, RN]

Waking up during surgery does happen, I think it's usually called "anesthesia awareness". I used to get ear tubes about once a year or two when I was a kid. I had no idea that you weren't supposed to be fully aware of what was going on around you when under anesthesia, but I often was, and it really wasn't all that distressing. I had mentioned it once and it was dismissed as dreaming. It wasn't until the surgeon wigged out when I mentioned I liked the music he played, particularly "Cecilia" since my parents wouldn't let me listen to it, that I realized it wasn't normal. I remember him telling my mom he didn't see how that was possible since by the time Cecilia came on the 8-track or whatever he was playing he was well under way with surgery and I should have been completely out. I didn't feel any pain so it really didn't bother me. I don't know if that was why, but when I was older they started using ketamine, which was way worse, I remember as it was wearing off I would see people but their facial features weren't defined, that still freaks me out.

Here's what everyone looks like to me when coming off of ketamine:

[catman88]

I work as an ophthalmic tech and we have had patients wake up during surgery and tell us the next day that they recall certain things that the Dr said, or things that they saw. When I have had opportunities to shadow, I have seen patients "wake up" during surgery...I put that in quotations only because they are (obviously) quite groggy and don't always know what's happening. I don't believe that we typically report it, but I am sure for the patient it is a much bigger deal than it is to us, speaking from my own experience only!

[Esme12, ASN, BSN, RN]

Anesthesia awareness is a known occurrence that is rare but probably under reported because it isn't talked about outside the OR suite

[h=2]Anesthetic Awareness[/h] Patient awareness under general anesthesia (or anesthetic awareness) is a rare experience that occurs when surgical patients can recall their surroundings or an event – sometimes even pressure or pain –related to their surgery while they were under general anesthesia. In some cases patients may suffer from post-traumatic stress disorder following an awareness experience. While severe cases of anesthetic awareness are uncommon, research is ongoing to determine the causes of awareness and ways to prevent it from happening.

Anesthetic Awareness Fact Sheet

Patient Awareness Brochure (PDF)

Although awareness under general anesthesia is rare, this brochure was created by the American Association of Nurse Anesthetists, the American Academy of Anesthesiologist Assistants, and the American Society of Anesthesiologists to explain this phenomenon, address questions patients may have, and assist patients in communicating with their anesthesia provider.

Anesthetic Awareness

[xoemmylouox, ASN, RN]

I broke my arm when I was 5. I can remember waking up during surgery when they were placing pins. At this point I don't remember much detail at this point just bright lights and being in an uncomfortable position. Then I was out again. Did I actually wake up.. I don't know. Just thought it was so awesome as a kid to have metal holding my elbow together :)

[Horseshoe, BSN, RN]

I'm going to have an endoscopy in a few weeks. I told the gi that I was really anxious about it because the last one was terrible. I felt everything. I was gagging so hard tears were streaming from my eyes. The doc started yelling at me to stop gagging. ("If you don't stop gagging I'm not going to be able to finish this procedure!"--direct quote) She reassured me that this time I would be properly sedated.

I know it sounds minor, just an endo, but I still remember that terrifying feeling of choking and being screamed at. It was almost ten years ago, and it still shakes me up

I work at an endoscopy center. Years ago, RNs worked the rooms, giving conscious sedation. Now, we use CRNAs to give general anesthesia. Done properly, patients do NOT wake up during procedures. If they even begin to stir, the CRNA immediately adjusts the medication to prevent waking. I have not had even one patient who told me she woke up during an endoscopy while receiving propofol, and I've worked there over 2.5 years.

I don't blame you for gagging and choking and your doctor was being a big fat jerk to suggest you could actually control that. Put a hose down her throat and see if she gags!

[chrisrn24]

I work as an ophthalmic tech and we have had patients wake up during surgery and tell us the next day that they recall certain things that the Dr said or things that they saw. When I have had opportunities to shadow, I have seen patients "wake up" during surgery...I put that in quotations only because they are (obviously) quite groggy and don't always know what's happening. I don't believe that we typically report it, but I am sure for the patient it is a much bigger deal than it is to us, speaking from my own experience only![/quote']

During my OR rotation in nursing school this happened too but as soon as it was noticed they got more sedation.

[JoseQuinones]

I had oral surgery done last year and I remember very clearly waking up in the middle of the surgery. I saw the light, I saw their faces, and I tasted my mouth full of blood. I tried to yell or move, but nothing much happened. I wasn't scared so much as annoyed. Then it seemed five seconds later they were tapping my arm and telling me to wake up. It happens, but I wouldn't say it was particularly traumatic.

[OCNRN63, RN]

I work at an endoscopy center. Years ago, RNs worked the rooms, giving conscious sedation. Now, we use CRNAs to give general anesthesia. Done properly, patients do NOT wake up during procedures. If they even begin to stir, the CRNA immediately adjusts the medication to prevent waking. I have not had even one patient who told me she woke up during an endoscopy while receiving propofol, and I've worked there over 2.5 years.

I don't blame you for gagging and choking and your doctor was being a big fat jerk to suggest you could actually control that. Put a hose down her throat and see if she gags!

The previous doc was a man. This new doc was very nice and assured me she would give me propofol.

The last time I was given Demerol and Valium. Ridiculous. Thanks for your post!

[SwansonRN]

When we do conscious sedation at the bedside I've had a few patients who were difficult to sedate, especially during EGDs. I feel like the GI docs are too focused on the task at hand to notice that the patients eyes are wide open and they're gagging/tearing. I always have to stop them and ask for more drugs. Can you imagine how awful that must be? Luckily with the versed the patients don't remember it, but I do tell them what happened after all is said and done.

[IrishIzCPNP, MSN, RN, APRN, NP]

The previous doc was a man. This new doc was very nice and assured me she would give me propofol.

The last time I was given Demerol and Valium. Ridiculous. Thanks for your post!

I woke up during a colonoscopy. I now always get propofol. When I woke up all I could say was "owe".

[shodobe]

Anesthesia Awareness is the real deal. I researched it in depth a few years back so I could give a inservice on it to the OR staff. Interesting subject.

[nurseprnRN, BSN, RN]

I read a recent paper of this linking it to PTSD, which is quite understandable. Apparently some people are not as susceptible to the sedation parts of the anesthesia agent armamentarium, and remember their open heart and other major surgeries quite clearly, quoting conversations they heard in the OR, the music played, the pain and tearing/pushing/pulling sensations, and so forth. There have been attempts to recognize this during anesthesia, with variable results. This is an excellent article that explains it in terms of anesthesia principles, discusses the technology, and gives a number of patient descriptions.

Here's a brief excerpt: "This experience is called “intraoperative recall” or “anesthesia awareness,” and it’s more common than you might think. Although studies diverge, most experts estimate that for every 1,000 patients who undergo general anesthesia each year in the United States, one to two will experience awareness. Patients who awake hear surgeons’ small talk, the swish and stretch of organs, the suctioning of blood; they feel the probing of fingers, the yanks and tugs on innards; they smell cauterized flesh and singed hair. But because one of the first steps of surgery is to tape patients’ eyes shut, they can’t see. And because another common step is to paralyze patients to prevent muscle twitching, they have no way to alert doctors that they are awake."

Awakening - Joshua Lang - The Atlantic