What it's like to wake up during surgery

allnurses Guide · Dec 5, 2014

What it's like to wake up during surgery
Read more at Stuff of nightmares: Waking up during surgery

Definition of awareness. Under general anesthesia, a patient is given medications intended to cause unconsciousness and relieve pain. If the medication to render the patient unconscious fails, awareness occurs. In other words, the patient wakes up, becomes aware of certain events occurring during the surgery, and may recall some or all of the events. Further, if the medication to relieve pain fails or is inadequate, the patient may feel pain while awake. Finally, cases involving general anesthesia often require the patient to be given medication intended to prevent movement. In very rare instances, the sleep and pain medications fail while the paralytic agent does not, making it virtually impossible for the patient to communicate this dire situation to the anesthesia providers.

Frequency of awareness. Anesthesia awareness occurs infrequently, and the duration and severity vary. Patients may or may not feel pain. Some patients experience a feeling of pressure. It has been estimated that roughly one patient per thousand receiving general anesthesia experiences some level of awareness, usually fleeting. It is important for patients to understand that severe awareness experiences are highly unusual.

Patients should NOT be afraid! The remote possibility of experiencing awareness should not deter patients from having needed surgery. The plain truth of the matter is this: Modern surgery is only possible through the miracle of anesthesia.

Anesthesia safety. Anesthesia today is safer than it has ever been due to advances in technology and pharmacology, as well as more stringent practice standards and educational requirements for anesthesia providers. A 1999 report by the Institute of Medicine titled "To Err is Human" indicated that anesthesia is nearly 50 times safer than it was in the early 1980s.

Certified Registered Nurse Anesthetists (CRNAs). These advanced practice nurses are anesthesia professionals who safely administer approximately 32 million anesthetics each year. CRNAs provide anesthesia care for all types of surgeries and other procedures, including open heart and transplants.

CRNAs: At your side, on your side. CRNAs are hands-on caregivers who take pride in advocating for their patients. They stay with their patients throughout their surgeries, diligently monitoring their vital signs and adjusting their anesthetics as needed.

Causes of awareness. Despite the dramatic improvements in the quality of today’s anesthesia care, awareness during general anesthesia can still occur for a variety of reasons. Common causes of anesthesia awareness are inadequate anesthesia and equipment failure or misuse.

High-risk surgeries. In some high-risk surgeries such as cardiac, trauma, and emergency cesarean deliveries, using a deep anesthetic may not be in the best interest of the patient. In these and other critical or emergency situations, awareness might not be completely avoidable.

Lasting impact. A minority of patients who experience anesthesia awareness may develop posttraumatic stress disorder (PTSD), which is associated with repetitive nightmares, anxiety, irritability, and preoccupation with death.

Preventing awareness. Research into the causes and prevention of anesthesia awareness is ongoing. Anesthesia providers combine their clinical judgment with the use of different monitoring technologies to ensure that their patients are unconscious and pain-free during surgery. Brain monitoring devices can be used to measure depth of consciousness, and are available in the majority of hospitals across the United States. Studies have shown that these monitors can help anesthesia providers further reduce the risk of awareness, although they alone are not a guarantee of preventing awareness.

Patient/anesthesia provider communication—before surgery. Patients should have the opportunity to meet with their anesthesia provider before surgery to discuss the remote possibility of awareness, the approach to anesthesia that will be used, how they will be monitored during surgery, if the anesthesia provider they are meeting with will be the anesthesia provider who stays with them during surgery, and any other concerns they might have. It is important for patients to be honest about medications (including herbal supplements) they are taking, alcohol and drug consumption, physical conditions, and other factors that could influence their body’s reaction to anesthesia.

Patient/anesthesia provider communication—after surgery. Patients who believe they have experienced anesthesia awareness should be encouraged to discuss their experience and their feelings about the experience with their anesthesia provider.

"Awake" movie. "Awake" is fictional entertainment that exploits anesthetic awareness as a plot device. Viewers should remember that while patient awareness under general anesthesia does occur, severe cases such as the one depicted in "Awake" are highly unusual.

Anesthetic Awareness Fact Sheet

Awareness During Anaesthesia

The second article also explains some of the different levels of awareness under general anesthesia. Explicit awareness is what the news article is referring to.

The brain monitors/BIS has not shown to decrease awareness. I think the biggest reason for this is that these systems only monitor frontal lobe activity when the part of the brain that controls awakening is actually in reticular activating system located in the brainstem. Reticular activating system - Wikipedia, the free encyclopedia

TeacupPom · Dec 6, 2014

I've always had a tolerance to anesthesia. I woke up once...sat straight up however, it wasn't noticed right away. Here's what I experienced. The thing I remember the most is seeing those bright OR lights and seeing people in crinkly, blue, paper outfits. Now, I get these flashbacks whenever I am hooked up to the anesthesia; or see anyone in that classic "surgery blue."

allnurses Guide · Dec 6, 2014

I've always had a tolerance to anesthesia. I woke up once...sat straight up however, it wasn't noticed right away. Here's what I experienced. The thing I remember the most is seeing those bright OR lights and seeing people in crinkly, blue, paper outfits. Now, I get these flashbacks whenever I am hooked up to the anesthesia; or see anyone in that classic "surgery blue."

As CRNA I hear these stories a lot, but I can tell from your story that 1. You probably were not under general anesthesia, which is one of the things that the article is talking about and is requirement for awareness under anesthesia, and 2. You did not have a muscle paralytic on board or you wouldn't have been able to sit up, which is the other problem with these anesthesia awareness situations.

People often remember coming into the OR and waking up in the OR after the surgery is complete, and assume that this vague recall was awareness. That is not a form of surgical awareness.

To have surgical awareness you have to:

1. Be having general anesthesia, which typically means you will need an LMA or ETT.

2. You have to be aware of the surgery or aware while the surgery is going on.

3. You almost always have to have had a muscle paralytic, because who the world would sit still while someone is cutting on them.

Everything that we give patients in anesthesia alters their perceptions. Some patients have vivid dreams while asleep, some patients don't remember anything for the rest of the day or longer, but anesthetic experience varies widely for every patient.

sallyrnrrt, ADN, RN · Dec 7, 2014

i have significant tollerance, and have awaken twice.....

both times due to malfunctioned, iv.....

first time, attempted setting up, saw mayo, bloody sponges, and some one said, "no sally we can do it" 1978.

in 2011, during total shoulder at begining of procedure, i tried getting up again as surgeon went to cut, had safety belt abraisons across chest, and multiple full hand bruises on legs..... i knew the particular anes., and knew he likes to induce with dilaudid, i tried explaining my tollerance, he chose to ignore........i will refuse him as a provider in future, and request CRNA

allnurses Guide · Dec 7, 2014

i have significant tollerance, and have awaken twice.....
both times due to malfunctioned, iv.....
first time, attempted setting up, saw mayo, bloody sponges, and some one said, "no sally we can do it" 1978.
in 2011, during total shoulder at begining of procedure, i tried getting up again as surgeon went to cut, had safety belt abraisons across chest, and multiple full hand bruises on legs..... i knew the particular anes., and knew he likes to induce with dilaudid, i tried explaining my tollerance, he chose to ignore........i will refuse him as a provider in future, and request CRNA

A lot of has changed since 1978.

I don't know of any anesthesia provider that would induce with a narcotic for shoulder arthroscopy.

I would recommend bringing your entire anesthesia records next time you go for surgery for anyone that has had trouble with their anesthetic in the past.

jwk · Dec 8, 2014

i have significant tollerance, and have awaken twice.....
both times due to malfunctioned, iv.....
first time, attempted setting up, saw mayo, bloody sponges, and some one said, "no sally we can do it" 1978.
in 2011, during total shoulder at begining of procedure, i tried getting up again as surgeon went to cut, had safety belt abraisons across chest, and multiple full hand bruises on legs..... i knew the particular anes., and knew he likes to induce with dilaudid, i tried explaining my tollerance, he chose to ignore........i will refuse him as a provider in future, and request CRNA

??? Induced with dilaudid? Hmm, I don't think so.

jwk · Dec 8, 2014

??? Induced with dilaudid? Hmm, I don't think so.

Sorry, hit the wrong button too quickly.

As already noted by two of us, nobody induces anesthesia with Dilaudid. There's more to your story.

Patients don't have a "tolerance" to anesthesia. Some certainly require more (or less) agent or drugs than others, but one doesn't develop a "tolerance" to anesthesia in the way one might do so with narcotics or benzodiazepines or other drugs. WTB is right - a lot has changed since 1978. I have patients tell me all the time they're "hard to put to sleep". It doesn't matter - I always have enough of whatever I need to keep every patient adequately anesthetized. I joke with patients all the time that "I never lose".

Is it possible you woke up in the middle of your procedure? Yes, but it's highly unlikely. Your description from 1978 sounds like it could just as easily have occurred at the completion of the procedure. When patients awaken, they are often disoriented for a few minutes. I always talk to my patients as they awaken and tell them "you're waking up - we're all done with your surgery".

I don't know what to make of your second experience - the "induce with dilaudid" comment IMHO indicates you don't really know what happened or why.

Dielsh · Dec 17, 2014

I am a practicing CRNA. I have awareness under anesthesia for one of my surgeries. Nothing was done wrong. I probably had undiagnosed hypertension. When the gas was turned down for my subsequent low BP after induction is when I has the awareness. I was given a lot of narcotics so I had no pain, just pressure with the surgery. I was paralyzed and knew it would take about 40 minutes for the paralytic to wear off. I eventually stared to tap my fingers( I was prone). I had nightmares for about 6 months. Other than the nightmares, nothing lasting. My best friend had done my anesthesia and she was more upset than I was. I have had surgeries after without incident

allnurses Guide · Dec 17, 2014

I am a practicing CRNA. I have awareness under anesthesia for one of my surgeries. Nothing was done wrong. I probably had undiagnosed hypertension. When the gas was turned down for my subsequent low BP after induction is when I has the awareness. I was given a lot of narcotics so I had no pain, just pressure with the surgery. I was paralyzed and knew it would take about 40 minutes for the paralytic to wear off. I eventually stared to tap my fingers( I was prone). I had nightmares for about 6 months. Other than the nightmares, nothing lasting. My best friend had done my anesthesia and she was more upset than I was. I have had surgeries after without incident

It would be interesting to know what the end tidal on the volatile agent was when this happened.

sallyrnrrt, ADN, RN · Dec 17, 2014

wtbcrna, the shoulder replacement surgery was 2011, it was a MD Anes.........

'78 was brest implant exchange, sorta crude anes :)

sallyrnrrt, ADN, RN · Dec 17, 2014

this guy regularly induces with 2-4mg dilaudid....honest.......i am a critical care nurse, seen him requestcmany times........that is why i made a big deal re opiate induction not ideal.........i have unfortunately had a lot of ortho surg, only problem with this guy.....most in my area use "magic milk" :)