Does general anasthesia have any painkilling effects? Seems strange to me that people could wake up and feel everything. And yet can’t move even their eyes.
Given the extreme levels of pain and terror reported, how would their heartbeat not rise rapidly, something it would be impossible for the surgeon to not notice?
One thing I’ve read is that the amnesiac effect of general anasthesia is more powerful than it’s knockout effect. So many people can wake up during surgery and just not remember the experience. So two subquestions on this one:
a) Wouldn't reports be highly unreliable and possibly be false memories?
b) If you do wake up to someone rummaging around in your insides, but will forget it later, do you experience it as normal consciousness while you're awake, or due to the amnesiac effects do you forget what's going on from minute to minute? So the second after a cut is made you forget about it?
Don’t know about internal surgery but I had cataract surgery a year ago and during the first one I remember being told 3 or 4 times to stop moving my eye. The second one I don’t remember a thing. Guess the anesthesiologist dosed me a bit higher for the second so they didn’t have that problem again.
Don’t know about general anethesia, but some unpleasant procedures require the patient to be awake and alert. A friend had such a procedure many years ago, something to do with sticking instruments (medical, not musical) down his esophagus. They gave him a medication that was supposed to prevent transfer of information from short-term memory to long-term memory. Before the procedure began, the doctor was asking my friend questions, and my friend was suppose to indicate when he was hearing a question he’d been asked before. When he stopped noticing that one of the questions was a repeat, the doc knew the medication had taken effect, and the procedure could begin. My friend’s wife was there with him, and says that he was quite miserable during the procedure - but didn’t remember any of it after it was all done.
Drs are more aware now that you can wake up during surgery so they look for it. Also it turns out that there might be a genetic part of it , redheads have more of an issue with the drugs not working as well so if your hair is red they are really careful about knocking you out.
Correct me if I’m wrong but I doubt there have been many proper studies of “awareness under anethesia.”
When we are asleep our brains power our dreams, they relax us and I think they like give our body a full service … like seeking out faults and attempting to correct them.
So if our brains don’t totally shut down when we are asleep then they must be active when we are under anesthesia.
Then if a surgeon says something like: “This woman looks like she’s pregnant.”
And someone else goes: “No we checked she isn’t pregnant.”
And he goes: “I know that but I said she looks like she’s pregnant.”
Maybe when that woman comes out of the anesthesia, she might wonder why she all of a sudden feels she’s overweight or that she may be pregnant.
I’ve had 3 EGDs, all under ‘twilight sedation’. Like you said, you have to be able to work with the doc to get the camera down your throat. I’m a gagger and put it off for a good 10 years but finally decided I needed to take care of it. It was no different than when I had actual surgery under general anesthesia. They gave me a med and told me I’d start getting tired and then I was in the recovery room waking up.
The time disappeared. The doc may have been talking to me during the procedure…or he might have just knocked me out for a few seconds and send me a bill. I wouldn’t know the difference.
That is, of course, a trademark of Versed.
This might be slightly different but I’ve been aware during dental surgery (extraction and bone graft). I could feel what was being done to me but not as acutely as if I was wide awake. That makes me think there is also a pain killing agent in the anesthesia. I *felt *like I was making sounds but if I was, the rat bastard dentist ignored me. I couldn’t move any of my limbs, which I know happens during regular sleep paralysis but I swear on my cat, I was awake. Also, my feet hurt like hell, as if they were going to burst out of my shoes, Hulk style. Do anesthesia cause the feet to swell?
The volatile gases used for general anesthesia have a muscle relaxant effect, but are not paralytic. Specific paralytic drugs such as rocuronium are administered when needed for surgical reasons. Cases of awareness under anesthesia generally happen when a paralytic drug has been given, otherwise the patient would indeed move.
As far as painkilling effect, that’s sort of hard to quantify. At a normal anesthetic level, patients will be unconscious and not move in response to a painful stimulus such as a surgical incision, but will still have an autonomic response such as increased heart rate and blood pressure. It should be noted that brain-dead organ donors have similar autonomic responses.
The surgeon wouldn’t notice, because they are performing the surgery and not paying attention to the patient’s vital signs. That’s not their job. The anesthesiologist or nurse anesthetist would notice. This is why most cases of awareness under anesthesia happen during surgeries where the patient might have unstable vital signs for other reasons, and where it may be unsafe to administer sufficient doses - for example, trauma, cardiac, and emergency obstetric patients are at higher risk. Also as I said increased heart rate does not necessarily indicate awareness.
While this may be true, there are many different anesthetic drugs, some of which are more amnestic than others. Some reports may be false memories, or memory fragments from when the patient was starting to wake up. However there are certainly reliable confirmed reports of awareness under anesthesia.
Also, as I understand it, the amnestic effect of many drugs is not black and white. While you might not remember some mild discomfort, memories of an extreme trauma could still be retained.
Cataract surgeries are usually done under local anesthesia with the patient essentially awake, with just enough medication to keep them calm (and incidentally provide amnesia). Ophthalmologists often want patients to be able to follow commands and look in certain directions, etc. The usual approach to unwanted patient movement during that sort of situation is to give less sedation, not more, because more sedation will lead to further patient disinhibition.
I believe that more recent evidence debunks the so-called redhead effect.
Anesthesiologists are really careful about knocking anyone out.
Yes, you’re probably referring to the BIS monitor, which is a single number derived from EEG waves by a proprietary formula. It’s still debatable whether use of a BIS monitor does much to reduce awareness or post-operative recall. It is probably more helpful in reducing the administration of too much anesthesia, and therefor may be useful in reducing post operative delirium and cognitive dysfunction in the elderly. It’s far from universally used. Many hospitals don’t have it at all. Some use it for cardiac surgeries, and for surgeries where IV anesthetics have to be used, which are harder to titrate to a proper level.
No, there have been many studies, as mentioned. And there have been wildly differing results of how common this phenomenon is.
Being under anesthetic is a completely different neurologic state than being asleep.
That’s also very similar to the experience you would have had with propofol sedation, though in that case you would have actually been asleep.
Nitrous oxide is commonly used in dental surgery, and it is a potent analgesic but weak anesthetic. The vast majority of dental procedures under anesthesia are not under general anesthesia, so it’s not at all surprising you had some awareness and recall. Of course, this means that they almost certainly used local anesthetic, which is why you couldn’t feel it so acutely. In general, no, it shouldn’t cause your feet to swell.
Well, if you’re really actually unconscious no, you’re not feeling pain. But general anesthesia is not just one drug, it’s a mix of drugs. Some of them cause paralysis, but do not affect sensory perceptions. Thus, if the paralytic is still effective but something else has worn off yes, you can be awake and aware AND completely unable to move or communicate.
Unfortunately, my mother woke up during surgery once,
During open heart surgery. Which is consistent with what **Shmendrik **said about cardiac patients being at higher risk for this sort of thing than some other categories.
No one detected an elevated heart rate because, as she was on a heart-lung bypass machine and getting open heart surgery, her heart was in fact not beating at all.
Granted, this is an extremely rare event. These days patients are monitored differently, sometimes even with their brainwaves being monitored to detect whether their brain is a wake or safely in a medically-induced state of unconsciousness.
Reports of being awake during surgery do tend to be met with skepticism because yes, drugs can affect one’s memory.
My mother’s claim was met with extreme skepticism, but she was able to recall about 20 minutes worth of operating room events, including conversation, sufficiently to lend credence to her claim. In her case, memory was reliable and could be confirmed.
Again, this sort of event is extremely rare and more rare these days than in the past.
Depends on what drugs are in effect and what may have worn off.
For subsequent surgery, my mother would not give her consent for the operation until she was reassured that she would NOT remember any part of it, at all. They hit her pretty good with drugs that cause amnesia (along with everything else) and she lost about four months of her life, and she complained about that, too, but I think that was in part because she didn’t remember making that deal. She did say it was better than waking up during a triple bypass.
Some time ago, I had a noninvasive outpatient surgery that required general anesthesia. For about a week afterwards I had uncontrollable shaking, nausea and the dry heaves at night. When I told the surgeon about this, he said it was a reaction to the anesthesia.
So when I had a colonoscopy I told the anesthesiologist about it. He must have given me a lighter dose because I was awake during the entire procedure, feeling at times some pain, and listening to the anesthesiologist and the gastroenterologist joking around. Oddly though I couldn’t muster up the energy to say anything. I just lay there thinking, “This is really weird; I hope it won’t take very long.”
a) Some drugs are known to give rise to hallucinations, or ‘extraordinarily vivid false memories’. Other drugs are know to give rise to feelings of paranoia, or sexual feelings. Anesthetists avoid giving drugs like that, especially in combinations like that. They are trained to use drugs that mostly don’t have undesirable side effects.
b) Even when you have persisting memories, they are accessed as stories, linked to other thoughts and memories. As you know, you can find your way back into memories by doing something like walking back into the room (‘what was I going to get?’), or trying to remember what you were thinking about just before the dropped memory. If you have surgical memories, they may be linked to the experience of having surgery, and of being anaesthetized, and may be difficult to recover in any other context.
This is good information, I have a red haired friend who was going to have her hair dyed before surgery next month. I will tell her it is no longer necessary.
Versed is great stuff, at least in my experience. Doesn’t matter to me if there were disagreeable sensations during a colonoscopy if I can’t remember them.
About 10 years ago, I woke up for a few minutes during a open abdominal surgery to remove a tumor from my stomach. Fortunately it was found out to be benign.
It was during the stage they were waiting for the intra-op pathology. I could hear noises and talking in the operating room very clearly. Not about me. I could not open my eyes or move anything and was in sheer terror. I did not feel pain; probably because of opiates or something during the anesthesia - actually I didn’t feel much pain for a few hours after I woke up. I hoped my blood pressure or heart rate would shoot up enough to sound some alarm.
Fortunately, that finished with a cry of “He’s awakening !” and I remember nothing more of that episode.
The surgeon* said later - “Could be, but these cases are mostly post-op imaginations”. Seemed real enough to me, but what do I know ?
I think the reason for the whole episode was that the anesthesiologist didn’t really have time to talk to me prior to the operation, the whole schedule was late due to earlier procedures. She asked while being wheeled into the op-room if I took any medication.
*The surgeon was not in the op-theater during the wait for the pathology result; at least I could not hear his voice. He did not deny or affirm my story.
The thing is that I smoked like a chimney and drank maybe 15 espressos a day. My liver was detoxifying stuff very rapidly due to that, I later found out.
I don’t think I was long term traumatized by this episode; I did’t have any serious anesthesia since then - but even with light sedation for colonoscopy/gastroscopy in the following years I was always asked about nicotine/caffeine/alcohol consumption prior to the (Versed ? Propofol ?) sedation.
I recently had a procedure fine called RF Ablation. I have chronic pain from failed back surgery and to try and stop the pain the doc stuck a very large needle into my back and put it in contact with the nerve causing the pain. He then used radio frequency to burn the nerve and destroy it.
During the procedure the doc woke me up while the needle was touching the nerve to ask me if the nerve he was touching was in my back or my leg.
When I woke up I could not move, but they pain was unbelievable. So much so I started screaming (as much as one can while in a fog). He kept asking “back or leg” and I found it very difficult to speak, but managed to yell leg. A soon as I confirmed leg he put me back under. I definitely remember it and I sure as hell felt it. It was the worst and most intense pain I’ve ever felt.
Bottom line, I waa half under and half awake. I knew and felt what was happening, but couldn’t move. I’m here to tell you that touching a nerve is something you never want to experienced!
And sadly it seems the procedure waa a busy. No pain relief at all. Sigh.
Thanks for all the interesting info.