Some outpatient medical procedures will use a form of sedation called twilight sedation where the patient is not totally put under. The patient will be awake, but may not feel pain and may not form memories during that time. When the sedation wears off, the patient will not have any memories of the procedure. However, while the sedation is wearing off, the patient may feel like everything is normal and not realize they won’t remember what is happening because their ability to form long-term memories is not fully restored. So I was wondering, is there something the patient can do to be aware that they won’t remember what is happening?
When I had twilight sedation, I have vague memories of being in the recovery room and nurses and the doctor telling me things, but I have no memory of what they actually said. I vaguely remember feeling fine and thinking that the sedation had worn off, but now looking back I realize my ability to form memories still wasn’t working. I wish I had known that memories weren’t forming so I could tell the medical staff that I wasn’t going to remember anything and they should write everything down.
So basically, what can a person do when they’re coming out of twilight sedation to know they still aren’t 100%? For example, have a note that says “Look at a card from the deck, look away for 1 minute, then try to remember the card”. What are some things I could have done to know that my memory was still affected?
I was conscious. I remember thinking I was okay. I have vague memories of getting my backpack, reading a book, looking at my phone. I still had my long term memory, but I just couldn’t form any new memories. So if I had put instructions in my backpack, I think I would have remembered to look at them just like I remembered I had brought a book for the recovery room.
There’s no way to tell that your memories aren’t going into long term storage. I’ve had two experiences with long term memory failure. One was after a concussion and the other was anesthesia related. It’s like that time was just snipped away.
I’m guessing that the hospital staff also can’t tell if your memories are going into storage or not. The day and a half that I lost after the concussion surprised my parents, and they were worried and watching closely. From my perspective, I was suddenly in a hospital bed and asked if I had fallen asleep in the elevator, because entering the hospital elevator was the last thing I remembered and it felt like it had just happened. They were puzzled because the elevator had been more than a day ago. They told me things I had talked about since the elevator, but none of it was there.
Hospitals really should give any instructions for after anesthesia in writing. And if there’s a friend or family member there to give the patient a ride and some aftercare, they should be given the instructions, too. And not just because the memories might not stick. I’m not sure what they gave me when they removed my wisdom teeth, but they really should have given the instructions to my husband, who was my required ride home.
There was a snip-out of memory during the surgery, which didn’t affect me following the instructions. But somewhere along the way they gave me something that didn’t ease the pain, but that made me not care about it. As I was leaving, and getting instructions about ice packs as soon as I got home, I was smiling and nodding. I took the instruction card and put it into my jacket pocket. I guess my husband was bringing the car around at the time. I didn’t care.
We got home. It still hurt. I probably knew that the instructions were in my jacket. I didn’t care about the pain or the instructions. I decided to take a nap in the recliner and woke up the next day. Good thing there was no swelling. By the time I woke up, the window for the ice packs had closed.
Wow. This is weird. I just found an instruction sheet for aftercare when I had an operation on my hand. I do not remember getting the sheet or anyone talking me through the instructions. Like you, the ice bags for swelling was up on line 2 after do not get the stitches wet. I instinctively knew these things. At the time I was kinda put out that they didn’t explain bandage changing or should I change it at all. It was all right there on the sheet. Hmmm? Seems like there should be a better way. Mr.Wrekker was there but he was basically useless, except for moral support and driving:)
When the lil’wrekker has had procedures the pediatrician office called the next day to ask about her. That seems like a good idea.
Nowadays, maybe they should also text you the instructions. Or maybe every two hours send: Are you awake enough to read and follow the instructions yet? Y or N.
For some people I’d swear that opening texts at the ping has mapped in strongly enough to be muscle memory. When they’re no longer in an altered state of consciousness, they can read and respond.
Huh. I went into ‘Twilight’ for cataract surgery. I remember the docs talking football, but then nothing, and waking up back in recovery. My Wife was there to ask any questions I might miss. But I remember it well and I was given plenty of instructions before hand.
Then, we went out to lunch. I had a cheeseburger at Cheesecake Factory that could have been better.
One of the reasons I knew there were memory gaps is because I had no memory of what I read in my book while I was in recovery. When I went to read it the next day, it was like someone had just moved my bookmark forward by several pages. I had vague memories of reading the book, but none of what I read made it into my memory.
I was supposed to have twilight anesthesia for one of my eye surgeries, but…
There I am on the table, eye paralyzed, and Dr. Eyegouger starts cutting. At the same time, he is chatting about apps on his phone with the surgical assistant. I bellowed “Pay attention to what you’re doing, dammit!” He said to the anesthesiologist “I think he needs a little more” and that’s the last thing I remember until the recovery room.
Assuming that twilight sedation is what they call it when you’re given a sedative that induces amnesia, it’s quite strange.
Basically it’s like you blink and you’re awake and aware somewhere else. My experience was with a sedative called Versed that does induce amnesia.
Prior to a knee surgery about 30 years ago, I was sitting upright on the gurney chatting with the nurse who said that she was going to administer the Versed. I told her that I knew about it- it had been used as an interrogation tool in the Tom Clancy novel Cardinal of the Kremlin, and that I probably wouldn’t remember anything for a while after I had it.
Sure enough, she put it in the IV, and literally the next thing I knew I was in the post-op recovery room swaddled like a baby. Very disorienting, and I knew that it was going to happen, and afterward, what had happened. I even asked her later how much longer I had been awake- it was another half-hour or so.
I’ve always wondered about the amnestic effects pre-op. The first time I had surgery was for my nose, back in 1989. I was wide awake when they took me into the OR, in fact helped transfer myself to the operating table. Then they gave me the happy juice, and the room tilted, and next thing I knew I was in recovery .
When I had my gallbladder yanked in 2010, and wrist surgery earlier this year, they gave me the happy juice in the preop area (for the wrist, it was when they moved me to a different area to administer the regional block). I have no memory of the regional block from that occasion, or the transfer to the OR (either time) - but I assume I must have been “awake” enough to assist both times. I hope I didn’t misbehave or say anything mean either time :eek: (a friend was having a procedure, and her husband was still with her when she got the goodies, and she denies ANY memory of giving him a rather passionate goodbye!!).
So far when I’ve come out of “just” sedation, I’ve always been aware enough that I start forming memories. Probably not as crisply as if I didn’t have the meds, and it’s useful to have the instructions written down - but frankly the fact that they give out post-op instructions to a patient at ALL without a witness present is mind-boggling. When a friend had a colonoscopy recently, I was there afterward - and she definitely did not catch all the details (I had to remind her of her f/u instructions - fortunately written down).
I had twilight sedation for the first time earlier this year, and I never expected it to be as (seemingly) sudden a change from thinking “Oh I guess they’ve just pushed the IV into my left arm, I think I’ll turn to my right and see what’s going on there” to “Hey someone’s pushing my bed into a recovery area.”
I was so nervous about the surgery (more for the reason for it–turned out okay!) that I didn’t do what I’d wanted to do… though I don’t know if this would’ve been allowed:
Since people had told me that I would be partially conscious and might even react to questions, even though I wouldn’t remember it afterword, I wondered if I’d be permitted to take in one of those small 3x5 spiral notebooks and write my experience down. I thought it’d be a kick to see my own writing afterwards and have no memory whatsoever of it.
Would this be kosher, or is it too non-sterile or whatever? (My operation was nowhere near my upper body so it wouldn’t have disturbed the activity going on down under, so to speak.)
Funny thing is? I actually have nostalgia for that waking-up and recovery time. For about an hour I was just being taken care of, I felt safe, I had no pain–okay maybe very very minor soreness, but negligible–and had no immediate worries because the docs/nurses/orderlies were super-nice and attentive. Plus, apple juice and graham crackers!
OMG, now I know why I’m so nostalgic for it: it was just like nap time in Kindergarten!
Anyway: would my pen-and-notepad idea have been okay? Even if my handwriting turned into scrawled letters as I drifted further into twilight, that would’ve been creepy/eerie in a cool way as well.