Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Waking up during surgery

mosaicscience.com

Post reply on HN
Print view View original

21–30 of 44 posts

Re: Waking up during surgery

#21

Post by JshWright »

zoba wrote: post #6

Wouldn't your heart rate increase to alarming levels? If you were awake & in pain during surgery, you would (of course) freak out. Even if you were paralyzed, your heart rate would increase and the doctors would know. This is what a doctor once told me when I asked. I'm not sure how to contrast that with what the article says.

Yes. The anesthetist is monitoring the patient's vital signs, and one of the things they are watching for are elevations of the heart rate, indicating inadequate sedation.

This isn't foolproof though. Not everyone will have the same physiological response, and over the course of an hours long procedure (during which nothing happens in the "routine" case), it's easy to lose focus and perhaps not notice a change for a little while...

Re: Waking up during surgery

#22

Post by JshWright »

gotocake wrote: post #15
zoba wrote: post #6

Wouldn't your heart rate increase to alarming levels? If you were awake & in pain during surgery, you would (of course) freak out. Even if you were paralyzed, your heart rate would increase and the doctors would know. This is what a doctor once told me when I asked. I'm not sure how to contrast that with what the article says.

Especially in the case of an intubated patient with neuromuscular blockade, I don’t think an EKG would be useful. You’re already going to have all kinds of fluctuations from the anesthesia, muscle relaxants, analgesics and just from the intubation. I’ve read about the use of EEG [1] as a way to detect awareness, but it has serious limitations. Most of all though, many anesthetic agents have a profound effect on the a…

Paralytics used in surgery impact voluntary muscle control only, they have very little in the way of effect on things like heart rate.

Heart rate is absolutely monitored closely during surgery (precisely because it can be an indication of inadequate sedation).

Re: Waking up during surgery

#23

Post by JshWright »

winrid wrote: post #3

I recently had a foot injury. In the ER they put me under and the (fantastic) surgeon "twisted" the foot back into place. I don't remember anything, however other people said I was moaning in pain while under anesthesia. Pretty weird.

Anesthesia and analgesia are two different things. There are also different types of anesthetics. For "procedural sedation" (the sort of thing you would do in the ER), it's common to simply use a dissociative agent (like Ketamine), so you aren't really "out", you just aren't "in" either.

Re: Waking up during surgery

#24

Post by ars »

remote_phone wrote: post #14
gotocake wrote: post #4

Earlier quoted context omitted.

Ever since I’ve been a little kid this one thing has stuck with me; if you can’t remember it, is it like it never happened? I used to wonder that about nightmares, but I tended to go with the view that a version of you did suffer, and on some level the impact is there. Like a person with anteretrograde amnesia who can’t remember learning to work a specific maze, but still realizes the gains of the previous attempts.…

As recently as the 1980s, they would do heart surgery on newborns because the surgeons felt that the babies wouldn’t remember anything about it. It sounds monstrous to me, however.

That's not why they did it. They did it because anesthesia wasn't as good then, and there were significant risks to the infants.

When the risk of pain outweighed the risk of anesthesia the practice stopped.

Re: Waking up during surgery

#25

Post by baby »

I woke up during my wisdom teeth surgery.

Actually, I'm not even sure I did, but I remember doing it. The doctors never told me anything about it.

I remember waking up and seeing something covering my eye, and moving my hands to do thumb ups and peace signs (I knew there were students in the room watching the surgery), and then I remember hands trying to immobilize me, and me trying to start thumb wars, then blacking out.

I don't remember pain, just that it was fun to fuck around with them.

Re: Waking up during surgery

#26

Post by fifteenforty »

As an anaesthesiologist (well, senior trainee), I hesitate to comment on this, but here goes nothing...

I think it’s important to remember that the vast majority of anaesthesia delivered does not involve ‘general anaesthesia’ nor neuromuscular blocking drugs. Most patient’s experience of anaesthesia is sedation, where the aim is comfort, not absence of recall.

There is a bit of a movement to reduce our reliance on neuromuscular junction blocking drugs, which will hopefully lead to a decrease in the incidence of awareness under general anaesthesia.

In my institution, even of general anaesthetics, less than 30% would involve neuromuscular blockade.

Neuromuscular blockade only affects your skeletal muscle, not muscles like your heart or those in your gut.

Re: Waking up during surgery

#27

Post by cgag »

gotocake wrote: post #4
winrid wrote: post #3

I recently had a foot injury. In the ER they put me under and the (fantastic) surgeon "twisted" the foot back into place. I don't remember anything, however other people said I was moaning in pain while under anesthesia. Pretty weird.

Ever since I’ve been a little kid this one thing has stuck with me; if you can’t remember it, is it like it never happened? I used to wonder that about nightmares, but I tended to go with the view that a version of you did suffer, and on some level the impact is there. Like a person with anteretrograde amnesia who can’t remember learning to work a specific maze, but still realizes the gains of the previous attempts.…

I'm pretty sure using these amnesia type drugs is the standard for endoscopies and colonoscopies (versed aka midazolam). You can find horror stories about them online. You can have those procedures done with just propofol or without any sedation but I'm pretty sure they give you versed by default.

I'm sure you can find horror stories for propofol and other drugs, but I'm vastly more uncomfortable with the idea behind intentionally inducing amnesia.

Re: Waking up during surgery

#28

Post by hermitdev »

baby wrote: post #25

I woke up during my wisdom teeth surgery. Actually, I'm not even sure I did, but I remember doing it. The doctors never told me anything about it. I remember waking up and seeing something covering my eye, and moving my hands to do thumb ups and peace signs (I knew there were students in the room watching the surgery), and then I remember hands trying to immobilize me, and me trying to start thumb wars, then blacking…

I also woke up during my wisdom teeth extraction. Likewise don't remember any pain, just being shaken as they tried to extract one of the teeth.

Contrast that to my first eye surgery, for which I was completely awake, and the local anaesthesia wore off. That was hell. Excruciating pain while the doc had various instruments in my eye. I voluntarily stopped breathing as I clenched against the pain. Set off all sorts of monitors. The whole stress of it and the swelling in the eye had me blind in that eye for nearly 3 weeks. First week was total blackness. Slowly started fading back in as the swelling went down. Very disconcerting.

Second eye surgery, made clear what happened and the doctor was far more liberal with the anaesthetic both before amd during surgery and I had no pain and minimal swelling and near perfect vision immediately out of the OR.

Re: Waking up during surgery

#29

Post by tomcam »

They just woke me up during a colonoscopy due to sleep apnea (I did warn them and even bring my CPAP, which they chose not to use.) Highly reminiscent of the “I’m going to go medieval on your ass” scene in Pulp Fiction.

Understandable, but not fun at all.

Re: Waking up during surgery

#30

Post by afro88 »

sidlls wrote: post #16
idlemind wrote: post #11

Even if you don’t wake up during surgery, it feels like there’s an imprint of the trauma. I had a very long operation and by the time I came round I was in pieces emotionally, with no clear idea of what had happened but still a deep sense of dread. On some level it felt like my body knew what had just happened.

It's common for people to be disoriented and emotionally unstable after surgery.

How long for?
Post reply on HN