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Waking Up During Surgery (2019)

mosaicscience.com

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Re: Waking Up During Surgery (2019)

#21

Post by wittyreference »

flave wrote: post #2

Okay this is an interesting article and an interesting subject. But, it looks a lot like fear-mongering. I feel strongly about this because I had two procedures done under local for fear of exactly this situation (coming up but being sedated) and both experiences where tough . > Founded in 2007, it has now collected more than 340 reports So 24 self-reported cases a year in all of N America. There are 48 million in pa…

They went on to describe the forearm experiment which showed a much higher rate of awareness. I don’t see why you’ve chosen to omit that. You seem to casually discard the idea that awareness without memory is irrelevant, but when I’ve informed patients of amnestics they’ve been horrified - maybe needlessly so, but I’m not so arrogant as to think “silly patient, your horror is wrong and therefore irrelevant.”

Many people don’t regard “you’ll be in pain and then forget” as the same as “no pain.”

And the idea that HR and BP are perfect indicators of pain is ridiculous. Anesthetics reduce the responsiveness of both; cardiac parameters don’t respond perfectly, and you don’t need perfect anesthesia to impair them.

In my hospital, at least, we don’t take for granted that we achieve perfect coverage. It’s normal to give patients a bolus of amnestic at the tail end of a procedure to cover any gap in pain/distress while we were bringing them back to consciousness.

Re: Waking Up During Surgery (2019)

#22

Post by stared »

murbard2 wrote: post #4

Thought experiment: what if we were all aware during general anasthesia and felt all the pain and these cases differed only in that they retained a long term memory of it? I know there are ways to measure pain, brain activity etc that most likely rule this out. But what if? Are experiences, even unpleasant ones, really experienced if they leave no trace at all, not even a memory?

Without going into too much spoilers, a horror video game Amnesia: The Dark Descent has some tropes around this topic.

Re: Waking Up During Surgery (2019)

#23

Post by darkerside »

bloak wrote: post #18
darkerside wrote: post #12

Earlier quoted context omitted.

I agree with it. Just because it ends doesn't mean it didn't happen.

I can't decide whether I agree or not. For an extra level of weirdness, imagine the person who caused the accident collecting the damages. It's not very improbable: you could be driving a car with your parents as passengers and you crash it, through honest incompetence, without committing a criminal offence, and they die, painfully, while you survive. Your insurance pays money into the estate for the pain your parent…

You're feelings of guilt have nothing to do with externally imposed punishment. Everybody is going to react differently. Since will feel tremendous guilt and some won't. Even if they do, some will handle it well and some won't. It's not an effective way to mete out punishment.

The world is senseless enough already. (I believe) the best we can do as humans is to try to make it a little more fair, which means connecting negative effects to negative causes. And when we do the opposite, we build systems that sow chaos. To that end, I have to say I'm actually philosophically offended by your suggestion.

Re: Waking Up During Surgery (2019)

#24

Post by thret »

Koshkin wrote: post #19
edem wrote: post #5

Earlier quoted context omitted.

My idea was that anasthesia switches off consciousness itself. It is like closing your eye when you look at the Sun while using painkillers is like wearing sunglasses.

General anesthesia does have an analgesic effect. Many people who woke up during a surgery have reported not feeling any pain. My fear is that sedation, on the other hand, could lead to the patient suffering but not remembering (much of) it afterwards.

Yes, this is my fear. After surgery it is not a problem, but in the weeks leading up to a surgery it's terrifying.

Re: Waking Up During Surgery (2019)

#25

Post by andix »

I know someone this has happened to.

Nobody believed her, until she could tell them what the doctors were talking about during the surgery.

It was a special case though, a surgery during pregnancy. It is really hard to do that in a way not to harm the unborn child.

Re: Waking Up During Surgery (2019)

#26

Post by andix »

throwanem wrote: post #16
cj wrote: post #6

I'm inclined to chalk this up to false memories. Especially if someone is going in with nervousness or awareness that "waking up without being able to alert the surgeon" is a specific point of anxiety of the patient. But, who knows. https://en.wikipedia.org/wiki/False_memory

It should be easy to disprove false memory, I'd think, at least in the case of procedures that are recorded. Ask the patient what they remember happening, and compare with the recording to see if those things did occur or didn't. I'm not inclined to assume every report of this happening is due to false memory, which is itself a somewhat controversial topic. As the article points out but is not even slightly novel in…

Doctors usually talk during (some parts of ) the surgery. About whatever is on their mind. If the patient can recite some details about that, it's probably not false memory.

Re: Waking Up During Surgery (2019)

#27

Post by fooqux »

wittyreference wrote: post #21
flave wrote: post #2

Okay this is an interesting article and an interesting subject. But, it looks a lot like fear-mongering. I feel strongly about this because I had two procedures done under local for fear of exactly this situation (coming up but being sedated) and both experiences where tough . > Founded in 2007, it has now collected more than 340 reports So 24 self-reported cases a year in all of N America. There are 48 million in pa…

They went on to describe the forearm experiment which showed a much higher rate of awareness. I don’t see why you’ve chosen to omit that. You seem to casually discard the idea that awareness without memory is irrelevant, but when I’ve informed patients of amnestics they’ve been horrified - maybe needlessly so, but I’m not so arrogant as to think “silly patient, your horror is wrong and therefore irrelevant.” Many peo…

> Many people don’t regard “you’ll be in pain and then forget” as the same as “no pain.”

I find this incredibly fascinating. If people were to be offered a sum of money in exchange for feeling immense pain for an hour but then having that memory wiped, I wonder how many would shrug and say "I won't remember anything? Sure, sign me up." I wonder at the ethical and morality of such things. If the person's reality is based solely on their memories, is it even unethical? Like I said, fascinating.

Thank you for the intriguing thought experiment for today.

Re: Waking Up During Surgery (2019)

#28

Post by lr4444lr »

Just an anecdote: I once had a procedure that required I be under a "light" general anesthesia (don't recall which). I was generally paranoid at the time though about everything, and strapped an audio recorder to my leg secretly. Turns out I did wake up mid procedure (the audio suggests doctor and nurse rushed to stop me from touching the area of operation of my face, and that I was distressed) but as the doctor promised, the sedative would have a strong effect on my short term memory and I remember not being able to recall any of what I had heard on the recording. I don't consider this at all traumatic: my memory was selectively wiped of that time period by virtue of the drug. Life just went on. It may not be popular to say, but I do feel from my experience that pain with no memory is pretty much as good as no pain, in the grand scheme of things.

Re: Waking Up During Surgery (2019)

#29

Post by sliq »

flave wrote: post #2

Okay this is an interesting article and an interesting subject. But, it looks a lot like fear-mongering. I feel strongly about this because I had two procedures done under local for fear of exactly this situation (coming up but being sedated) and both experiences where tough . > Founded in 2007, it has now collected more than 340 reports So 24 self-reported cases a year in all of N America. There are 48 million in pa…

Your personal experience has absolutely zero impact on the value of this article. The "it doesn't exist because i never experienced it" mindset is a dangerous one.

Re: Waking Up During Surgery (2019)

#30

Post by andix »

murbard2 wrote: post #4

Thought experiment: what if we were all aware during general anasthesia and felt all the pain and these cases differed only in that they retained a long term memory of it? I know there are ways to measure pain, brain activity etc that most likely rule this out. But what if? Are experiences, even unpleasant ones, really experienced if they leave no trace at all, not even a memory?

This is known to be kind of true. At least some part of the body remembers the pain. And it can have some long lasting effects (chronic pain, or stress). That's why nowadays during many surgeries they try to suppress the pain as much as possible locally.

So if you get surgery on your leg, it is best if you have additional anaesthesia or pain killers working in this particular leg. So you wouldn't feel all the pain even without general anaesthesia.

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