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Waking Up During Surgery (2019)

mosaicscience.com

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Re: Waking Up During Surgery (2019)

#11

Post by throwanem »

ycombinete wrote: post #3
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…

That speculation at the end is truly bizzare. I’m sure that, if I suffered such an experience, the first thing I’d do upon waking would be to talk about it!

Would you? It would probably be by far the worst agony you'd ever experienced, and given the circumstances you might also not be able to be certain you had actually experienced it. Beyond that, you'd likely face strong dissuasion if you did try to talk to anyone about it, even a doctor or nurse involved in your care, assuming the article is accurate in saying most don't really believe it can happen. It might be hard to argue with someone in a position of professional authority saying it was all just a bad dream, a pre-waking hallucination, or similar - nothing more than the anesthesia messing with your head a little, nothing you'd need to worry about. And you might well want very much to believe that was true, too.

I don't know, and I don't feel competent even to really guess. I have a degree of physical ability to tolerate pain that has drawn surprised comment from doctors and dentists in the past; between that and the mental and emotional toolkit I've had to develop in consequence of various painful illnesses for which I wasn't immediately able to obtain care, I might, very possibly, if the procedure was short and God was kind, be able to withstand something like this without being entirely crippled by trauma, maybe. Even then I don't know that I'd tell the surgeon; it would be a difficult and uncomfortable conversation to have at a time when I'd no doubt already be feeling unusually fragile. And that's me - for someone totally naïve to severe pain, and lacking any of the advantages I have in dealing with it? It's horrifying just to think about.

Re: Waking Up During Surgery (2019)

#12

Post by darkerside »

bloak wrote: post #10
darkerside wrote: post #8

Earlier quoted context omitted.

Yes? You think you keep your memories when you die?

Interestingly, in Germany at least, when someone is killed in an accident, in determining the damages payable to the person's estate (i.e. other people) they take account of how much pain (it is speculated that) the person suffered in the seconds before they died. To me this seems ... weird. I don't think they're worried about psychological trauma in the afterlife, but who knows?

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

Re: Waking Up During Surgery (2019)

#13

Post by azalemeth »

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…

I've had three general anaesthetics, all as a child or teenager. I only remember "the anaesthetic" for one of them: a large dose of what I now know to be propofol went in a cannula and the (attractive, for a 14-year-old) nurse stroked the cannula on the back of my hand after it was administered. That felt warm and nice. Purple butterflies them started to come up out of my hand, through the back of the venflon, and came around my vision, until I was surrounded by warm, beating wings and a pleasant drifting into unconsciousness (tinged with a feeling of contentment). I woke up -- much to my great chagrin -- in "moderate discomfort" what felt like instantaneously later, although several hours had gone.

None of my hallucinations were real. Everything that I "saw" probably took place in a 1-2s period as I was falling under, and was entirely a figment of my imagination. Were I worried about waking up during my procedure, it's entirely possible that my brain would have hallucinated something far less innocent. These reports are very difficult to substantiate, but a lot of monitoring is done under general anaesthesia: depending on the surgery and the anaesthetic this might range from measuring the inspirational and expirational partial pressures of O2, CO2, other relevant gasses such as N2O and the anaesthetic agent itself, e.g. desflurane or sevoflurane. Heart rate, blood pressure and the like are all routinely monitored. It's therefore possible to compute the effective concentration of agent in the blood stream and directly prove that the concentration is adequate. Sometimes EEGs are taken and can directly show brain activity, or nerve conduction pathways are mapped and can show conscious activation. Waking up during (competent) anaesthesia should never happen, and I think that the 5e-7 chance put above is probably an upper bound. At any rate, it pales in comparison with the complication rate from many surgeries, which, of course are usually several orders of magnitude higher: 1e-3 for death is often considered acceptable, for context.

Re: Waking Up During Surgery (2019)

#14

Post by IG_Semmelweiss »

"This all makes anaesthesia as much art as science"

This is one of the most important parts of the piece. It is something that most people out side of healthcare are not aware.

Anaesthesia is very much an art.

Anaesthesia is unlike other medications, "take xx mg over yy days."

Anaesthesia effects can vary wildly from person to person. Weight plays a big role, but so does bed position, condition, sex, body part etc. There is a variety of confounding factors. There is no textbook dosage for a given situation.

Anecdotally, acknowledging this before any surgery with a simple bedside conversation, may improve outcomes with anaesthesia.

Anaestheologists move from patient to patient quickly. Recognizing how their job is more than just inserting the needle, will make you stand out from other patients.

Re: Waking Up During Surgery (2019)

#15

Post by ctdonath »

throwanem wrote: post #11
ycombinete wrote: post #3

Earlier quoted context omitted.

That speculation at the end is truly bizzare. I’m sure that, if I suffered such an experience, the first thing I’d do upon waking would be to talk about it!

Would you? It would probably be by far the worst agony you'd ever experienced, and given the circumstances you might also not be able to be certain you had actually experienced it. Beyond that, you'd likely face strong dissuasion if you did try to talk to anyone about it, even a doctor or nurse involved in your care, assuming the article is accurate in saying most don't really believe it can happen. It might be hard…

As said: speculation. A study would have found a meaningful number expressing hesitation to discuss but doing so anyway, plus those who won’t but clearly experienced trauma - pointing to a percentage actually quiet about the incident.

Re: Waking Up During Surgery (2019)

#16

Post by throwanem »

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 saying, we don't have a firm understanding of why general anesthesia works, just that it does. That's good enough to be going on with, but not yet understanding the mechanism at work means it's reasonable to expect we also don't yet have perfect knowledge of why and when it doesn't work perfectly, and there is therefore nothing implausible about there being rare outliers such as those under discussion here.

Re: Waking Up During Surgery (2019)

#17

Post by throwanem »

ctdonath wrote: post #15
throwanem wrote: post #11

Earlier quoted context omitted.

Would you? It would probably be by far the worst agony you'd ever experienced, and given the circumstances you might also not be able to be certain you had actually experienced it. Beyond that, you'd likely face strong dissuasion if you did try to talk to anyone about it, even a doctor or nurse involved in your care, assuming the article is accurate in saying most don't really believe it can happen. It might be hard…

As said: speculation. A study would have found a meaningful number expressing hesitation to discuss but doing so anyway, plus those who won’t but clearly experienced trauma - pointing to a percentage actually quiet about the incident.

Of course it's speculation; as far as I know nobody's done much research of any kind into this phenomenon. Making it more widely known seems like a good way to improve the odds of someone doing such research, so in that sense the article is worthwhile, whether speculative or otherwise. And, again, how could it not be? The subject matter practically compels such consideration.

Re: Waking Up During Surgery (2019)

#18

Post by bloak »

darkerside wrote: post #12
bloak wrote: post #10

Earlier quoted context omitted.

Interestingly, in Germany at least, when someone is killed in an accident, in determining the damages payable to the person's estate (i.e. other people) they take account of how much pain (it is speculated that) the person suffered in the seconds before they died. To me this seems ... weird. I don't think they're worried about psychological trauma in the afterlife, but who knows?

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 parents suffered, and you then collect that money, minus inheritance tax. By adding to your feelings of guilt, perhaps it's a fair punishment?

Re: Waking Up During Surgery (2019)

#19

Post by Koshkin »

edem wrote: post #5
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?

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.

Re: Waking Up During Surgery (2019)

#20

Post by Xenoamorphous »

bloak wrote: post #10
darkerside wrote: post #8

Earlier quoted context omitted.

Yes? You think you keep your memories when you die?

Interestingly, in Germany at least, when someone is killed in an accident, in determining the damages payable to the person's estate (i.e. other people) they take account of how much pain (it is speculated that) the person suffered in the seconds before they died. To me this seems ... weird. I don't think they're worried about psychological trauma in the afterlife, but who knows?

Well if a loved one died I for sure would feel even worse knowing that they suffered. I guess that’s the reason for bigger compensation.
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