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Waking Up During Surgery (2019)

mosaicscience.com

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Re: Waking Up During Surgery (2019)

#81

Post by zomg »

i certainly agree with the statements about people having varying tolerances to these medicines. prior to my hernia surgery, the nurse gave me propofol in my IV and told me i'd start to feel drowsy and fall asleep. yeah, right...

after surgery, my doctor asked me what i remembered. i told him i remember receiving the dose of propofol, 10 minutes being wheeled into the OR (we made a right turn, a left down a hallway, and a right into the OR), and the last thing i remember was the OR nurse jamming the mask on my face (and not answering a question i had asked her, as we were chit-chatting when they moved me to the operating room table!).

he couldn't believe that i recalled the propofol dose, the directions to the OR and that the last thing i recall was the nurse jamming the mask on my face to shut me up!

Re: Waking Up During Surgery (2019)

#82

Post by rscho »

lr4444lr wrote: post #28

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 prom…

Sedation without going into general anesthesia is not an easy thing at all, and even experienced anesthesia providers will sometimes struggle. However, patients moving or being otherwise disoriented is quite frequent and in itself is a non-event except when trying to reach for the surgical site, as you describe. As for distress, it's often not from pain but rather confusion, which can somtimes devolve into agitation and necessity to deepen the anesthesia. In my experience, true awareness is exceptionally rare. It's true that some procedures, such as cardiac or emergency C-section have an increased risk of event due to the particular context, though.

Re: Waking Up During Surgery (2019)

#83

Post by PragmaticPulp »

tectonic wrote: post #76
lr4444lr wrote: post #28

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 prom…

By this argument, living an entire life of suffering and then not remembering it when you’re dead would mean that it doesn’t matter and all suffering can be ignored. I hope that’s not the ethical code we settle on.

The sedation prevents the memories from forming, and also prevents the person from processing what's going on. The actual pain signals are also significantly dampened.

It's not equivalent to a lifetime of suffering in any way.

Re: Waking Up During Surgery (2019)

#84

Post by PragmaticPulp »

lr4444lr wrote: post #28

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 prom…

> 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.

If given the choice, I'd choose this over over deeper sedation.

Sedation and Anesthesia are not entirely risk-free. Even routine Anesthesia has been correlated with various subtle cognitive differences in the days and weeks after a procedure in some (though not all) studies.

I'd rather be given the minimum dose necessary to get the job done than have a provider go overboard with medications to avoid the small chance of someone breaking through the sedation.

Re: Waking Up During Surgery (2019)

#85

Post by shigawire »

bserge wrote: post #36
IG_Semmelweiss wrote: post #14

"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. T…

That's really the case for medication, as well. I wish doctors would be better in this regard and pay more attention to individual needs. I understand that would be more difficult and would likely increase costs, but still. The way it's done now is as you said, "take x mg at y interval" based on the tests done during drug development. If you don't respond to the medication the same way as the majority, you're in for…

This is the role of the modern pharmacist in the clinical team.

Nurse is the care expert

Physician is the diagnosis and treatment expert

Pharmacist is the medication expert

Re: Waking Up During Surgery (2019)

#86

Post by PragmaticPulp »

DHPersonal wrote: post #34
lr4444lr wrote: post #28

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 prom…

I recall hearing about this phenomenon about a decade ago, and at the time someone theorized that the specific memory may be lost but the effects were still present, and that these effects could cause general anxiety and distress without the person understanding the reasoning. I think it is perhaps more philosophical than rational, but it did give me pause to consider that perhaps not everyone forgets enough of a sur…

There are entire fields of study dedicated to studying the long-term effects of various trauma. Unfortunately it gets mixed in with the "repressed memories" and other pseudoscience ideas, so the pop-science news articles are not good sources of information.

That said, memory repression isn't the only type of anesthesia involved in these procedures. Patients are given multiple medications, which do everything from dampen the pain signals to relax the patient.

It's not equivalent to just forgetting the pain stimulus. The pain stimulus is massively reduced, even if it were to break through to the patient's awareness.

Re: Waking Up During Surgery (2019)

#87

Post by rimliu »

trhway wrote: post #78
lr4444lr wrote: post #28

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 prom…

>pain with no memory reverse situation - all the memory and no pain. I had a surgery on my nose done under local, and it was kind of unreal experience when the surgeon stopped cutting and took what looked like a typical woodworking chisel and a small hammer and started to chisel away the bone in my nose - all without any pain, my head is just like a piece of wood - the force would transfer and the back of my head wou…

I heard that in USSR the policy for apendectomy was that adults got only local anesthesia and kids would get general. No idea if that was the official policy or rumors only. I had appendectomy when I was 12 (that was USSR times) and got general anesthesia.

Re: Waking Up During Surgery (2019)

#88

Post by munificent »

fooqux wrote: post #27
wittyreference wrote: post #21

Earlier quoted context omitted.

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 ba…

A few years back, I had a procedure that involved twilight sedation. That means you're aware of the experience while it's happening, but have no memory of it afterwards.

I thought about this exact thought experiment constantly leading up to the day of the procedure.

It's a fascinating philosophical question. Did I experience the pain of the procedure? A past me before the procedure agreed to commit some future me to pain. During the procedure, that me then certainly experienced pain. But the hypnotic drug washed that memory away leaving a third me that had the benefits of the procedure but no memory of the pain.

So what is the moral calculus to perform when signing your future self up to pain that your future future self will forget?

Re: Waking Up During Surgery (2019)

#89

Post by HeyLaughingBoy »

lr4444lr wrote: post #28

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 prom…

My wife has actually had both, on separate occasions. About 15 years ago, she smashed her wrist, breaking it into multiple pieces. In the ER, they explained that the wouldn't give her an anesthetic to push things into place for a splint (to hold it together until surgery could be scheduled), but they'd give her meds so she would forget the pain. I was absolutely amazed that it worked. She vaguely remembers telling them "let's git 'er done" and then nothing for about an hour after that.

Fast forward about 5 years or so, she's on the operating table to have titanium plates inserted to hold her ankle together and she apparently wakes up in the middle of the procedure and started trying to rip her IV out while the surgeon and nurses struggle to hold her down (she's pretty strong) while the anesthesiologist puts her back under. She has no memory of this: the only reason we even know about it is that one of the nurses mentioned later that "you caused quite a stir in there."

Training horses is not for the faint of heart :-)

Re: Waking Up During Surgery (2019)

#90

Post by trhway »

rimliu wrote: post #87
trhway wrote: post #78

Earlier quoted context omitted.

>pain with no memory reverse situation - all the memory and no pain. I had a surgery on my nose done under local, and it was kind of unreal experience when the surgeon stopped cutting and took what looked like a typical woodworking chisel and a small hammer and started to chisel away the bone in my nose - all without any pain, my head is just like a piece of wood - the force would transfer and the back of my head wou…

I heard that in USSR the policy for apendectomy was that adults got only local anesthesia and kids would get general. No idea if that was the official policy or rumors only. I had appendectomy when I was 12 (that was USSR times) and got general anesthesia.

most probably it was some kind of officially established policy/practice. My mother got the appendectomy when she was an adult, and i got the nose job when i was almost 16, while the hernia surgery that i had at 5 was naturally under general.
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