[HN Gopher] Waking Up During Surgery (2019)
___________________________________________________________________
Waking Up During Surgery (2019)
Author : hoffmannesque
Score : 66 points
Date : 2021-04-22 08:42 UTC (14 hours ago)
(HTM) web link (mosaicscience.com)
(TXT) w3m dump (mosaicscience.com)
| IG_Semmelweiss wrote:
| "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.
| bserge wrote:
| 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 a ride. If x drug doesn't work, try something else until
| something works. It's a pretty terrible approach, tbh.
|
| It's rare to find a doctor who will keep in mind the many
| individual factors, often they have a lot of experience (to
| build that database of knowledge, which sadly is not shared)
| and _actual interest_ in their work, a surprisingly rare thing.
| IG_Semmelweiss wrote:
| That's well said.
|
| Just because it is standard practice doesn't mean its the
| best approach. Its just the accepted approach.
|
| Nassim Taleb has a quote on the subject that i love:
|
| "The difference between medicine and poison... is dosage"
| knodi123 wrote:
| Nearly 500 years ago, Swiss physician and chemist
| Paracelsus expressed the basic principle of toxicology:
| "All things are poison and nothing is without poison; only
| the dose makes a thing not a poison."
| shigawire wrote:
| 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
| tejohnso wrote:
| Reminds me of this somewhat relevant post about the mysteries
| of Anesthesia
|
| https://medium.com/@lukehollomon/anesthesia-works-on-plants-...
| gwern wrote:
| Further reading:
| https://www.lesswrong.com/posts/wzj6WkudtrXQFqL8e/inverse-p-...
| murbard2 wrote:
| 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?
| stared wrote:
| Without going into too much spoilers, a horror video game
| Amnesia: The Dark Descent has some tropes around this topic.
| edem wrote:
| 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.
| Koshkin wrote:
| 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.
| thret wrote:
| Yes, this is my fear. After surgery it is not a problem,
| but in the weeks leading up to a surgery it's terrifying.
| throwanem wrote:
| Potentially relevant research discussing, in part, whether
| drugs that disrupt memory formation and/or sympathetic nervous
| system activation can improve outcomes after traumatic events:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620711/
| darkerside wrote:
| Yes? You think you keep your memories when you die?
| bloak wrote:
| 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?
| darkerside wrote:
| I agree with it. Just because it ends doesn't mean it
| didn't happen.
| bloak wrote:
| 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?
| darkerside wrote:
| Separate note. Don't make the mistake of thinking meaning
| and life are binary. People too often think life is
| meaningful (everything is eternally meaningful) or
| completely meaningless. Allow that neither of those are
| true, and that all things carry some meaning for some
| amount of time.
| darkerside wrote:
| 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.
| hnbad wrote:
| Is that weird tho?
|
| If a type of accident is usually going to cause horrible
| pain if it causes death, this creates a bigger incentive to
| avoid serious injury in the first place (which also helps
| avoid death from those injuries).
|
| If suffering is taken into account for injury, also taking
| it into account for death avoids situations where it would
| be preferable for the perpetrator to cause death rather
| than have the victim survive in pain. There's no threshold
| because the fatality is considered in addition to rather
| than instead of the suffering.
| Xenoamorphous wrote:
| 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.
| bloak wrote:
| If that were the reason, then surely the compensation
| ought to be paid directly to the lover or lovers rather
| than to the estate of the person who died, who might have
| left their money to charity, not to the lover or lovers.
| They almost certainly do have mechanisms in place for
| compensating family members directly, but compensation
| for pain suffered in the seconds before death goes to the
| estate of the dead person, not to the family, if what I
| read was accurate and still applies. That compensation is
| presumably independent of whether the deceased had any
| family and independent of who inherits it.
| andix wrote:
| 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.
| yboris wrote:
| Here's something worse: for a while, _curare_ was used on
| children when undergoing surgery. Turns out that rather than
| anesthetizing them, it simply paralyzed them. Kids came out of
| surgery describing how they felt the surgery, and doctors just
| insisted that that was post-surgery nightmares.
| StavrosK wrote:
| That's too bad, it seems like a pretty easy to confirm, but I
| suspect nobody gave a crap.
| ectopod wrote:
| This is reminiscent of the lethal injection protocol. It
| consists of:
|
| * A fast- and short-acting barbiturate to knock you out.
|
| * A muscle relaxant to stop you breathing.
|
| * Potassium chloride to induce a heart attack. It
| incidentally causes great pain.
|
| If the effect of the barbiturate wore off too quickly this
| would be an appalling death. Does it? Quite possibly. The
| creator of the protocol said
|
| > _It never occurred to me when we set this up that we 'd
| have complete idiots administering the drugs_
|
| But nobody gives a shit.
| StavrosK wrote:
| I wonder if a heroin overdose would be better.
| rybosworld wrote:
| I woke up during a procedure as a kid. I do have a faint memory
| of it, though no trauma (as far as I can tell) and I do not
| remember having any pain. Basically the doctors just gave me more
| anesthesia and I went back under.
| jeffreyrogers wrote:
| I woke up while having my wisdom teeth taken out (doubt it was
| general anesthesia, but it was something more than local
| anesthesia). It was incredibly painful. Fortunately they noticed
| pretty quickly and did something and I was out again pretty
| quick.
| kevin_thibedeau wrote:
| This happened to me when I had teeth removed for braces while
| under N20. When the wisdom teeth came out I opted for sodium
| pentothol.
| selimthegrim wrote:
| Yes, this has happened to me (Ativan wore off) too but I was
| more disoriented than in pain at that point.
| [deleted]
| cj wrote:
| 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
| throwanem wrote:
| 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.
| andix wrote:
| 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.
| t0mas88 wrote:
| I've read a story some years ago about a patient that
| didn't have any pain but did have some vague memories about
| the procedure that he should not have had if he was fully
| under. The patient was able to describe the topics of
| informal small talk during their procedure.
| stephenhuey wrote:
| Check out the sibling comment in which lr4444lr recounts taking
| a secret audio recording device into surgery.
| istorical wrote:
| It's a known phenomenon not a mythological creature like
| bigfoot. Dentists for example often have to re-administer
| anesthesia mid-procedure when a patient wakes up mid-wisdom
| tooth extraction for example.
| JustSomeNobody wrote:
| I once woke up during oral surgery. They just put me back under
| and continued. I wasn't sure if it had happened or I dreamed it
| and so I asked them. They confirmed that I had and said it
| occasionally happens, NBD.
| Dumblydorr wrote:
| Wow, this lady has 2 to 3 nightmares per night even ten years
| later, after an exploratory surgery? That's pretty extreme, I
| think most people wouldn't have had 6 to 8 thousand nightmares
| about this experience.
| tokai wrote:
| I would guess her actual memory of the up-waking would be very
| unreliable after thousands of nightmares.
| intergalplan wrote:
| My dominant (practically exclusive, actually) nightmare for
| over 20 years involved forgetting a class schedule or where a
| classroom was. Initially triggered by the (enormous) middle
| school I attended for the first half of 6th grade, then it
| morphed into a whole new set of very-similar nightmares after I
| started attending college. I'm sure I had thousands of those
| nightmares. Hell, I so rarely remember _any_ of my dreams on
| waking these days (used to recall a detailed, ordered _history_
| of my dreams each morning, without even trying) that for all I
| know I 'm still having them several times a week without
| realizing it.
|
| I'd believe thousands of nightmares over the span of a decade,
| for a traumatic surgery experience.
| Retric wrote:
| It's a reasonably common response to traumatic events for
| people to have regular nightmares for decades afterwards. ~2-3
| a night for a decade would be high, but not unheard of.
|
| _a study comparing Vietnam Veterans to civilians showed that
| 52% of combat Veterans with PTSD had nightmares fairly often.
| Only 3% of the civilians in the study reported that same level
| of nightmares._
| https://www.ptsd.va.gov/understand/related/nightmares.asp
| andix wrote:
| 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.
| ornornor wrote:
| I assumed that this was part of the reason why parients heart
| rate is monitored. If you're paralyzed from the drugs but awake,
| conscious, in lain, and panicking then your heart rate would
| shoot way up and that would alert the operating team that
| something isn't right, wouldn't it?
| flave wrote:
| 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 patient surgeries performed PA in USA so V
| conservative estimate is 5*10^-7 chance.
|
| Later, on follow up, my doctor explained to me why they don't
| worry about patients coming up. It's because this traumatic
| experience the patient is describing, if they were awake and
| experience trauma, would result in a raised heart-rate and blood-
| pressure. The link between trauma and those physical responses is
| one to one.
|
| If and when patients begin to get a raised heart or raised blood
| pressure you better believe they're getting a much higher dose
| and/or a change of anaesthetic.
|
| > One of the largest and most thorough investigations was the
| fifth National Audit Project carried out by British and Irish
| anaesthetists' associations, in which every public hospital in
| the UK and Ireland had to report any incidents of awareness for a
| year. The results, published in 2014, found that the overall
| prevalence was just 1 in 19,000 patients undergoing anaesthesia.
|
| This is comparing apples with elephants. 'incident of awareness'
| is nothing like the idea of being fully awake and compos during a
| surgery.
|
| >but many people may feel unable or unwilling to come forward,
| and would instead prefer to just put the experience behind them.
|
| Speculation
| batch12 wrote:
| I have had several surgeries with everything from a light to
| general anesthetic. I warn the nurses and doctor beforehand
| that I have a history of waking and remember previous
| operations. Most do not believe me. I remember the sound of my
| wisdom teeth being cracked open and opening my eyes while they
| were being cut out. I remember scaring the shit out of a nurse
| and doctor when I woke and started talking mid-procedure. I
| remember being held down when I kept trying to roll onto my
| side as if I were asleep. Typically, the reaction is something
| like "he is awake" followed by a flurry of action, then sleep.
| I don't know why this happens-- I suspect something makes the
| anesthesia wear off faster than normal. I also have an issue at
| the dentist with numbing-- they usually have to hit me twice.
| If that doesn't work fully, I just tell him to go ahead and I
| will deal with it.
| istorical wrote:
| I also had this happen. Literally almost the exact same,
| don't remember whether I opened my eyes or not but I remember
| hearing crunching sounds coming from my mouth and realizing
| it was them drilling or hammering or doing something
| destructive to my wisdom teeth. But zero pain. Just a wtf
| that is weird af feeling. But then I passed back out (not
| sure if they did something to make me fall back asleep or if
| it occurred of its own accord).
| BurningFrog wrote:
| Do you have red hair?
|
| I ask because they're known to need more anesthesia.
| batch12 wrote:
| Yes, partially. When I grow a beard it is red.
| flave wrote:
| lol so do I and it's one of the reasons why I thought I was
| more likely to 'wake up'
| ycombinete wrote:
| 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!
| tapland wrote:
| I remember the doctors asking me after partial removal of a
| brain tumour if I remembered them waking me up during the
| surgery.
|
| I wish I did, but I remember absolutely nothing.
|
| This was about 15 years ago, and I don't remember if they
| said they would wake me up prior to the surgery. Maybe to my
| parents.
| rz2k wrote:
| Was that done to actively map your brain so that they could
| be especially careful around areas related to functions
| like speech?
| throwanem wrote:
| 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 naive to severe pain, and lacking any of
| the advantages I have in dealing with it? It 's horrifying
| just to think about.
| ctdonath wrote:
| 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.
| throwanem wrote:
| 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.
| andrewl wrote:
| It's not uncommon to wake people up during brain surgery,
| or do the surgery without fully anesthetizing the patient
| at all. They _would_ anesthetize the skull area they cut
| through. And the brain tissue itself doesn 't register pain
| when cut. They do it so the surgeons can interact with the
| patient to guide them in what areas they have to stay away
| from when removing a tumor or doing other work. Here's
| more:
|
| https://www.mayoclinic.org/tests-procedures/awake-brain-
| surg...
| throwanem wrote:
| Sure, I'm aware, and I don't know of any reports of
| emotional harm as a result of that. I think it'd probably
| be the combination of pain, helplessness, surprise, and
| recollection that'd be what causes the trauma in cases
| where people regain consciousness _unintentionally_. In
| the kind of surgery you describe, at most two of those
| seem likely ever to be present, and because the awareness
| is intentional I expect there 'd be more and/or different
| pharmacological support to help insulate the patient from
| the full reality of the situation. So I don't think awake
| brain surgery is likely all that usefully comparable to
| the accidental awareness we're discussing here.
| andrewl wrote:
| I thought you were referring to Tapland's report "I
| remember the doctors asking me after partial removal of a
| brain tumour if I remembered them waking me up during the
| surgery" when you said it "would probably be by far the
| worst agony you'd ever experienced."
|
| _Accidental_ awareness during surgery has always sounded
| massively traumatic to me. Even thinking about it makes
| me intensely uncomfortable.
| refurb wrote:
| Most surgeons, at least males ones, will have another nurse
| present during recovery as some pretty weird memories can
| form.
|
| I remember reading about a case where an older female patient
| wouldn't talk to the surgeon after. Finally she admitted she
| was upset as "the surgeon has put his penis in her hand".
|
| Luckily he had a nurse present the entire time and what he
| had done is place two fingers in her palm and told her to
| squeeze.
|
| Yet this patient was 100% convinced he had been inappropriate
| with her.
| sliq wrote:
| 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.
| flave wrote:
| I'm making the point that I, and many other people, have
| experienced the downside of the baseless fear-mongering
| around 'waking up' during surgery.
| wittyreference wrote:
| 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.
| TheCraiggers wrote:
| > 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.
| DanBC wrote:
| You might be interested in the radio programme "Brian
| Gulliver's Travels".
|
| https://en.wikipedia.org/wiki/Brian_Gulliver%27s_Travels
|
| https://www.bbc.co.uk/programmes/b01m29vt
|
| They included an episode ( _Kognitia_ ) where people are
| able to forget traumatic experiences. Here's a tiny clip:
| https://www.bbc.co.uk/sounds/play/p00yj97w
|
| They're available on Archive.org here:
| https://archive.org/details/briangulliverstravels1-2
| munificent wrote:
| 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?
| rz2k wrote:
| I think there are ethical questions for the beneficiaries.
| Isn't like subjecting someone else to intense pain for an
| hour in order to receive money?
| tyingq wrote:
| Statistics on women who choose a "no painkiller" second
| childbirth after doing so the first time might exist.
| DHPersonal wrote:
| That might be an aversion to using painkillers again
| after experiencing awful side-effects in the first
| delivery.
| tyingq wrote:
| Ah, I meant those that go without painkillers a second
| time.
| DHPersonal wrote:
| The lingering physical effects of a body experiencing
| trauma for that amount of time might be too damaging for
| some to be willing to accept amnesia as a panacea.
| kijin wrote:
| There might also be a difference between a) You will be in
| pain for an hour, remembering the whole thing, and at the
| end of that hour, your memory will be wiped; and b) You
| will be in pain for an hour, but you will not form any
| memory of any part of that hour in the first place. It's
| the difference between saving data to a huge file and then
| deleting it, versus piping the data to /dev/null as it
| comes in. AFAIK amnestic drugs are intended to be closer to
| the second method.
| flave wrote:
| Okay, so how is this person in massive amounts of pain
| without having the physiological response of a raised heart
| rate and raised blood pressure?
| azalemeth wrote:
| 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.
| lr4444lr wrote:
| 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.
| UncleOxidant wrote:
| I remember waking up from general anesthesia during removal of
| my wisdom teeth. The oral surgeon seemed kind of surprised,
| cursed and asked the assistant to give me more anesthesia. I
| didn't find it all that traumatic either at the time, but I was
| only awake for a minute or so.
| Der_Einzige wrote:
| Sorry, but there is nothing else to say except that you are
| extremely wrong. This kind of belief is exactly why male
| circumcision is not seen for the evil that it is. Please try to
| consider the possibility that trauma without conscious memory
| can have disastrous results - as other commenters are trying to
| get you to understand...
| codemonkey-zeta wrote:
| > you are extremely wrong
|
| Can you point to evidence suggesting this? Not trying to be
| adversarial, just genuinely curious since almost everyone in
| this thread is just exchanging anecdata.
| rscho wrote:
| 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.
| crazygringo wrote:
| > _pain with no memory is pretty much as good as no pain_
|
| I can't speak to your specific case, but in general that's not
| true.
|
| Even if you have no conscious memory of trauma, it can manifest
| itself in ongoing stress, fear, and general PTSD-like symptoms.
|
| You may have been lucky in waking up but perhaps without pain,
| but that's not the case with everyone.
| trhway wrote:
| >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 would feel the pressure every
| time the hammer would fall and the scraping vibrations of the
| chiseling would just reverberate through the scull. ... More
| than 20 years later ENT here was genuinely curious where did i
| get such a nice job done. USSR military surgeon :) And back in
| the USSR my mother had her appendix removed under local too,
| and the surgeon was communicating to her various stages of the
| surgery, like what he is going to do and how that may be
| felt/perceived.
|
| I wonder about the merits of those different approaches. (very
| handwavy as IANAD) With the local the pain doesn't seem to
| reach the central nervous system. With the sedation or general
| it reaches i suppose, yet the central nervous system has no
| reaction. If one supposes that the strong pain may be a kind of
| neuron pathway/connection altering signal ("EEPROM burning"),
| it would be plausible to expect that that unfelt or felt-and-
| forgotten at the time pain under sedation or general may still
| have some effects down the road.
| rimliu wrote:
| 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.
| trhway wrote:
| 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.
| HeyLaughingBoy wrote:
| 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 :-)
| DHPersonal wrote:
| 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 surgery
| to escape its effects, even in the best of circumstances.
| jeffreyrogers wrote:
| Yeah, they've done experiments with patients with no long-
| term memory where they do things like shock them when they
| shake hands. People develop an aversion to it but can't
| explain why.
| PragmaticPulp wrote:
| 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.
| PragmaticPulp wrote:
| > 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.
| tectonic wrote:
| 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.
| 99_00 wrote:
| No need to be concerned. Exactly zero people are concluding
| that suffering can be ignored because someone is ok with not
| remembering pain during a medically necessary surgery.
| PragmaticPulp wrote:
| 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.
| LeifCarrotson wrote:
| I wonder if the journalist is asking the wrong people.
|
| Instead of interviewing patients supposed to be under drug-
| induced amnesia, and finding the few who remembered, ask the
| doctors and nurses who are being asked to restrain patients in
| distress. A specialist in a procedure that requires light
| general anesthesia would, if this was true, have done surgery
| on thousands of people in various degrees of distress.
|
| To me, that would be a pretty heavy secret to carry, and a
| 'conspiracy' that large would be impossible to conceal. I do
| agree, though, that pain without memory is pretty much as good
| as no pain. When you're conscious but unable to remember being
| conscious, are you still capable of suffering?
| nefitty wrote:
| My initial intuition to your last question was, "No,
| suffering usually entails some sort of looking-back process
| that places the pain in that context."
|
| I then realized that animals can suffer, and either I'm
| confounding Buddhist and Western psychological definitions of
| suffering, or suffering doesn't require consciousness of it
| occurring for it to be suffering.
|
| I hope that makes sense!
| zomg wrote:
| 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!
| LordGrey wrote:
| Another anecdotal data point:
|
| I received full dental replacement implants (the all-on-four
| style) a couple of years ago. During the procedure, I came out of
| it enough to remember trying to get "something" out of my mouth
| that was bothering me, and a nurse literally shouting at me to
| stop.
|
| My wife was waiting for me and could see down the hallway where
| my room was. She said that at one point the doctor came out of my
| room gagging and holding his throat. After a few minutes, he went
| back in.
|
| Later, we discovered that I fought everyone in the room. I had
| punched the doctor in the throat, tried to rip my IVs out, etc.
| The incident I remember (the yelling) was just a part of it all.
|
| I've since read up on anesthesia and the subject is both
| fascinating and scary ("science with a lot of art mixed in").
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