Monday, December 03, 2007
Awake: Waking up during surgery
"My toes wouldn't move. My whole body was completely paralyzed. I had no way to let them know I was awake...I felt the doctor take my hand and I thought oh dear god, they're getting ready to cut my hand."

That's Jodie Stanley describing being awake during surgery. It's a phenomenon called anesthesia awareness. Jodie, a registered nurse, says she had never heard of it until it happened to her. Victims have called it their worst nightmare. "They may remember sounds or conversations in the operating room or they may have excruciating pain or wake up feeling paralyzed, not being able to respond. It's like being alive, but inside a corpse," according to Dr. Peter Sebel of Emory University School of Medicine.

A new movie called "Awake" just came in at No. 4 in the weekend's box office tally. The thriller stars Hayden Christensen as a patient who is fully conscious but physically paralyzed during surgery. The movie's promoters have said, "It will do for anesthesia what 'Jaws' did for swimming in the ocean."

To be clear, anesthesia is very safe, and awareness incidents are rare. Out of the 30 million cases in which anesthesia is used, anesthetic awareness happens in about 1 or 2 cases out of every 1,000 according to the American Society of Anesthesiologists.

Researchers believe that anesthesia awareness is under-reported by 50 percent to 100 percent of the official numbers, says Carol Weihrer, president and founder of the advocacy group Anesthesia Awareness. She bases her numbers on her own experience as an advocate and information she has pulled together from other organizations.

She emphasizes that whenever it does occur, the impact can be traumatic. According to her organization, approximately 50 percent of awareness victims suffer from post-traumatic stress disorder.

It's definitely a scary risk however remote, but there are certain things that can help reduce your risk of experiencing anesthesia awareness. Brain monitors can help reduce the risk by more than 80 percent, but they are available in only half of operating rooms according to Sebel.
Here are some important points you should address with your doctor before going under:

Operating room brain monitors: Are they available in your facility?
Weight: Your body mass index (BMI) or amount of body fat is a factor. Anecdotally, women and slimmer patients report more awareness.
Age: The older you are, the less anesthesia you need.
Existing disease: Your risk can change, especially with diabetes or cancer.
Medications/herbal supplements: Any medications including herbal supplements can have a big effect on the anesthesia.
Type of surgery: Some surgeries are more susceptible to awareness including cardiac and obstetric operations and acute trauma surgery.

Have you or someone you know experienced anesthesia awareness?
Waking up during surgery can be quite disturbing and has happened to me on a few occassions. Listening to the doctor/nurse conversations is to me the most disturbing part. Outside the operating room you view these progessionals as exactly that and their conversations are always very proper.

Under the knife and when the think you are under the rules change dramatically. You hear about the bad night partying they had, chatter about all types of things not associated with what they are doing and even "flirt" with each other. Kinda scary when you hear them talk like any other person you know and think that they are not concentrating on the surgery or matter at hand priority. I have experienced it a few times. The doctors usually don't believe me until I tell them what they did last weekend partying. Then they are embarrassed. Whenever I now have to be put out, I explain what has happened and my resistance to the anesthesia they are using. That usually works and they make sure I am "out". The conversations are quite funny sometimes but unsettling most of the time.
you have to keep in mind that many, many surgeries are now performed as "mac" anesthesia. this means that although sedation is given patients are indeed awake. the area that surgery is being performed on is given local anesthetic rendering the area numb. the patient is comfortable during the procedure but aware. this is not the same as "anesthesia awareness" since general anesthesia was not the intended endpoint. patients are told what to expect before hand and should expect to be awake/ aware. don't do these doctors who work very hard to correctly and safely perform their job a disservice by assuming all procedures require genreral anesthesia.
Not every doctor goes out for "bad partying" on the weekend. As an anesthesiologist I can tell you we are well trained and take the nature of our profession very seriously. When you are in my OR you are not "just a Patient". You are MY PATIENT and my responsibility. The fact is we do not yet know the full extent of how general anesthesia affects the body, nor do we fully understand the inner working of the brain. Until we can explain all of this, general anesthesia is a complex area of medicine and will continue to be such. This is one of the reasons we undergo extensive training, with over 12 years of post secondary education.

The risk of awareness is extremely low. ANY awareness though is not something we strive for and is currently an area of great interest in anesthesia societies. There is definitely a difference between MAC, or Monitored Anesthesia Care, and General Anesthesia. During a MAC you are sedated, and the surgical site numbed with local anesthetic but you are breathing on your own. You may recall words spoken, or things in the operating room but due to the local should not have pain.

During General anesthesia you are rendered completely unconscious and your breathing is either assited or completely taken over by the anesthesiologist. Your vital signs are montiored either way. You are never left unattended.

The point is, anesthesia and surgery are a serious undertaking. They have inherent risks. The fact that some people remember doesn't necessarily mean they were under a GA. MAC cases are more and more prevalent as surgical techniques have advanced. This is a good thing as patients generally awaken much faster from MACs and feel much better sooner. For a relatively small procedure like a carpal tunnel, there is absolutely no reason to have a general anesthesia. In fact, many would consider it malpractice to do so.

Unfortunately, the NIH grants extremely low amounts of research $$ to the field of anesthesia. Until these dollars are increased, the ability to study those with anesthesia awareness and hopefully decrease the incidence is limited. The monitor alluded to in this article- the BIS monitor_ is not the perfect answer. The BIS is still controversial and has not been proven to decrease anesthesia awreness. This certainly may change as new positions are adopted by the American Society of Anesthesiologists.

As a concerned physician and a scientist, however, I will continue to be vigilant and base my views on science and evidence, not on Hollywood movies.
I was having a hernia operation, and also under general sedation. I remember going under, but then midway during the procedure felt a lot of tugging on my peritinium. I woke up hearing the doctors talking, and I was thinking to myself I should say something because its really starting to hurt. But,I found that I couldn't move, and in the same moment I felt intense pain. Then everything went blank. I woke up in the recovery room. The surgeon later explained that during the procedure while working on the peritinium, my vitals dropped unexpectedly, forcing him to stabilize me first before continuing. He explained that I must have experience an acute vasovagal response which caused my vitals to drop, and then essentially faint while under anestesia. Although my experience was short lived it was very real.
I have had awake episodes in 2 different surgeries. The first one the anestesiologist asked me later if I could explain it. I remember seeing my stomach cut open, but that one didn't hurt. I just shut my eyes quick and was out. The second was a brain surgery and when they cut through a muscle in front of my ear it hurt bad, and it still seems to hurt at times. I thought I was the only one.
Surgery is one of the most valorous things a person can do. It takes a great deal of strength to understand that your injury or disease may need surgery and once the decision is made to have the surgery, there should a way to insure the patients somberness throughout the surgery. Waking up during surgery can cause one to experience post-traumatic stress disorder after the surgery and can also cause many complications during the surgery. For example, if one has a heart condition and he/she wakes up during a leg surgery; this person can lose control and have a heart attack. With all the advances we have in technology nowadays we should be able to insure that anesthesia will not wear off. In addition we should also find a way to help people more prone to these awareness cases by effectively administering more anesthesia to a patient.
I woke up when having my wisdom teeth pulled. I have been put under many times and this is the first time I experienced anesthesia awareness. I think the doctor/dentist didn't give me enough of the good stuff, so I woke up during the procedure just enough to be aware, to hear talking, to see things (my eyes had medical tape over them), and to feel pressure (but not pain). It freaked me out and I passed out. I have talked to other people and it is apparently fairly common during dental surgery, as the person administering the anesthetic is usually not an anesthesiologist!
I had my gall bladder removed earlier this year. When I was in recovery I asked my mom if anyone mentioned fybroids to her (she had talked with the surgeon after that surgery) and she said no. I thought it was weird that my first memory was fybroids. I remember hearing discussion of it and remember thinking "I have fybroids? What?" The surgeon had left me a photo which I assumed was an picture of my gall bladder. I brought it with me for my follow up and it turned out the photo was a fybroid, not my gall bladder. He was pretty freaked out that I heard conversations during surgery. I don't remember any pain though.
It was a number of years ago but I had surgery to reconstruct and repair a broken jaw after a motorcycle accident. I remember every excruciating minute. The incisions, the moving of bone fragments, the hardware being put it...I can still remember it like it was yesterday. When I brought this to the attention of the care providers they basically told me I was making it up.
It happened to me during oral surgery while I was unconscious--- I was able to tap the dental assistant's hand with my finger --- she said " doctor, our patient is with us" and he said " can't be, and then I tapped again" and everyone laughed ---I then went "back to sleep".....
I once faced this and have told many people about it, but few would agree with me. Most laughed:)
This was 15 years ago when I was a teenager and I had to undergo appendicitis surgery. First, when I was given the anathesia, I had weird feeling as if I was breaking up into tiny particles like atoms. not being a chemistry major, I ccant explan more than that.

Then, during the surgery I woke up during the middle of the surgery . I felt immense pressure and weird pain. I heard the docs instructing for the instruments and saying thats theres lot of water, do suction. I wanted to say something, open eyes, move but couldnt do anything. I dont remember anything few minutes after that.

Later I told the nurse about it and she didnt beleive me. Then I mentioned the conversation that I had heard and that they did suction. And she was SHOCKED. I even remembered the OT nurse's name.

Later it was found that I had severe infection in the intestine and there was watery substance that needed removal.
I releived that I am not the only one facing this. Question for dccs here.....Is it possible that the same can happen to me when I go in for some other surgery. Should I make the docs aware of it. Remember this was 15 years ago.
Being an RN, it was not as bad as if I had no medical training. I woke up during surgery to correct bleeding after breast cancer surgery. I knew that I was intubated, could not breathe or move. I tried to relax so the machine could breathe for me and dozed off a couple of times. Once awake again, hearing the OR staff laughing and talking, I decided to try and move and eventually moved my foot. Someone noticed and told Anesthesia and they checked me and put me under. The next morning I asked the doctor if I had dreamed it or was I actually awake. He shook his head and said,"I'm afraid so". I would not want to experience this again. It is a little scary, knowing that you have a plug in your throat, keeping you from breathing.
About 20 years ago, I was scheduled to have a partial hysterectomy, vaginally, with a spinal as anesthesia. During the surgery I was also given something to relax me, intravenously. I was brought into the OR and relaxed and given a spinal. Unfortunately for me the spinal did not "take" and I could feel everything. I could feel tugging and pain. I was trying to verbalize that I was in pain. The medical student who was in the room heard me and said "Mrs. -- can you feel that." And it took every effort for me to (sounded to me like) loudly say "YES". Next thing I knew, something was put over my face and I was asleep. The surgery was performed under general anesthesia. The anethesiologist was nowhere to be found when I was in recovery and my mother and husband had to track someone down to get scripts for morphine because I was there with nothing. Spinal wasn't in effect and absolutely no meds. I was in so much pain I was shaking enough to almost fall off the gurney. I got nothing until I got to my regular room hours later. Then I was given morphine in each butt cheek. The relief was so much that I cried and the tears were running down my face while the nurses were bathing me to put me into my bed. I have never forgotten this. My doctor was totally unsympathetic and did not even want to hear about it. He said "are you still talking about that." when I mentioned it a couple days later while I was still in the hospital. I was disgusted and found another doctor immediately.
I woke up during surgery and, in fact, sat up. I was undergoing laser surgery and sat up on the table to see the doctor. I looked up at the anethesiologist who said "Good morning! Are we awake?" and I replied "Of course I am". The doctor at that point said "Why isn't she out? Give her more, make sure she's out."
I passed out after that but woke up when they were taking me out of the operating room. I was even having a very coherent conversation with the doctor.
It was a strange and disturbing experience, but now I must say that that I can laugh about it. But I feel very fortunate that I felt no pain as others have reported.
It happened to my wife. She was having surgery in her intestines, and woke up and was watching on the monitor. She suffered no pain, but was fastinated by the images. She finally asked if that was her on the monitor, and very quickly was put back to sleep.
I woke up during a test procedure where they ran a tube down my throat to scope out the area. When I woke up, I raised my head up off the table and began to gag because of the tube. A nurse noticed my head raise up and pushed it gently back down and said "we aren't done yet". They gave me more anesthetic and I went back to sleep. It was a horrible but luckily short time period.
15 years ago, during reconstructive surgery from breast cancer, I experienced what you are calling 'anesthesia awareness'. I became aware and realized I couldn't move or breathe, then began to panic. I kept thinking 'I have to move! I have to move and let them know I am awake!!!' I ultimatley starting moving my head back and forth, then I heard someone say something about giving me more anesthetic. I could hear the surgeon and others talking during all of this but I did not feel any pain. I had to have two more surgeries after that and told my physician and anesthesiologist about what I experienced with hopes that it would not happen again.
I have had 3 foot surgeries (both feet each time) where bone has been cut and reset with screws, etc. and 2 out of 3 times I woke up when I heard the saw start up and also when doctors (1 for each foot) were discussing my toe nail polish color (I forgot to remove it). I could feel them moving my feet around and my arm on the long thin table but never had pain and didn't realize it was possible, it didn't traumatize me or anything, I am lucky.
This appears to be a worryingly common experience. I am having a laparoscopy next week under my first general anaethetic since an emergency c.section in 1979. I am scared to say the least, as I exeperienced anaesthetic awareness during my c.section, and awoke paralysed to feel the unbelievable agony of the abdominal incision followed by hands and retractors literally ripping my abdominal muscle layer apart. It was so terrifying and excruciating I thought I was going to have heart attack and die.
Years later as a midwife witnessing my first ceasarean section in theatre. I wasn't surprised to have my operative experience confirmed in detail as I watched the way in which that particular surgery was performed. I only hope that anaesthetic technique has improved in the last thirty years.
I had open heart Surgery (2nd time), for my valve. I was 20 at the time. I believe I was awake during my surgery, however they told me it must have been after. All I know is that I was completely awake heard at least 4-5 people around me and talking. I panicked. I was scared that I would also feel something and then be in pain. The only thing I could think of to do was concentrate all my energy to my fingers or hands and try and move them. It worked, but then I heard them say I was having a seizure, which terrified me more, so I stopped. Someone had said something along the line of “give her an injection”. They sounded worried. Then I must have fallen a sleep. All I know is that after the surgery, I would wake up every 5 mins with a jolt and this happened for some time. To this day I wake up suddenly every couple of month that way and I know it is related to that event. It has been 9 years now and the next time I go for snuggery I will have that on my mind. I don't think I will ever forget that.
I think my story may be quite relevant. I used to feel very similar things when sleeping (I still experience them, although less frequently). It's quite scary, actually - I'd often wake up from sleep only to realize that I can't move (like being inside a corpse), can't even breathe! Any attempt to move (or breathe) would cause pain in the corresponding body part (in the chest when I tried to breathe), and correspondingly I got really scared. Trying to shout out only makes it worse.

I think it happens more often when I can't breathe freely (e.g. if I turn my face into pillow), but not always. Also, the only way out of it is to quickly try to calm down, stop trying to snap out of this state and try to think hard about something, try to concentrate on some mental image. It's not easy to calm down though when you're scared s**tless and can't breathe.

And, maybe it can be relevant - sometimes during my sleep, I "wake up" inside my dream. I can continue to see it , hear it and be in the dream - realizing completely that it's a dream, even thinking about something else, or slightly (very slightly) manipulating what I see. But when I try to concentrate to manipulate the dream to create a "dream on demand", the more I concentrate, the more the dream fades away. At first, the "picture" fades away completely, and soon thereafter the "sound", for whatever reason. Then I wake up in disappointment..

I've never heard about anyone experiencing anything like that before now, when I saw the feature about anesthesia awareness. Anyone else like me here?
I had a reaction to some of the drugs used to sedate me. The drugs paralyzed me. I could not move or breathe or indicate that this was happening to me. After what seemed like an eternity, I heard Priscilla the nurse say, "I can't locate her pulse." Evidently then I passed out. When I questioned the docs and RNs later, they said everything was OK. Even after 30 years, it still scares me to think about it.
Okay, let me get this straight. This happens in ONLY 1 or two cases out of every 1,000...and there are 30 million times anesthesia is used...that amounts to between 30,000 and 60,000 cases every year...if it is only under-reported by 50%...that means between 45,000 and 90,000 cases a year of anesthesia awareness. Somehow, those odds still are not reassuring to me. I have had a couple surgeries, however, I have fortunately never experienced this phenomenon.

I have not seen the movie, nor am I interested in seeing it. I am fairly young and may have to undergo surgery sometime in my future. I don't want to have those images in my mind as I'm trying to decide whether to have any future medically necessary surgeries.

Thanks for the tips. I'll be checking on the brain monitors in our local operating rooms and asking my doc LOTS of questions.
Serge - you had sleep paralysis - different, and fairly common.
I have not had anethesia awareness under general, but had terrible pain during colonoscopy, as nobody took my warnings seriously about my existing tolerance for one of the muscle relaxing drugs. I cannot imagine ever undergoing a voluntary procedure of any kind, after that horrible experience.
I live in Japan. I am American and I haven ever had a major surgery, Im 29. Knock on wood.
I post because here in Japan they have a phenomenom called "Kana Shibari". Its like waking up but your body is still asleep. You can look around sometimes but you cant speak or move. Its supposedly very scary and the oddest bit is it happens OFTEN in Japan.
I had never even heard of this in the USA or in Europe when I lived there. It sounds oddly familiar.
Is it me or are Americans never grateful. Just over 100 years ago you'd have a much higher chance of dying during anesthesia, if you could even get any. Nothing in medicine is perfect, and it never will be. There are too many variables. Physcians do their best, and I don't know any surgeons or anesthesiologists who say, "You know what, I'm going to do a half-assed job today." The stakes are high under the knife and everyone takes the job seriously.
I just wanted to comment on this entry because it has personally touched my life. I caught the last part of Larry King when they aired the "Awake" segment (I was waiting for my favorite show, AC 360 to come on!). Unfortunately, I was subjected to a botched operation. However, I did not have to go through an incisions or complicated surguries, it was a relatively routine procedure.When I was 14, I had an endoscopy done so the doctors could take biopsy's of my GI tract. While the doctors were putting the tube down my throat, I woke up and had a panic attack on the table. I was not fully "under" but I was fully aware of the situation. The only possible way to describe the feeling would be to compare it to the waterboarding technique that has been in the news recently. After the valium was increased, I woke up a second time while the tube was in my intestine. While I was suffering through another panic attack, I could hear the nurses and the gastrointerologist trying to calm me down. Luckily, I fell back asleep quickly. After that harrowing experience, I was adamant about never submitting to any kind of test like that again. I sympathize with all the victims of these unfortunate events. It's hard to trust a respected professional again after such a horrific accident.
This happened to me during a routine Tubal Ligation. I woke up during surgery after under anesthesia for 1hour and 1/2. I woke after I felt this tugging sensation in my abdominal area. I woke screaming "I can fell it, I can feel it!!!". Then all I could see was the nurses and the doctors scrambling around trying to put me back under the anesthesia. Next thing I knew I woke in the recovery and nothing else was ever mentioned about the incident.
I think this happened to me yesterday. So I got on Google and looked for information and found this article. I believe I woke up during my oral surgery. I opened my eyes was unable to comprehend what I was looking at. I heard the heart monitor start to beep faster and I was out again. I can't be sure that this actually happened, I was too loopy immediately after my surgery to think to ask the surgeon or one of the nurses. I'm lucky that I didn't feel anything when I woke up.
I am a redhead with a long history of resistance to anesthesia. A single shot lasts just a minute or two and sometimes less than that. Oral care, stitches, you name it, the shot given to numb the pain just will not work. Even worse, "sleep anesthesia", spinals and general anesthesia have caused countless problems. Years ago I sat up during a D&C. No pain, but I heard the doctor yell at the anesthesiologist to "PUT HER THE HELL BACK UNDER". My three C-sections and hysterectomy were horrible experiences that left me deathly afraid of any further surgeries. My last C-section resulted in a shouting match mid-surgery between the "crew" and myself because I was in so much pain. The pulling sensation was so powerfully painful it felt like they were taking the baby out starting between my ears, down through the middle, and with all my insides taken out with the baby! I felt like the fish I used to gut. I have since learned that redheads may have a problem with anesthesia so I tell my anesthesiologist to keep me in blissful heaven or there will be hell to pay. The colonoscopy I recently had (with just a "sleep" like anesthetic), turned out just fine. I slept a little longer than usual afterwards but that was fine by me. And yes, I told the anesthesiologist about the difference between heaven and hell before he put me out.
I have "awakened" during every surgery I have had, although have never felt any real pain. I never found it disturbing however; I've always thought it was cool. I have had 2 heart surgeries, 1 back surgery, an appendectomy, and too many cardioversions to count. All were under general anasthesia, and all but the cardioversions included being on life support. When I "awoke", I could hear, knew who I was, where I was, and understood what was going on. I always figured, hey, the doctors don't sound conerned, why should I be? It wasn't like I could do anything about my situation, so just listened and eventually I went back under.

The first time it happened, I asked my surgeon if it was possible. He asked me what I overheard and when I told him, he confirmed the conversation. He asked if I had felt anything and that it can happen. He made a note in my file concerning the event. As time went on, I would make comments about things that I heard, which my mother thought was hilarious as I was asleep at the time of each event. My mother and cardiologist even did an experiment by staging conversations to see if I would recall them when I came out of anesthesia. I always did. But then, according to my mother, I carry on entire vocal conversations with myself qhile asleep or under anesthesia. My doctors have also confirmed this.

Everybody is different and responds differently. I have had so many "not suppose to be possible" reactions to things, that I just take it in stride when oddness occurs.
I didn't actually wake up during surgery, I just never fell asleep. The paralyzing agents they used took effect before the anesthesia did. I felt my throat close up and my body completely paralyzed. I tried to the doctors and nurses that I couldn't breathe, but I was unable to move. It felt as though someone was choking me. I heard one of them say,"HMM... that is strange." Then another said ,"Yeah, she seems to be in distress." They must have realized that I was still awake and maybe administered more drugs to make me pass out. Meanwhile, I thought to myself that this was it.I was going to die and I would never get to see my children again. When I woke up after surgery I was extremely upset and tramatized. The doctors downplayed the whole situation, but how could I expect them to understand. He said jokingly to me, "Oh I wouldnt let you die." Not very funny if you ask me. I have had numerous surgeries and I always felt like it was no big deal, and it couldnt happen to me. Now I feel like if I ever have to have surgery again it will be like reliving that tramatic experience over again, I just dont think I could do it.
This also happened to me after a routine Tubal ligation. I could feel intense pain in my abdomen (which my doctor later said was the clamping of my skin.) I couldn't move or speak, and eventually went to sleep. This has me really afraid to have surgery again.
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