I had a breast augmentation in 1997 and was told this procedure would be performed under twilight sleep. It was my first surgery ever. They explained I wouldn’t feel anything and wouldn’t remember what took place. Once the Doctor made the incision, I was fully conscious. He took a metal spatula type tool and began scraping my chest muscle up and off of my chest wall. I felt severe pain pain and began to cry making no sound. I tried to speak but only a slow, very quiet moan came out. I kept trying to speak as the pain was unbearable. Tears streamed down the sides of my face when a nurse looked at me and said to the Doctor, she’s feeling this! Administer more.. NOW! I was out afterwards. When I woke up, I vividly remembered what happened. It was traumatizing. From here on, if I have to have any procedures done, I tell the Doctor twilight sleep DOES NOT work on me. I need to be put completely out! I believe not everything works for everyone.
I've had nightmarish responses specifically to Versed (midazolam); I constantly went in and out of awareness during wisdom tooth surgery and one other surgery. I have been told be anesthesiologists that this response is not uncommon. But it continues to be used specifically because it impairs memory, which seems really sketchy to me. Since those 2 awful experiences, I have shared my experiences with doctors in planning for procedures. and asked specifically for propofol, and have never had a problem. Propofol is not considered general because for short procedures at least, you don't need to be intubated, but at least in Massachusetts, it's required to be administered by a dr or nurse that specializes in anesthesia, and you are truly out and you don't remember anything.
In 2004 I had laporoscopic inguinal hernia repair in Key West under general anaesthesia. Afterwards there were bruises across my chest. The following night I had a vivid nightmare of struggling against restraining straps and cursing. I've always thought this was a replay of the surgery.
Later that year I had another hernia repair but this time at a hernia clinic in Miami. I asked for as little anaesthesia as possible and apparently the practitioners bent as far as they felt they could, so I was awake at the start and finish. It went fine and I had no nightmares afterwards. The surgeon was curious to know when I had been awake. It also helped that this was open surgery repair, not laparoscopic hernia repair which is a pointless rip-off.
@Zack Taylor Thanks for sharing your story. It would be really interesting to know how the medical team explained the bruises, and what they told you about your behavior during the first hernia repair.
Since I have reflux with Barrett's Esophagus, I need regular upper endoscopies, and at my age, the occasional colonoscopy. I have no recollection of my first upper endoscopy, done with the benzodiazepines, and even the discussion with the doctor afterwards was fading from my memory by the time I got to the car, so I asked the driver to help me remember.
The second one was quite different: I remember every detail--including the bunching up (and weight) of the camera probe in my stomach as my duodenum was examined. I can remember it still. I suppose the dose was too little. I thought I would gag, but my experience, unlike the author's, was pleasant and interesting. This was similar to my first colonoscopy where I was conscious the entire time watching on a screen as the probe went through my colon. I remember it like it was yesterday.
Last year, I had both procedures done at the same time. But by then the same place was using Propofol; an anesthesiologist had to administer it. I remember them having me roll over on my side, and telling me to bite down on a rubber guide of some sort, and then it was lights out. I bit down on the guide then woke up feeling great, and a little surprised it was all over (both ends even!).
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For a colonoscopy several years ago, the doctor said he would give me Valium and Demerol. I said that I had been prescribed those drugs in years past after a car accident and he should please use "a lot" because I felt I had a real tolerance for them. Well, I awakened in the middle of it - Doctor: You have to stop screaming! Me: You have to stop hurting me! Thereafter, a different doctor, a different facility, all subsequent colonoscopies under Propofol, and no issues of awakening during the procedures - just a sad understanding of why Michael Jackson must have loved the drug as I woke up feeling incredibly refreshed each time.
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An important reminder that in medicine, as in all other areas of human life and functioning, reality's ever-present interacting dimension's of uncertainty, unpredictability, randomness, and lack of total control, no matter the level, types and quality of our efforts can and do operate. Making an accurate prediction, for possible prescreening in a treatment plan, based on a large or small "relevant" sample, for a specific person, at this point in their life, and contexts, is always a "risk." Risk being a probability and not an unalterable, unchangeable, for-ever-anchored fact. For the patient anesthetized with the "no memory," NON-guaranteed, their 100% unexpected PTSD following unexpected awareness, is not some numerical % in a published paper. Or presented at a conference. It's real. It's unwanted. It can be lifetime.The doctor and the team, in all likelihood, did what they always have done. Successfully. This time not! And for the patient, under full anesthesia, successfully operated for a given condition, who is now a "vegetated" BE ing, if there was no medical negligence, or pathological process operating, the doctor and the team, in all likelihood, did what they lways have done. Their success ALSO resulting in a failure. Why? How? Not having an adequate explanation, we semantically describe: Luck. Good. Bad. Thank you for sharing your experience.
This totally happened to me about 10 years ago with an endoscopy. There is a history in my family of needing more pain meds/sedation meds, etc. than should be required for our size, so I told them as much. Apparently they didn't get the memo. Woke up in the middle and was absolutely terrified...I honestly thought I was going to die, so I fought viciously to get myself out (I ripped out all the tubes and physically assaulted the nurses trying to hold me down) until they could get someone in the room to administer enough meds to fully knock me out. Honestly, I'm surprised that I didn't successfully make it to the door!
I've had major surgery since without issues, but I would refuse conscious sedation in the future (I made have foot surgery this year and plan to tell them this). The commenter Biff clearly hasn't had any of this happen to them (or perhaps is a medical professional who is angry about potentially litigious patients?)...
Thanks Kimberly. I would love to hear more about your experience if you could contact me directly via the link at the bottom of the article?
Hey everyone, it’s called “conscious” sedation not “unconscious” sedation. You can’t claim to have been awake when you were told you would be conscious. If you want general anesthesia, then ask, and if appropriate, you will be unconscious. Some procedures do not require general anesthesia. The idea is for anesthesiologist to give standard of care, least invasive method appropriate to the procedure. Perhaps people should read the information they are given and then not be horrified or get PTSD after receiving exactly what they were told. Buck up buttercups.
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@Biffnyc Thank-you for your comments, which highlight a number of common misconceptions. Patients are generally not bothered by simply being awake. It is when awareness is accompanied by pain or fear that they are distressed. No consent form states that along with possible awareness there is a chance you might have unbearable pain or that your altered state might mean you don't recognize your surroundings or what is happening to you. Additionally, there is no mention that you might be physically restrained or that the medical team might ignore your attempts to stop them. Finally, there is no mention of the risk of possible flashbacks, nightmares and psychological sequelae that might last for months or years, possibly impacting your ability to return for future medical care.
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@Kate Johnson In consent forms it is not possible to list every unlikely, rare occurrence. It is extremely unusual for what you describe to happen. If you are restrained it is to protect the sterile field. None of these things happen for nefarious reasons. This is all in the interest of the patient as a whole. Millions of anesthetics, sedation and general, are given each year. This article makes it sound like these bad experiences are commonplace which is a lie. Should your surgeon list every blood vessel that MIGHT get nicked during the surgery because twice in her lifetime she saw this happen. Get real. There are no absolute guarantees. People go into medicine for humanitarian reasons. If it was for money, they'd go into investment banking.
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@Biffnyc
Wow, I’m a retired RNFA, based on your comments it’s plain to see you are not remotely acquainted with what “humanitarian” means. Medicine, Nursing, and associated professionals should be filled with compassion and empathy neither of which you possess. Find another career. You are a danger to the patients who have the misfortune of coming in contact with you. BTW, Patients are restrained for their protection not your convenience.
Telling someone not to get PTSD is like telling someone not to breath. One does not plan to experience a traumatic event, they just happen.
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Meniscus repair L knee. Awoke fully conscious while Dr was entering my knee with instruments.
Pain was overwhelming... I raised from the operating table to grab for my knee. As I was grabbing for my knee I heard the Dr tell the nurse to “knock him out... give him more anesthesia, more now”. I completely remember the ordeal and to this day just talking about it causes anxiety. After surgery in post op recovery the Dr came to tell me what has happened. He actually complemented me telling me under sedation Drs often see the real personalities of their patients and I had showed strength and restraint. Dr apologized profusely for the incident (as he labeled it). There began my fear of being “put to sleep”
Subsequently I’ve awakened during a colonoscopy and a dental procedure with a complete awareness and the feeling of pain.
I recently had another meniscus repair on my right knee. Prior to surgery told anesthesiologist about my experiences with sedation. The Dr responded “I guarantee you will not wake on my watch” which I did not awaken during the procedure. Had dental surgery and told Dr about my awakening from anesthesia experiences... he too assured me that would not happen during his surgery. If they administered additional meds or other meds I do not know.... I stayed asleep thank God!
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I had conscious sedation with my colonoscopy. Stress on Conscious. - I have clear memories of seeing the screen with the camera images of my innards on it. I heard the doctor say that she had removed 2 polyps and I saw the little vial with them in it. I felt the instrument go around a corner and winced. The nurse told me that the amnesia part of the drug cocktail would kick in and I wouldn't remember the event. Well, 10 years later I am still waiting for that amnesia drug to start working. It probably helped me deal with things that the discomfort was pretty tolerable. And that I was conscious enough to talk.
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I had a cesarean birth with my second son. C-sections are commonly done with a local but that hasn't always been the case. It was such a bizarre (and very traumatic experience) but being awake and hearing him cry for the first time was so incredibly powerful. I even held and nursed him as they continued the surgery. I have to have another surgery and I have elected to do it with a local because of my c-section. Being able to talk and hear my providers was empowering. I was able to ask for things and let them know how I was feeling, physically and emotionally.
As a doula, I have been on the other side of the table. I worked in a hospital where they allow staff doulas in the OR. I was able to engage with the mama and advocate for her in ways that one can't do without a second support person.
Having had both of these experiences, I think most surgeries should have an option for a support person if they conditions are right. I held a mama's hand and told her what he baby looked like (she was unable to hold him due to medical attention needed to her baby). Our support personal played music and sang with me when my son was born. It was such beautiful experience to turn something so unexpected and so traumatic into something empowering.
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I had shoulder surgery with a "local" anesthesia--i.e., no general anesthesia but with sedating medicines. The surgeon said almost nobody requests this. I remember lying there, with a blue cloth over my eyes, hearing the operation. At one point the surgeon leaned under the cloth to ask me how it was going. I believe I said "fine." It was cool.
It was a nice memory.
I also had foot surgery under the same conditions, although that anesthesiologist gave me too much medicine and I don't remember it. I do remember becoming alert and seeing a bunch of people surrounding my foot, and my toes cut open. I asked some type of question. My memory was that everybody freaked. And someone said to give me more medicine so that's all I remember. I have no memory of feeling anxious or afraid--in fact I had wanted to be alert during the procedure.
For most of my life I passed on Novocaine when getting something done with my teeth. Hurt a bit more, but that was to be expected. (I also believe that Dentists are more careful when there is no Novocaine).
I don't enjoy pain--in fact I'm a wimp. But when it's my body I want to be "there" as much as possible when something is happening to it. Give me as much medicine as needed to cut the pain, and no more, and then let me be there.
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I awoke during a colonoscopy. I remember opening my eyes, looking around and then closing my eyes. I don't remember any pain or discomfort, just being awake. I was told by my doctor afterwards that, even though I woke up, they decided not to give me more anesthesia because at the time I woke up my blood pressure fell abruptly. There was an anesthesiologist present. There is much variability to our responses to these drugs. I also have a part of my mouth, lower left jaw, that is very difficult to anesthetize with novocaine. I have had had several dental procedures in that area with the same dentist, and he told me I have an unusual configuration of nerves in that area. He is very respectful of my pain and inevitably winds up numbing the entire left side of my face before proceeding.
@Lila
I had a similar experience during a root canal on a tooth in the upper left jaw. The dentist injected me multiple times until he reach the maximum amount of local allowed. The entire left half of my face was numb except that tooth. I chose to continue the procedure, I’d rather endure an increase in pain for a short period of time rather than spend days in pain waiting for the rescheduled appointment.
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You were supposed to be conscious, so you didn’t accidentally wake up during the colonoscopy. Being awake and some memory is what conscious sedation is by definition.
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@BMUS I had 2 root canals with the same experience." Sorry, I have given you surgical doses of novacaine, and I can't give you anymore." I cried during the procedures.
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About 10 years ago I had a parathyroid gland removed at a major NY hospital. At some point I woke up and saw the blue fabric covering my face just as Ms Johnson describes. There was no pain thankfully but I wiggled my feet like crazy and then suddenly was back asleep. When I mentioned this later it was poo-pooed.
Now I know it was not my imagination!
I question when these consious sedation cases were performed. It is the state of the art for most upper endos and colonascopies to have propfal sedation adminstered by a certified anesthesia provider, CRNA orMDA. Midazolam and fentanly were used up to 5 years ago as insurance wouldnot pay for the anesthesi provider. Now most endoscopists bundle the cost of anesthesia in with the cost of the procedure.
Likewise, propofal is used for sedation cases whenthe patient does not need to respond to the proceduralist. In my many years as a CRNA, I have always said that sedation is just that and you may remember. It is not a general anesthetic. If a general anesthetic is what you need/want, you need to clear it with the doctor doing the procedure.
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If you can disassociate the scourge called Scientology from Hubbard's preceding book, Dianetics, you may find the answer. If Dianetics was right in it's theory about the recall of trauma being the source of many subsequent psychological ills, then stress as a post-anesthetic event is clear. So is its treatment.
I was involved in some pre-publication research in my university. The problem was that if Dianetics worked, which to some extent it absolutely did, then Psychology, with a capital P, was largely a hoax - not completely, but as it's practiced in America, yes.
So the Psychologists various Associations chose to laugh Dianetics out of further research.
Hubbard, who was brilliant, had written some science fiction books back when no one took that seriously. He was also a brilliant semanticist. He worked with several very avant garde people in brain neurosurgery and also in extremely advanced theoretical math to create the theories of Dianetics.
Unfortunately, when he wrote Dianetics, there were no words that fit some of the details, so he created new ones - or added new meanings to old ones, just as is being done constantly now. Those terms were what our psychological establishment used to laugh him out of continuing the research.
In Hubbard's anger as a publicly pilloried intellect, he created Scientology which tarnished him forever. And psychology continues to drain the pockets of our wounded society.
I wonder whether some doctors over-sedate patients undergoing colonoscopy to avoid possible legal hassles. My colonoscopy and upper endoscopy was early in the morning, but I was essentially "out of it" for most of the day. When I served as the "resonsible adult" for a friend's colonoscopy, even several hours after he got home he was still so groggy that I was afraid to let him climb the stairs to his bedroom.
I know sedation doesn't have to work that way. When I had my wisdom teeth out, it was a "complex" protracted surgery. Each of the four teeth was a different "textbook case" of difficult bony impaction, and I was 39 years old. My recollection of the surgery was "bite block in.... bite block out." Nothing in between, no pain, no distress. And within a few minutes after the bite block came out I was fully awake and walked easily to my dad's car (though I certainly would not have even thought of driving myself).
I suspect that if conscious sedation is done with proper care, it will very likely achieve the desired goal of low distress and amnesia. But if it's done with a focus on protecting the doctors and facility from the threat of lawsuits, or worse with a focus on keeping the assembly line running at top efficiency to satisfy the CPAs and MBAs who oversee the surgical facility as a profit center, the result will be less than optimal.
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@Ted often it is impossible to give someone enough to make them totally amnestic when using CONCIOUS sedation. As the name says, you will be conscious and breathing on your own the whole time. Care has nothing to do with how a particular person will react.
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When I was 23 I had a significant abdominal surgery. I had trust in the surgery team. After I told them I was awake. They said No it was my imagination. I quoted their conversation. They left the room. That was 40 yrs ago.
The memory has faded. I no longer have nightmares. But I have a sharp pain in my gut, and a quite fear deep inside, even if I have a splinter to come out.
I remember and so does my body.
But I am alive.
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@murphy I'm the author of the piece and would love to hear more from you please, if you could contact me through the link at the bottom of the article?
One way to make any "twilight" procedure on a patient much more nurturing would be to make it common practice to have a support person (for moral support, ideally a family member or close friend but otherwise a professional or volunteer, in the nature of a doula—but for any procedure) in the room (sitting on a chair, some distance out of the way).
Having a calm and loving support person in the room with the patient (who can lovingly and gently talk to, praise, and reassure them) while they undergo any "Twilight" procedure is a great boon but also common sense and should just be common practice in hospitals and clinics.
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This makes a lot of sense. I had a second c-section almost 6 years ago. My husband waited outside while the anesthesiologist had difficulty getting the spinal block to work. I passed out on the table (I have lower than average blood pressure and tend to hold my breath in situations where I feel anxious) and woke to find several hospital staffers hovering over me with concerned expressions. My son’s heartbeat had fallen and everything sped up. It was terrifying. Fortunately, a nurse had gone to fetch my husband. They ran into the OR and, upon seeing him, I immediately felt relief. Still afraid but not alone. Stands to reason that having a loved one in the room would provide similar comfort, even during more routine, uneventful procedures.
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Definitely. I awoke in the middle of a dental procedure to extract teeth (2) to prepare for implants. What awakened me was the dentist tugging and grinding away at my teeth. I went right back to sleep, but have been feeling pretty strange most of the time since --unexplained bouts of sadness and lethargy as well as a total recollection of the noise and pressure of the event. This happened last October, 2018. I should add that one reason I sought out a new dentist was a nigh-phobic fear of dental procedures. In the interview the dentist's description put me at ease...hah. If it's 3 in 10,000 that's I suspect a very lowball figure. And it cost out of pocket (I'm uninsured) an extra $477 for the sedation! So how can they adjust the level of conscious sedation, or should I just go for sodium pentathol and a new dentist? Thanks at any event for writing about this (and current plan is to go back, mid-four-on-one, to a dentist equipped with pentathol).
I have woken up 2x during a hernia repair (the 2nd time to the sound of the stapler inserting staples). I have woken up during a colonoscopy, asking about what was on the screen. The worst time was when I recall having a knife repeatedly scrape against the inside of my neck, during an effort to remove a lymph node. My surgeries are numerous. I tell the anesthesiologist what has happened before. One time - after a colonoscopy, I slept most of a day afterwards. I feel sorry for anyone who experiences trauma, as I seem to have a better ability to quarantine my experiences.
@Bruce Maier Thanks for commenting on my article and I would love to hear more from you via the link at the bottom of the piece.
I experienced "waking up" from "conscious sedation" during a colonoscopy. I was in terrible pain but I was unable to speak or move in any way to communicate this to the surgeon. When I told him this later he said that he had some trouble near the end and had to stop and not go farther. I was sure I would never have another colonoscopy because I was too afraid; it was such a terrible experience. I needed one several years later and had one with trepidation and full anesthesia. I wonder whether the popularity of doing these procedures in clinics outside of a hospital where full anesthesia is not available, as well as caution around the use of anesthesia, has contributed to the popularity of conscious sedation. I have no idea of the prevalence of "waking up" but it should certainly be calculated and offered to the patient as a possible negative when the decision, as to what sedation is to be used, is made. But then, no one would choose conscious sedation and the non hospital procedures would have to stop.
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@Sarah Thanks for your comments on my article. I would appreciate if you could contact me through the link below so I can get more details?
Didn't Michael Jackson die from an overdose of propranolol?
@Philip Martone
No. Michael Jackson had a combination of a number of medications in his system that resulted in his death. Propofol is the one most associated with his death. It is a sedative that in high enough doses can result in obstructive sleep apnea. Because of the depression of consciousness, the subject cannot wake up to correct the inability to breathe effectively.
Propranolol is a different class of medication that can be prescribed to lower blood pressure or slow heart rate, which may decrease performance anxiety.
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You mean propofol. The problem is that it was given at his home, in his bedroom, by a cardiologist. A recipe for disaster.
I had my gall bladder removed years ago, under general anesthesia. I’m not afraid of surgeries and knew what the doctors would have to do in details. However, sometimes I have nightmares in which I experience an extremely uncomfortable feeling of something being sucked from my abdomen. No pain, but great discomfort. It took me a long time to understand that it’s probably a residual memory of the surgery. It would have been better, if possible, to stay awake and follow what the doctors were doing. There’s a possibility I wouldn’t have these nightmares. I chose not to be medicated at all when I underwent an endoscopy. It hurt just a bit, I drooled a lot, but as I was participating, the event wasn’t traumatic at all.
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@HLN Thanks for adding to the discussion on my article. Your story is fascinating and perhaps suggests you have implicit memory of the surgery. Please could you contact me through the link at the bottom of the article? Thanks
I am one of those people who "remember" when totally "sedated" under Versed. I have dealt with PTSD associated with what happened while "sedated."
It was horrible, frankly, and I'm very happy people are finally looking into this. No one should have to experience what I did.
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@Lynn Taylor I would love to hear more from you about this Lynn. You can reach me through the link at the bottom of the piece
Although I was an RN for 33 years, I had no knowledge of muscle memory until I rode in my first century bike ride. If your body remembers how to ride a bike for 100 miles, where are those other memories ?
In August 2017, I was hosting for ECT therapy but of severe depression. Two months of three times per week, I had no fear but I didn’t care about anything. When I became an outpatient, the fear began slowly and developed to having to be sedated before being wheeled out the room. The sounds, odors everything set off a profound fear. I haven’t been able to return for maintenance therapy but the depression is in remission. My body did remember
Thank you for this article: I thought I was out of my mind. I have had three recent procedures under conscious sedation and I remember portions of each one.
1) The first time I felt a lightning bolt ripping through every nerve on one side of my face. Then chaos as they struggled to get me more oxygen, a mention of giving me more something and then nothing until recovery.
2) The second time required a long wait after an injection still theoretically under sedation with my head tilted back. The doctor was gone, but I asked the nurses and anesthesiologist how long it would take until I knew if it was going to work. They said "you'd know by now," at which point tears just started streaming up my face. And the nurses stood around asking each other what was wrong and one said something like "she knows it failed." I remember everything from then onwards.
3) The third time I awoke to the excruciating pain as I was having an injection fill my cheek with a golf ball sized amount of steroids and anesthetics which was pressing down onto my damaged nerve. I started to cry and one of the nurses came over and held and stroked my hand while I sobbed. If I ever see her again, I will thank her.
Each time they told me I wouldn't remember anything, and when I relayed memories immediately following the procedures they said, "people occasionally remember temporarily, but those memories are almost always lost." When I mentioned it at follow-up appointments, they acted like I was making it up.
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@A friend Thanks for commenting on my article. I would love to hear from you via the link at the bottom
Years ago, during abdominal surgery, I kept hearing someone screaming and thought, "I wish they'd hush that person." After some time, I became aware that I was the person screaming, and I was in terrible, terrible pain. I struggled to calm myself enough to speak and finally managed to grasp the coat of the anesthesiologist and gasp, "Please help me!" He said,"We will, but we want you to breathe awhile." I continued screaming.
I checked my records afterwards. No mention of the incident or of any breathing difficulty. I should have sued.
Later surgeries produced similar, though less drastic, results, despite my alerting doctors to my previous wakings. If I ever require surgery again, I will research the anesthesiologist and meet prior to any procedure. No patient should go through such nightmares.
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During oral surgery in the 1980's I woke from light sedation. The memory remains including my dialog with the dentist who was clearly bothered by my protests. He continued without administering additional anesthesia. I've experienced conscious sedation multiple times since that incident without waking or remembering the surgical portion of the procedure. Clearly, the drugs used for conscious sedation have improved over the decades. However in the hands of the uncaring horrible memories can result.
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While in Gainesville, Florida, I had the rare opportunity to be part of an experimental treatment program that opened up the shared Tibetan medical practices (in conjunction with the Univ. of Gainesville medical school) under His Holiness, The Dalai Lama. I was being treated for headaches and mild depression.
In a cold amphitheater, before hundreds of residents, the Tibetans, examined me and announced their prognosis -
“She is suffering because her womb was torn from her.”
The words released a searing and torrential flood of emotions - lost memories, pain and a visceral recognition of a hysterectomy a few years earlier. It was as if everybody cell in my body burst forth in quivering recognition.
That hysterectomy - done in the most modern American hospitals and with state of the art drugs, was hiding under my radar of cognition. It was released -
In it’s primitive horror.
And true healing began.
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@Athena
It is amazing that the monks could know that, it seems that the healing process was just as amazing for you. This article and your reply shows hoe little we know about the human brain and mind. Best wishes to you!
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I have had two hip replacement surgeries and two cataract surgeries. First hip replacement, with a spinal, I asked not to be completely unconscious because I was curious. I remember talking a bit with the nurse-anesthetist, and ALSO hearing the saw, and feeling a hammer. I had no fear—just wondered what kind of saw. The second hip replacement, I remember nothing. But the Dr. told my friend, and me later in the day, that when he made the first incision, I said“Hey! I felt that!” So they gave me a General at once. Must have also put in some versed. I have no traumatic effects from what must have been quite painful, and remember only what the surgeon told me later.
My first cataract surgery, I remember nothing, so I asked to be less sedated the second time. The Anesthetist said OK, but there was versed in it and even with less I probably wouldn’t remember. He didn’t give me any till they took me in to the operating room, and kindly pointed out the machine with which the surgeon operates, and talked about what they were doing. Then I don’t remember anything of the surgery. My daughter, who was in the recovery room, reports that I told her that after the surgery, I had been taken in to the “Jungle Room”, which was a real jungle, that everyone really needed to experience! I don’t remember the jungle room, OR telling my daughter!
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In 1965, at the age of 10, i underwent open heart surgery. i had general anesthesia, and was on the operating table for over 10 hours. i have suffered from anxiety and depression ever since. there is no question in my mind that the events from that time precipitated what i now understand to be ptsd. 30 years of psychotherapy have given me perspective, but the condition persists.
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@candix
Have you looked in EMDR?
“EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. ”
In just three sessions, I experienced relief from a traumatic experience that had been treated with years of traditional therapy to no avail.
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In my mind, there is absolutely no way that there is not a negative subconscious impact with every single surgery performed. The idea of going under anesthesia scares the tar out of me. Absolutely no mollifying or minimizing statement by any doctor is going to convince me that there are no lasting negative impacts from being anesthetized and operated on. My heart goes out to Miss Johnson.
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Thank you for this article. Just had an uneventful surgery. The surgeon did ask if I had problems with sedation. Wasn't sure what he meant -- thought nausea -- and said no. But this article brought back a memory. In 2002, I had exploratory surgery to see if I had temporal arteritis. I did not. But, I did wake up as they were stitching the incision closed. I said I was awake. They said I wouldn't remember. I do remember. Not pain but rather smells (coppery blood among others), the unpained stitching, the pressure of it, an odd popping sound as they stitched. I found it interesting. Many years ago I had surgery in Chicago. The surgeon did come to apologize for something that happened during surgery. He said that research showed that at some level people did remember surgery despite sedation. So he apologized. Guess next time I'll say that I was awake and aware as I've described.
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I have had 4 colonoscopies. The first time, Versed was used; I was conscious the entire time and had no problems, but afterward I felt drugged for more than 24 hours and had swelling at injection site; they told me the drug probably didn't go into the vein and thus took longer to clear. At my request, my next 2 colonoscopies were done without any anesthesia or sedation and were good experiences; they told me that if there were any difficulties during the procedure, they would pause and the nurse would give me Versed. But when I showed up for my fourth colonoscopy, they had hired an anesthesiologist, and I was told I couldn't have the procedure without anesthesia because they had no Versed on hand to give me if difficulties arose, so I was given propofol, which did NOT wear off quickly, as they had told me it would; once again, I felt drugged for at least 24 hours. And my procedure was MUCH more expensive because of the anesthesiology charges; I didn't have to pay, but this is a terrible practice. In Europe, almost everyone has colonoscopies without any anesthesia or sedation.
We need to know that we can ask about the anesthesia we will have and meet the person who will do it before signing any papers. Once I was brought in to emergency at the Zurich university hospital after an accident and as I had all my health details on my phone the surgeon knew everything about me. But the anesthesiologist still checked everything with my own doctor, it was 6pm on a busy Friday evening, and kept me conscious long enough to let me know what he was going to do. I relaxed, trusting him completely. After that I was under for 6 hours while a team of ten worked to save my smashed arm. They did it and I’m forever grateful.
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Just over 4 years ago, I had a lung biopsy. I was told that I would need to be able to follow the surgeon's directions for when to hold my breath, etc but that I wouldn't feel pain or fear and would not remember much. Although I didn't feel actual pain except very remotely, I was in absolute terror and anxiety through most of the surgery. I remember the doctor/student conversations, I remember talking to the doctor about where he lived, etc. I remained in a state of anxiety and trauma for more than a month. Eventually I was able to remember the steps and emotions of the surgery and retell them in my mind, which I did at least once a day until I was able to finally, sort of, remove some of its power over me. That said, I don't know what I would do if my oncologist recommended another lung biopsy. I also find it telling that I had the same surgeon for a subsequent port placement and he seemed very uncomfortable by the fact that I could remember our conversation and the surgery. Since then, with port removal, lumpectomy, colonoscopy, I have been out in muh heaveier anesthesia (not at my request).
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@MBC Thanks for commenting on my story. I am collecting patient accounts and would love to hear more from you if you could please contact me through the link at the bottom of the story?
@Kate Johnson
http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2670190
Moderate sedation (conscious sedation) does have a specific definition within the anesthesiology community. The specific degree of sedation is defined by the ability to respond with purpose and the stimulation required to get the response.
Unfortunately "conscious sedation" is poorly named because patients are frequently not conscious. Anytime a patient is conscious, speaking, or moving purposefully there is a much higher chance that patient will have explicit memories. It would be misleading to tell a patient that she will definitely not remember such an experience. Even when a patient is minimally responsive she can have explicit memories.
The information that an anesthesia provider uses to change sedation depth include responsiveness and vital signs. Any sign of stress indicates deepening the level of sedation. Physiologic signs include increased (faster) heart rate, increased blood pressure, and increased (faster) breathing rate. The limit to sedation is the impact to breathing. The deeper the sedation, the greater potential impact on breathing, leading to obstruction (really bad snoring to the point of not breathing). If signs of stress persist, sedation should be aborted for greater anesthesia expertise.
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@Kate Johnson
Please search for the following article on sedation:
Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology.
Moderate sedation (conscious sedation) is actually well-defined. Anesthesiologists define the degree of sedation by the level of response and/or purposeful movement. Conscious sedation is probably poorly named as a majority of patients appear unconscious. Anesthesia providers adjust doses of medicine for sedation based on a patient's stress response. A patient that is grimacing or moving in response to procedural manipulations is likely stressed. Stress can also be seen in vital signs, such as with increasing heart rate, blood pressure, or breathing rates. One of the main limits to sedating patients is the degree of obstructed breathing. The deeper the sedation the worse the obstruction. If a patient has signs of persistent stress with doses that cause obstructed breathing, the procedure should probably be deferred until more skilled providers are available and deeper anesthesia can be provided.
Anytime a patient can speak or respond purposefully, it is more likely that a patient would have explicit recall/memories.
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A number of years ago I had a colonoscopy and endoscopy at the same time. I remember without any conscious distress fighting off the doctors in a kind of colorless environment. Last year I had a colonoscopy and was completely put under because my records showed that I had woken up and fought them years before. A decision was made that I would always be given general Anesthetic although none of it was ever discussed with me.
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@K Thanks for commenting on my article. I would be grateful if you could contact me to discuss further through the link at the bottom of the piece
Unfortunately this has happened to me in three occasions, one general and two conscious sedation. When I spoke with my gynecologist after one such incident and wondered why he never apologized or spoke of it. He was embarrassed and told me he thought I wouldn’t remember it. When it occurred the third time, under anesthesia for a repair of a detached retina, I was very angry. I had specifically mentioned that I had past problems with anesthesia and I expected better care. As it was, I woke up with a speculum in my eye socket, staring at the surgeon, in pain and perfectly lucid. I complained about the pain only to hear the anesthesiologist say I was just apprehensive. Fortunately the surgeon requested more medication and the rest of the surgery was okay. I filed an official complaint and was given the run around which I expected as I worked there and knew the anesthesiologist and the dept. head, well known for covering their butts. Sad indeed. The surgeon was excellent. Now I always say, “If you ask me how I am and I answer you, you have not given me enough sedation”.
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@Kathryn B. Mark I would love to hear more from you please Kathryn. You can contact me through the link at the bottom of the story
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Great article Kate, and great dialogue in the comments.
I guess I was blissfully unaware of potential complications during three procedures I’ve been through.
1. ACL reconstruction with a spinal block and something else (?) that let me sleep through it.
2. Colonoscopy during which I was told it’d feel like a nap. It was a great nap!
3. Six weeks ago an open distal clavicle resection. We discussed and ruled out a nerve block and ended up with not-sure-what but I “slept through it” — again, blissfully unaware/ignorant!
Definitely food for thought for next time.
I wonder if there’s any connection with my fairly frequent sleepwalking as a child into my teens. I twice drove a car in my sleep!
Hi to Bob! :)
Part 2 ...
2) Which drugs for which depth of sedation/anesthesia: Most all of the drugs used can provide the whole spectrum of sedation through general anesthesia. Some are simply easier to use in certain settings. Midazolam, commonly used for sedation, can in higher doses cause general anesthesia. Propofol, in a large dose, is used for induction of general anesthesia. In smaller doses it is a wonderful sedative for a great variety of cases.
1) Who provides the service. This is controversial and complex. The simple theme is that as you move towards the anesthesia end of the spectrum, the more expertise the person providing the medications must have. Specifically, if the patient slips unintentionally into general anesthesia, someone needs to be ready and able to breathe for the patient. If not, you have a Michael Jackson event.
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I'm not sure what was used (if anything) for my liver biopsy but it didn't work. The radiologist-doc and two nurses were screaming at me to hold still as I was trying to retreat from the stabbing pain. NEVER again will I trust unknown medical providers. I wrote him a letter afterwards explaining that the procedure was agonizing and that I had trouble sleeping for more than a month following. He called me up several months later having finally connected with my letter essentially claiming ignorance. He was ignorant alright.
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@Alan Thanks for sharing that Alan. Please could you contact me directly through the link at the bottom of the article? I am collecting patient stories.
A couple of years ago prior to emergency surgery, I was told to breathe deeply into the mask. The second the mask touched my face my throat closed and I could not move my lungs. I prayed to pass out so automatic breathing would take over.
A month later follow up surgery under general again. The anesthesiologist let me guide the mask onto my face but again my throat closed up. She forced the mask onto my face and either I passed out again or the sleep medicine took over. Terrifying.
9 months ago, as I was being prepared for another emergency surgery in another state (fractured hip) the staff broke their protocol for my benefit and gave me prophenol as I was being put on the operating table. No mask until I fell peacefully asleep.
I am still anxious about any surgery I might need. But I thank the staff at UNC for listening to me.
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There are three separate issues:
1) Who is providing the service,
2) Which drugs are used,
3) How deeply sedated or anesthetized is the patient.
Starting with number 3. There is a continuum from sedation to general anesthesia. The targeted depth of sedation/anesthesia depends on the procedure and is adjusted by drug dose. Obviously, awareness is increasingly likely as you move on the continuum towards light sedation. The person providing the sedation/anesthesia should honestly disclose to the patient if there is a significant chance of awareness during the procedure. However, even when awareness is possible, there is no excuse for suffering. If an adequate depth of sedation/anesthesia cannot be provided by those present, the procedure should be aborted and rescheduled with an anesthesiologist who can provide whatever is needed.
--system demands a split answer --
Continued ...
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In 1981 I was paralyzed and awake while I underwent emergency surgery at Yale-New Haven. Although the surgeon and I talked about what happened (mainly because I quoted verbatim the discussion he and the surgery residents had), no one from anesthesia ever came to see the entire week I was there.
After I became an anesthesiologist, I have worked assiduously to prevent similar events in my patients.
However, there are many factors that play into it.
If a patient is bleeding, blood carries the anesthetic to the brain so in cases of large blood loss, the patient may have recall. If a patient's blood pressure falls precipitously, it may be too low for us to give additional medications. If a patient drinks alcohol, uses any kind of illicit drugs or takes medications that have an effect on GABA receptors in the brain, they need to let us know that - because we will need more than normal doses of our drugs.
Finally, the ONLY thing that prevents the body from "feeling" surgery is local anesthetic, including spinals, epidurals, and nerve blocks. But not every kind of procedure can be done under local or regional. General anesthesia doesn't prevent feeling; it only interferes with awareness.
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@Joy Thanks for your comments on my article. It sounds like your awareness experience may have influenced your career choice. I am collecting patient stories and would really appreciate your unique perspective if you could contact me through the link at the bottom of the article. Thanks
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I've had a few surgeries in past years and I think anesthesia is getting better. 7 years ago I had a uterine biopsy with a D and C done in the hospital under general anesthetic. I was well out during the surgery but it seemed to take a month to clear the chemicals from my system. I had to take naps frequently for over a month. Otherwise I never take naps.
Recently I had a carpal tunnel procedure with twilight sedation. I felt nothing, remember nothing and did not need long to feel the drugs were cleared. Last week I had a parathyroidectomy. I was pretty scared of having my throat sliced open. The anesthesiologist was very reassuring. I had general anesthesia as I assume it is extremely dangerous if one moves. No one suggested anything else but I felt well cared for. They also used a nerve block which worked well. I woke up alert afterwards.
This is another subject but they really want you to take opioids after surgery. Even when you say No, that you are not in pain. It just seems they would prefer you not have more strong drugs after surgery and anesthetic if you can do without. But they just push and push about it. I would never agree to a colonoscopy without sedation. And an endoscopy ? Tube forced down throat! Who are these people who can endure this ?
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I awoke during surgery when I should have been completely under. I awoke vomiting (must've been interesting with a taped mouth), clearly a bad reaction to the anesthesia. The operating room seemed to be filled with people laughing and a radio playing loud rock music- that much I remember, since the only sense I had was my hearing. I could not see because my eyes were taped shut (standard operating procedure, so to speak). For reasons unknown even to ME, I chose to not mention this episode after surgery, probably because I had recognized the voice of my surgeon, and he was laughing the loudest. Oddly, he died of a sudden heart attack just one week later (in his 40s). I was still dealing with itchy stitches when we found out he had died, and my husband said he didn't know my powers were so strong. Odd!
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My husband had a horrible experience during a colonoscopy, which he remembered very vividly, but which his surgeon denied! After reading this, I now believe the denial was because the surgeon did not believe that the experience would be remembered!
Anyway, my husband never consented to another colonoscopy, and I also never had, nor would I ever have one due to his experience! And, my husband wasn't the type who would exaggerate or embellish anything - he was a retired college professor, who had an excellent comprehension of medicine and medical procedures!
After reading this article, I now understand what type of sedation he had! Thank you for bringing this issue to light!
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Thank you for this article.
I've had the profound horror of experiencing this twice... the anxiety that has been linked to certain situations in my life is almost surely an outcome.
Anyone who has had this should tell subsequent medical teams directly (if possible) and be sure the incident is documented in medical records.
My heart goes out to anyone who has suffered this complete nightmare scenario.
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@hotGumption. I'm the author and would love to hear more from you, if you could please contact me through the link at the bottom of the article? Thanks
As an RN, from a family of RN’s, I would avoid surgery, except for the most dire of circumstances. That said, choosing an anesthesiologist is as important a decision as choosing a surgeon. The few times I have needed anesthesia, I have definitely made the choice of who administers my anesthesia.
Recently, when I had a minor procedure, I chose the anesthesiologist that all the OR staff said was the one they would choose. I was not disappointed. I had a good experience with no side effects.
One less thing to worry about.
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@Jane K
I’m a retired RNFA you are absolutely correct. Same goes for finding the best surgeon in each specialty. Excellent surgeons are also picky about who gives their patients anesthesia.
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As a CRNA(nurse anesthetist), I've practiced for more than a decade caring for thousands of patients providing everything from MAC(monitored anesthesia care) to GA(general anesthesia). From the start, I do not administer conscious sedation nor do most CRNAs or Anesthesiologists. Conscious sedation is typically administered by an RN. This author doesn't understand the continum( think of a time line with awake at one end and general anesthesia at the other with levels of sedation in between)of anesthesia as many don't. I'll agree wholeheartedly, MAC is often more challenging than GA because in GA, I typically provide a steady state of anesthesia and in MAC, it resembles more of a peak and trough pattern. A patient may well start in deep sedation to GA and as a case proceeds, he or she "lightens" and awareness is more likely. Every patient is unique as well as every procedure so to say "I always do A,B, C in my MAC cases or my GA cases" would be grossly generalized. First and foremost, being upfront with patients is critical in a successful surgery. I attempt to be very blunt and specific about what anesthesia is and isn't. We actually do not know the true rate of awareness under GA as it is historically under-reported or not reported for a variety of reasons. Every day, I strive to provide my patients with an experience that eases their mind, lessens/removes anxiety and makes the procedure successful.
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Why are we so determined to zero out all pain when we do not fully understand all the consequences of doing so. I have much better success with the alternative: 1. I become fully informed about the procedure beforehand and I know what to expect. 2. I am fully awake and watching during the procedure and not comfort sedated at all. Nerve block or epidural for major surgery-TKR. Procedures done were eye surgery, repair deviated septum and scrape sinus, and a total knee replacement. In all of them their was some pain but physical pain which leaves no real memories once it is gone, same as hitting your thump with a hammer. A big positive is not have all those chemicals in your body and you can get up and out right away. I did take pain meds after the knee surgery mainly so I could sleep which I consider very important. However I read some german doctors are using mindfullness and tea for recovery in place of meds and I would like to learn more about that.
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@Tom
That's you; other people would prefer to avoid searing pain and fear. This is neither a competition nor morality play.
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No one has proven that patients under general anesthesia have no memory of the procedure or what's being said. When I practiced dentistry under general anesthesia we were very careful about what was said in the OR. We tried to always be very positive whether it was true or not. For example " this procedure is gong exceptionally well" or "I think she will recover rapidly without any side effects". There are no down sides to speaking positively about the patient or the outcome. Statements like "This doesn't look good" or "Oops" are of not benefit to the patient. All participants in the OR should be as verbally positive as possible. It can't hurt.
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I am extremely unhappy with this sort of sedation. I have listed Versed as an "allergy." I think I have been given it anyway. I do not like the idea of being hurt or scared with all the physiological implications of that--and then being told it was OK because I would forget. I also had four eye surgeries where I had to be cognizant--and remembered every weird statement the staff made ("Have you ever seen anything that color before?" followed by "Ew, no.) Also they had Neil Diamond blasting--will never listen to him again. I don't like this--it feels like I am being manipulated--well, you don't remember, do you, so it doesn't count.
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@StarLawrence I would love to hear more about your experience if you could please contact me through the link at the end of the article?
@StarLawrence
You should be aware that a Local Anesthetic would have been used during your eye surgeries, so would not have felt any pain. Your feedback during the surgery is an important factor in assuring a good result. You could have asked them to change the music!
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You would feel pain if local anesthetic was not administered properly.
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I've done 2 randomized controlled trials of procedural sedation in which fentanyl-midazolam were the control arm. In the first study, the drugs were given by patient-controlled sedation for colonoscopy; in the second, drugs were given at the direction of the pulmonologist during bronchoscopy. Patients self-administered larger doses than the same gastroenterologists in the 3 months preceding the study; pulmonologists administered similar doses to the gastroenterologists, and lower than we would have predicted for PCS. Conversely, my second study on PCS randomized patients to patient-controlled versus anesthesiologist-directed sedation; patients administered lower doses than anesthesiologists. Proceduralists tend to understate, presumably because they are criticized for creating respiratory arrests, while anesthesiologists are willing to oversedate and utilize rescue techniques because they are criticized for patient movement. PCS isn't for everybody; it works best for people who have a strong internal locus of control, but I've only had one patient who correctly reported the number of times he pressed the button. Pose this question on Quora and I can go into more detail.
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@Cissy Thanks for this info. I'd like to learn more. Please contact me via the link at the end of the article
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I had lengthly ear surgery in the seventies and experienced awareness under general. Paralyzed I felt the unbearable pain and heard the Drs. discussing a problem with my right ear that they could not mitigate with the tumor having gone behind the ear drum. My experience was vehemently denied by the Dr. and anesthesiologist nevertheless which left me Dr. phobic and to this day distrustful. An equally persistent problem is that I seem to be pain sensitive and having read some of the research wonder if that awareness long ago was influenced by this conditon or contributed to it.
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@S. Bernard
So sorry to hear of your experience. I've been through it too and it's utterly terrifying.
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I awoke during surgery as a child back in the days when ether was still in use. I can still feel the mask on my face and smell the ether. I also remember the surgical team standing over me though I don’t recall feeling any pain.
As an adult I also awoke from conscious sedation on two occasions. The first was quite painful and occurred multiple times during a colonoscopy. I remember the GI saying more than once, she needs more. The second incident occurred during a cardiac catheterization with angiography. Although I could feel the catheter advancing through my arteries and heart chambers it didn’t hurt. I also watched it on the monitor and found it fascinating. The pressure applied to my femoral artery after the procedure was the most excruciatingly painful part and they don’t give sedation for that.
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@BMUS Thanks for your comments on my story and please do get in touch with me via the link at the end of the article
@BMUS
If I am thinking of the same procedure, several of my elderly family members have had the cardiac thing. The hardest part for them was having to lie on their back with no change of position for several hours. When you get older and have back and joint pain, lying on your back without moving for extended periods can be torture.
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@Madeline
I forgot about that part. It is difficult to stay in one position for an extended period of time especially for older folks, however, it’s crucial to prevent bleeding at the insertion site. If your relatives had to remain flat for an extended period of time say six to eight hours it’s possible they had a cerebral (brain) not cardiac(heart) angiogram.
One needs to set expectation. Twilight or IV sedation does not guarantee amnesia. I usually say that "you wont remember much, maybe the beginning or the end. if you think youre too awake or uncomfortable, tell me, because you are breathing on your own."
I think the person doing the procedure will tell the patient that they wont remember anything and that is a recipe for unmet expectations given different tolerance levels.
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@GreenMachine Also--after the procedure, they tell whoever is with you how it went--because, and they say this, you won't remember what they say.
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First, let me say that I am terribly sorry to hear about the experience under conscious sedation. I have seen conscious sedation go terribly wrong, and as a practicing CRNA, have had to step in to rescue patients and provide anesthesia emergently for these patients. With that acknowledged, I do want to point out a misconception in the article.
While not intentional, describing nurse anesthetists as providers of conscious sedation isn't accurate. Certified Registered Nurse Anesthetists (CRNAs) are providers of the full spectrum of anesthesiology services. Like our physician counterparts, we provide thousands of high-quality anesthetics, often completely independently from physician anesthesiologists (CRNAs also work in teams with physician anesthesiologists, depending on the local model). (see AANA.com). CRNAs are misunderstood - often being mistaken for physician anesthesiologists. So misunderstood in fact, that there is a current change being debated about our title, and changing it to Certified Registered Nurse Anesthesiologist, to more accurately reflect our scope of services. The term "Nurse Anesthesiologist" is becoming so common that it was recently added to Webster's dictionary.
The primary focus of the article is a good and worthy one – sedation is dangerous, and it should be handled by anesthesia experts.
Joseph A. Rodriguez, CRNA, Arizona Anesthesia Solutions Managing Partner Director for Northern Arizona, Medical Director, Tri-City Surgery Center
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@Joseph A. Rodriguez An ‘anesthesiologist’ is a physician. End of story. There’s no such thing as a ‘nurse anesthesiologist,’ just as there is no such thing as a ‘nurse surgeon’ or a ‘nurse pediatrician.’ A nurse is a nurse, and a physician is a physician; there’s no such thing as a ‘nurse physician.’ This is just another example of the AANA continually trying to blur the lines between anesthesiologists (physicians) and CRNAs (nurses) for political purposes.
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Dear Dr. Potatohead - Review every major published document from the ASA from the last 7 years and you will realize you are wrong. I’ll look for your reply. Facts do not change because you don’t like them.
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@Joseph Rodriguez Please cite an ASA document that uses the term ‘nurse anesthesiologist.’
I’ll look for your reply.
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I recently had gynecological surgery at a famous teaching hospital and went with a spinal. Although I'd had a similar surgery 10 years before and gotten no guff from the anesthesiologist, this time was different. Meeting me right before the operation, the young anesthesiologist tried to insist that I have some twilight on top of it. In a friendly manner, I said no..that I had a bad reaction during sinus surgery and did not want to repeat it. I insisted on writing in my preference on the hospital's permission form. She said the form was a legal document that couldn't be altered. Not true, I said, starting to get mad. The surgeon--who had done the first operation--came in and listened for a while. She said look, the question is, do you trust us to do the right thing. Stuck in there all dressed out for a surgery I badly needed, I said sure. We talked a while longer and I came up with a plan: that she would run an IV with just the tiniest bit of the bad stuff in case something went way south with the surgery and they had to knock me out fast.
It was odd to get all amped up and distrustful right before surgery. But the A. was true to her word and gave only a little...and when I got a bit dizzy before i was on the table and asked her to back off, she did. I was awake the whole time and it was a perfectly pleasant experience. The tugging I felt was odd, but interesting. And no consequences to my brain was great.
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During a tonsillectomy at age 3-4 in 1961-62, in a US army base hospital, probably under ether, I awakened: I remember hearing a voice, "Oh my god, she's not under!" and seeing the bright silver domed light overhead and masked faces. I have suffered from PTSD all my life, including a strong sensation of needing to cough something out of my mouth, pull something out of my mouth. This memory didn't surface until several decades later.
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@CS thanks for commenting on my story. I would love to know more about your experience. You can reach me via the link at the bottom of the article.
Are you a redhead? With dental procedures, it's been documented that redheads sometimes require significantly more anesthetic. I have a ginger son. . . so I've learned this.
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Redheads are shown I evidence based research as well as my experience to bleed more, especially as youngsters, as well as requiring more anesthesia to put them under.
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@Brenda
This is antiquated assumption based on old research from the 70's every new comparative study as shown no legitimate link to red hair and anesthesia. You are correct however that kids which peaks at two required more volatile anesthetic than the general population.
@CK
Study done in Louisville 2004 with only 20 people!! Hello sample size. Showed a 20% increase in inhailed anesthritc dosing required.
However, a later study by the same researchers in 2013 found absolutely no difference in IV anaesthetic requirements for red-haired females. The study concluded: “Anecdotal impressions among anaesthesiologists that propofol [a common IV anaesthetic] requirements are increased in redheads thus seem unsubstantiated”.
In addition, a larger study performed by Australian researchers in 2012 examined 468 adult patients undergoing surgery and general anaesthesia and, contrary to prior findings, showed that patients with red hair had no higher anaesthesia drug requirements than patients with black or brown hair.
They concluded: “We found no evidence that redheads had increased anaesthetic requirement or faster speed of recovery after surgery. Nor was there any evidence of a difference in pain response, pain intensity, or other adverse effects after anaesthesia and surgery…we could find no evidence that a patient’s natural hair colour meaningfully affects anaesthetic requirement”.
I want to be OUT COLD when I'm being operated on. And lots of percocet and oxy afterward.
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Do you have red hair? In the UK they have discovered a genetic 'defect' or anomaly that makes one less responsive to anesthesia. This geneis associated with 'red heads.' I have had my anesthesia episodes, but none so frightening as yours.
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You can scream, but you won't remember it. This horrifies me. There is a me that experienced extreme pain, but no longer exist.
It makes me worry about pain doctors impose upon people because they can and it's convenient for the doctors.
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This is a very interesting article with even more interesting comments. Perhaps there are too many elective surgeries and procedures. I have been told by some doctors and surgeons never to have surgery unless it is absolutely necessary. They are all over 70 by now!
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I went through several egg retrieval procedures for IVF. During one of them, I woke up enough that I was trying to climb off the table, but I couldn’t because I was paralyzed. The next day my stomach muscles were very sore, so I know I didn’t make this up. I already had some symptoms of PTSD, but it got bad enough that I had to switch to a less stressful career. Twenty years later I still am triggered by being in the medical environment and I have quit going to the gynecologist completely. My experience has definitely hindered my medical care.
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@Bamagirl,
After going thru 4 laparoscopies, many cycles of infertility treatments to harvest eggs, and other painful procedures, I developed "white coat syndrome" which made it very difficult to just go for a yearly physical exam, have my blood pressure checked, routine blood work, etc. It takes the right doctors & nurses to allow me to feel comfortable, so that my increased blood pressure, heavy sweating, & anxiety subside. More than 30 years later, I'm still dealing with it. However, I've had an eye surgery, and dealt with 2 blood clots in the same leg that required hospitalization, all without incident. Thankfully, waking up on the operating table never happened to me. But I understand the trauma that some patients go through, due to painful medical treatments. I've found some doctors & nurses are extraordinary, while others are not. I've learned to drink a big glass of water a couple of hours before getting blood drawn, and to practice deep breathing, imagining that I'm peacefully paddling a canoe. Anxiety is not something that can be easily treated. I don't want to take medication, so I've learned different ways to handle it. Sometimes the best one can do is to avoid a situation that causes anxiety. Sad when that prevents a person from getting needed medical or dental treatment.
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After having worked as a nurse anesthetist for 25+ years, I cannot stress enough that one should be aware of who is giving your sedation and/or anesthesia. Typically surgeries, procedures, and dental work are done in outpatient settings and the sedation and/or anesthetic are given by persons not trained in anesthesia administration. Doctors, nurses and dentists are providing the drugs without benefit of a 3+ year residency in anesthesia but just a blip of education in their training. Your proctologist may be administering your anesthetic as she or he will collect the reimbursement for the administration, not having to share it with anesthesia personnel. Greed trumps safety far too often in the American healthcare system. My suggestion is to ask your doctor who will be providing your sedation/anesthetic and what was their training and certification.
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I woke from general anesthesia during surgery. I started pulling a metal spreader out of my body. I will never forget the panic in the voices of the two surgeons. The first said "Oh my God! She's WAKING UP!" The second said: "Give her some juice! Give her some juice!"
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I would sue that anesthesia provider as they did not do their job competently and you have realized damages.
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@anita Thanks for your comments on my story. Please get in touch with me via the link at the end.
When I underwent a colonoscopy and endoscopy at a highly rated hospital, the anesthesiologist allowed me to experience the paralysis of my lungs. Which I learned later is a step in the general anesthesia process that should have occurred after I was first put to sleep. I am usually incubated in procedures because I have asthma. But that was the first and only time I felt I could not breath. The doctor told me take some deep breaths within the mask. Then I sat up immediately from laying on my back, screaming “I can’t breathe, I can’t breathe”, the last thing I heard was “yes you can”.
When I awoke in recovery I was crying “ I can’t breathe” and the nurse reassured me. I was terrified for days following that experience. I was supposed to have a follow up procedure but never did because I was afraid to return to the hospital and be placed anesthesia. I believe the anesthesiologist made a mistake when administering the medications...like the steps were out of order. I recently checked the hospital’s website and learned that anesthesiologist no longer worked there.
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Colonoscopies done in the US are risky, risky, procedures. Some MDs have the nurse give every patient the same dose of meds, no matter what their size, health status or weight. I know of none where anesthesia personnel administer the anesthesia. Again, they get to keep insurance or Medicare reimbursement if they give it as opposed to a qualified person. Another illustration of the fleecing of America.
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@Pam B
Some anesthetists give a very small dose of a medication that can hamper muscle function at the beginning of the anesthetic, so that when the muscle blocking succinylcholine is given, the patient is less likely to have aches and pains afterwards. Some people are more sensitive to the first medication, and can feel the effects on breathing before the general anesthesia takes effect. In addition, there have been recent studies showing that some of the muscle blocking medications have lingering effects beyond what we were taught to expect, so that patients can sometimes wake up at the end of the case with the sensation of difficulty breathing if the medication wasn't reversed.
@Brenda Not in New York. All my colonoscopies have had an anesthesiologist (M.D.) providing the anesthesia.
When I had sinus surgery in 1993, my surgeon pushed hard for conscious sedation. Knowing my emotional limits, I repeatedly refused and insisted on general sedation. The anesthesiologist agreed. When I awoke after the procedure, my surgeon admitted he was glad I’d stood my ground, because he ran into complications so serious he wouldn’t have wanted me to be even momentarily aware. General anesthesia has its dangers, but as this article documents, so do less sedating methods. I’ll take my chances with complete unconsciousness, thank you.
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For all procedures we do, it’s safety first. Conscious versus deep sedation, drugs to use and who administers them is a huge and controversial topic, not well explained by this article.
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As an anesthesiologist for over 35 years, I was impressed at the variation of human response to a given (standard) dose of sedation. Due to variety of physiologic factors, different people of the same size and age react differently to the same dose of a drug meant to render them unaware of what's going on. Some physicians may be hesitant to administer more sedation because it exceeds certain dosing guidelines. However, certain individuals need more and some need less. There are no clinical objective measures of how much drug is required for effect in a given patient.
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Benzos are actually kind of contraindicated for acute trauma and PTSD and seem to prolong and worsen the symptoms so it would seem to make sense that people who experience trauma while loaded on benzos would have pretty profound PTSD from the experience.
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@VanessaMD Thanks for your comment on my story and please could you contact me via the link below so I can learn more?
After 32 (yes thirty-two) hours of labor and two epidural injections, my OB decided I had to undergo a C-section to deliver my son. I was laid out on a table like Jesus being crucified on the cross. When they made the initial incision, I yelled, "I can feel that!" The doctor assured me I was only scared. As they further cut into me and I continued to scream that I could feel everything, and was totally aware when the doctor said, "Oops," the anesthetist was called in to give me some drug which put me completely unconscious.
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@de'laine My god. I am so sorry that happened to you.
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I questioned the need for general anesthesia for hip replacement surgery as my sister had experienced very rapid deterioration of pre-existing Alzheimer’s after being heavily sedated and intubated following a medical emergency. I had become conscious a few minutes before completion of a prior THA done with epidural and deep sedation; this didn’t bother me (it was my second time.) The Anesthesiologist explained why general was needed. This level of communication is important to allay anxiety.
Your article does not touch on ICU delirium, a reaction to heavy sedation producing similar symptoms to PTSD. Is this being studied?
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Avoid anti-cholinergics in the elderly. "Grandma was never the same after her surgery" because we do not regenerate our neurotransmitters like we did when young and vibrant. Used to prevent oral secretions, i.e. saliva, and not require so much suctioning of the mouth and throat, avoiding aspiration and lung infections, due diligence rather than these drugs will allow grandma to be perky and normal soon again.
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In 2003, I was having spinal surgery & was aware of everything going on. I couldn't speak or move (affect of paralytics) but heard & felt everything. As a nurse, I understood something was seriously wrong with the anesthesia. Awful doesn't begin to describe what I endured. Both the neurosurgeon & anesthesiologist doubted me until I repeated some of the conversation during my surgery.
Since then, I have had both general anesthesia & conscious sedation. The last procedure with conscious sedation left me in respiratory arrest.
Hence, I would much prefer general anesthesia with a board certified anesthesiologist. There is real, genuine fear of having any surgery or procedure after these complications - most cannot possibly relate to this.
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@SJ With my many detached retina surgeries, they put me out for five mins while shooting a local into the eye--but in one, they started before the local took effect, I said I feel that, bam, blackness, then voices, I was back awake and could not feel it.
@SJ Thanks for commenting on my story and please get in touch with me via the link at the bottom.
I've had several awareness experience, but the worst was during removal of my gall bladder. I sat up during the operation, they hit me with more sedative, and later when they removed the tube I flopped around. I was paralyzed, they had to reintube me and take me to the hospital, where I had to lie, awake and paralyzed with the breathing tube in place until my body cleared the paralytic. Talk about horrifying! Especially as I am claustrophobic.
I've not been the same since. Nightmares and poor sleep.
The anesthesiologist said it was due to something my body is missing.
My hairdresser says it is because I am a redhead. I have also always had trouble with dental work and attempts to mitigate childbirth pain.
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@Ginger thanks for commenting on my story. I would love for you to get in touch with me via the link at the bottom of the piece
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@Ginger
You most likely have Pseudocholinesterase deficiency. You have an inherited lack of an enzyme so your body can not break down down one of the common paralytics called succinylcholine. If you have surgery in the future this is important to tell your anesthesiologist.
Red heads often need more anesthesia to be sedated need more local anesthesia (at the dentist for example), and have different perception of certain types of pain.
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@Ginger What @Pmill said. Please consider getting tested for pseudocholinesterase deficiency to see its severity, and wear a Med-Alert bracelet. Should you be administered succinylcholine in an emergency (where you were unable to provide the information), the hospital could plan accordingly and keep you heavily sedated until the medication had worn off, possibly saving you both a nasty experience.
In addition, this can be a hereditary condition, so please notify your relatives. Your children, parents and siblings might also want to get tested.
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I woke up during separate colonoscopy and upper GI scope procedures and remember seeing the video monitor and making noise and moving. Then they said “she’s awake, more medications!”. Next time I had an upper scope I went to a different doctor and told him I wanted more sedation. I still woke up and remember having that icky guide in my mouth. Yuck.
I still have vivid menories of all those awakenings but don’t find them troubling now. At the time, they were troubling. It would have definitely helped if they had told me it was normal to awaken briefly during conscious sedation.
The first doctor told me in his home country they screen people for stomach cancer with upper GI scopes, and only use local numbing in mouth and throat, and that people sit upright in a chair during the procedure. 10 minutes, you’re done, next in line, please. No thank you!
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@KathyGail. And there are actually individuals who request no sedation or anesthesia for such procedures. They're highly motivated to tolerate whatever discomfort may ensue.
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@jimmyg
Like me.
I've had two colonoscopies (both without drugs) and there is a not on my record that says something to the effect of "patient requests no anesthesia during colonoscopies. During the prior procedures, patient was awake, relaxed and watched the procedure on the monitor after insertion." I'll be having my third this year and when I set up the appointment, I plan to remind the appointment staff that I will be having the procedure without anesthesia and to inform the medical staff that there a note on my record about that. If the attending physician has a problem with that, I request another doctor.
I have friends who've used meditation to tolerate tube insertion into their throat without drugs. I guess they can control their gag reflex.
For procedures that can be done without sedation, it's all about the patient's ability to not only tolerate the discomfort but to act in a way that does not endanger themselves or annoy the medical staff.
P.S. I've worked in two different hospitals that are part of the same medical center.
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Conscious sedation is safer by far for the patient than general anesthesia. Any procedure that may require some form of cooperative action from the patient makes it a necessity. I have had three procedures with conscious sedation and remember bits of the process, but have never felt in any way traumatized. I have sympathy for the author, but strongly believe this is a rare occurrence, and that the risks of general anesthetic are poorly understood by patients. Given the choice of one or the other, all things being equal, I would not choose the general anesthesia. Crying and depression after general anesthetic is very common.
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The American Society of Anesthesiologists Closed Claims Study shows that conscious sedation is NOT safer than general anesthesia.
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@Glenda Kaplan
I am an anesthesiologist. It is impossible to say that in every situation conscious sedation is safer than general anesthesia. Ideally, conscious sedation is used when the pain is controlled by other means (local anesthesia, nerve blocks, etc) or a brief period of deep anesthesia (inserting a tube into the oropharynx, numbing the skin), followed by a period requiring less sedation.
To try and perform a general anesthetic with sedation is where you get into trouble, as you have a prolonged period where airway reflexes aren’t fully intact.
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@Kim This is incorrect. The study makes no such claim.
This somewhat summarizes some other comments.
There is a move towards more conscious sedation and less general anesthesia. There's good reason for that, even if it isn't for everyone.
The choice of which to use can often be the patient's (depending on the procedure, of course).
An important development in some states is more involvement of anesthesiologists in the consent process. It is standard in Texas for patients to meet and talk with BOTH the surgeon and the anesthesiologist.
One thing to look for is whether there is someone there monitoring the anesthesia the whole time. I don't personally like the common dental model of one person doing both jobs. It makes it easy to not notice anesthesia problems if you're busy digging into bone.
Lastly, if anesthesiologists are properly trained in the consent process (a big if) then they will help allay your reactions...half the panic can be from the unexpected. If you are told what will happen, or what might happen, and give them information in advance about how you would like them to react, you will feel much better.
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@priceofcivilization It would be great if all doctors could be empathetic. Unfortunately it's difficult to teach that. But thank you for pointing out a huge problem which is that dentists-unlike surgeons, obstetricians, cardiologists etc.- are allowed to both perform procedures and administer anesthesia at the same time. And even worse, are able to charge like they are doing both concurrently. This is true nationwide as far as I'm aware. Fortunately, the California Society of Anesthesiologists is trying to change that here though it's an uphill battle.
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I am sorry that you have had the experiences you describe.
There is a reason for the term you used - “conscious sedation.”
For such procedures there is no 100% way to ensure amnesia or that patients will be "out" - unless general anesthesia is utilized. Unfortunately there ARE cases of awareness even with general anesthesia.
I advise my patients before surgery that the goals of "conscious sedation" are to make them comfortable and relaxed. They MAY be aware and remember parts of the procedure, though often they do not remember. There is no guarantee that I can offer no monitor to ensure amnesia.
If that is not acceptable, then I advise general anesthesia with different risks and potential complications.
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@David
Absolutely. Nobody claims (or should claim) that Midazolam is 100% effective at causing amnesia. I certainly witnessed patients (usually muscular, heavy drinkers) who proved astonishingly resistant to even the sedative, let alone the amnesic, effects of midazolam.
People here are confusing 'heavy sedation' with general anaesthesia (and unconsciousness).
Midazolam is a benzodiazepine - meaning that you can get away with giving very large sedative doses without much risk of respiratory arrest. Hence its popularity.
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Anyone who works in veterinary medicine can tell you that it's common for patients react to painful stimulus during general anesthesia. Sometimes they actually wake up or start to wake up.
Sometimes it's more subtle; their heart rate may increase. This was eye-opening for me when I started working in the field, since I thought general anesthesia was simply "lights out." I know several vet techs who are afraid of general anesthesia for themselves because they know what really happens!
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@Heidi
If you work with large animals this could obviously be more difficult, but keeping the animal warm during anesthesia should help with heart rate / breathing problems if you’re using something like isoflurane.
Also, the MAC value for an animal (and strain/subtype, if available) for a particular anesthetic can be a useful guide. However, at MAC, as defined, half of animals should still respond to a noxious stimulus.
I use isoflurane often with mice, if they’re warm I can maintain at 2% for hours, if not I usually start off at 2% and slowly move toward 0.5% as it cools down. Much trickier!
When my colonoscopy was completed I remembered hearing myself groaning during the procedure. I didn't remember pain, just the sound of myself reacting to it. The staff acknowledged that I had been evidencing distress and that they then gave more anesthesia. I am writing to say that I am actually very happy that the staff was conservative in administering the drugs. I usually respond profoundly to any kind of narcotic or depressant and had been worried about the anesthesia. I much prefer that the doctors took my concerns seriously and went slowly with the dosage.
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I'm relieved to hear I'm not alone, but I'm scared about an upcoming surgery.
I've had general anaesthesia twice and woke up both times, once like the author - in a flailing panic because there was a tube down my throat, the other time on the table in the OR but no panic. I understand (now) that you're not supposed to wake up until your body is breathing on its own again and the tube is gone, but I don't understand why I wake up before that.
I don't have PTSD about it, but I sure don't want it to happen again. What can be done to avoid waking up when you're not supposed to?
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@Karen
For starters, make sure that you tell the anesthesiologist about your prior experiences before your upcoming surgery. They can review what medications were used, and adjust what they give you this time - but you have to be proactive to make sure they know before they begin to prepare you for surgery.
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@george Thanks for replying, and thanks to this article I'm feeling more assertive about how I talk about it all with the surgeon and anaesthesiologist beforehand. There's no way to know what medications were used last time, it was decades ago. At the time, when I asked what happened, I was just told "it's fine" and that I was okay to go home.
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When I was in my 30s I had open heart surgery to correct a malformation. I woke up during the surgery, to the degree that I told myself I needed to remember what the doctors were saying because later they would deny that I had come to the surface. Sure enough, the surgeon got a smirk when I told him I had come awake enough to fell my chest burning hot in pain. The smirk disappeared when I told him I had gone fishing at the same spot in Kodiak, Alaska, that he had been bragging about during surgery. He admitted that at one point the monitors registered distress on my part so they had deepened the sedation. I am in my 60s now but am still terrified of general anesthesia. (It did not help when I expressed my fears about pain and dying under the anesthetic to another surgeon during a subsequent operation and he chirped, "Well, it is a pretty good way to go.")
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@fireweed My mother, in her 60's, told me while her surgeon was present, that she had been awake during arterial bypass surgery. The doctor scoffed, and so my mother recounted conversations in the room. He was very quiet after that. I regret now that I didn't think to ask her if she also felt pain or panic.
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@fireweed Thanks for your comments on my story. I'd love to hear from you if you could please contact me through the link at the bottom of the article?
I woke up in the middle of cataract surgery. Talk about painful. In recovery I complained to the doctor. His response: “Oh.”
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All patients are awake during cataract surgery. That is standard operating procedure.
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@Kim
Maybe that's SOP in San Diego, but here in NJ, they use conscious sedation - with an anesthetic that typically causes amnesia. However, the eye is thoroughly numbed (and immobilized), so I don't understand why KatheM sensed pain.
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I received small doses of midazolam for both of my cataract surgeries and experienced no pain during the surgery or post surgery pain. While I empathize with your experience, I am unable to comprehend your comments.
A simple way to avoid problems with sedation is to do without. This is not really that hard, provided your throat is numbed a bit with lidocane. I have a condition called Barrentt's esophagus that makes gastrocopies advisable every two or three years. The hardest part is the beginning, when you have to fight a gag reflex, but after that it is not bad. The upside is that you can drive yourself home and otherwise have a normal rest of the day.
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@John Williams
I know someone who had his colonoscopy with no anesthesia. He was a nurse anesthetist and he and the GI doctor offered the same to me.
I declined.
But I did appreciate the information and the offer.
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I was awake and aware and had full feeling during a violently painful ablative laser procedure some years also. I remember my body going into full, arched-back spasm with each pass of the laser. The pain was so off the charts that I cannot come close to describing it. I was conscious enough while this went on that I remembered the conversation between the doctors and the nurses, but I felt incapable of telling them how much pain I was in. I felt paralyzed and unable to speak. I don’t know whether I really was physically unable to form the words, or whether the drug had simply convinced by brain that I couldn’t. Do the drugs used for twilight sedation tamp down a patient’s will?
When I told the doctor about this afterward, he brushed me off and denied it, then he blamed me, saying I should have told him and he would have given me a nerve block. That was after I told him I was unable to form the words to ask for help, so he hadn’t listened to what I was saying.
I was more aware than I should have been during my twilight-sedation colonoscopy, too. I watched the procedure in the monitor screen, and felt the probe, and the cutting out of polyps, and a fair amount of pain. Yet no one in the room commented that I should not be so awake, or so aware of pain. My husband fell asleep for his procedure.
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@Passion for Peaches Like your husband, I had one painless and soporific colonoscopy, which did not prepare me for the extremely painful one I experienced 10 years later.
Assuming he would want to know, I expressed my discomfort to the physician. Instead he scolded me and told me that I was making his job difficult.
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Having had anesthesia training, I am aware of the issue and the newer methodologies for monitoring patients. However, recently undergoing an emergency abdominal surgery overseas, as I was initially brought to OR and having already received the pre-medication to start the process of sedating me prior to intubation and general anesthesia, I was groggy and I suddenly became aware of sharp pain on my abdomen, I had conflicting thoughts of maybe they've started and I'm not fully anesthetized or I'm imagining this. As it continued, I thought I have to say something but I apparently had already received the paralyzing agents given prior to intubation, and couldn't speak or move to tell anyone anything- but I presume I must have been quickly intubated and placed under general anesthetic inhalation agent as the next memory was waking up in the recovery room. I didn't bring it up to the local surgeon. I would call it a fleeting experience and something to bring up as a been there done that experience to recount, but I can say that I haven't had any kind of lingering PTSD type of symptoms from it.
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As a friend of mine points out, the mind quite reasonably reacts with terror to the idea of a masked person (doctor) holding a knife (scalpel) and coming at you!
You can "rationalize" all you want, but your inner self is screaming that you're in a very dangerous situation that you (generally) don't want to be in.
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When patients sue their anesthesiologists, we’ll get some answers.
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@Ed, the thing about twilight sedation is there is no anesthesiologist to sue.
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“ a growing range of practitioners, including certified anesthesiologist assistants and nurse anesthetists”
Certified Registered Nurse Anesthetists are providers that have safely been administering anesthesia for over 150 years. Not anywhere close to being new to the field, nurse anesthetists provide quality anesthesia in all settings and can be found predominating and sole practitioners in many parts of the United States.
https://www.aana.com
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@A Mesla
Read it again, she didn't say nurse anesthetists were new to this or any other field.
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Maggie Kotuk
Micanopy FL
I had bilateral hip surgery in 2007 under general anesthesia. For the entire time I was in rehab after the surgery I suffered acute inexplicable depression. No one on the medical staff considered depression to be a consequence of the body being broken apart, screws, rods ...hammered into the patient - put together again literally!
I have no medical proof of this... but I seriously think the body registers these "assaults" whether one goes under general OR conscious sedation - One has taken a 'hit' so to speak and there are psychological consequences.
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@Maggie Kotuk, injuries to the body, even purposeful ones, can be hard on the mind. I was in an auto accident and had several surgeries as a result this past spring, and while most of my physical wounds have healed, I'm still dealing with some emotional fallout.
Big changes, even when we know about them in advance, can throw us for a loop! Best wishes to you.
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@Maggie Kotuk: You've raised an excellent and very important point!
One does indeed "take a hit" (including emotionally, due to needing the surgery in the first place, PLUS all that follows afterward).
I agree with you that the body registers these surgeries as "assaults" in general - and particularly so a bilateral hip replacement, which is a major intrusion into the body (essentially a very complex medical carpentry job!).
Everyone's body processes anesthesia differently - and while doctors will tell you that all of those chemicals are out of your body quickly, almost anyone who's had that level of anesthesia finds that its effects endure for months afterward - and THAT can also lead to depression.
I'm glad you came through OK, and I'm sorry that none of the medical staff comprehended the likely cause(s) of your acute depression. It would help if hospitals trained their doctors and nurses to be more aware of this phenomenon.
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@Maggie Kotuk
I have had two surgeries involving general anesthesia==about 4 hour surgeries each time. After each I, too, felt depressed for weeks. I blamed it on the general, which really does affect our brains in surprising ways that are not entirely understood.
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As someone "in the biz," I just want to point out that conscious sedation has plenty of risks. It is still *physically* safer than general anesthesia, because the patient keeps breathing on their own. Strange or frightening feelings from conscious sedation do happen, and it's hard to know exactly who will experience them.
Dr. Raz mentions an important step: warning the patient that there may be some weird and potentially scary feelings because of the medications - but these aren't dangerous in and of themselves. Once the patient is aware *ahead of time* that such experiences might happen, they handle them much, much better.
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1985- general anesthesia for exploratory abdominal laparoscopy. I woke up on the table, completely paralyzed, unable to speak, open my eyes, even to breathe. I can still remember the sheer terror I felt that I was suffocating until someone noticed something --perhaps a drastic increase in my heart rate-- and put me under. I woke up screaming in the recovery room. I've had conscious sedation for a number of procedures in recent years, and don't remember a thing; it worked perfectly, for me.
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A friend of mine woke up during minor plastic surgery in a hospital OR to remove tattoos that were so dark they required skin grafts. He said he felt no pain, but but sort of whispered whenever he talked about it. He was clearly bothered.
The doctor told him afterward that it was an unusual reaction to anesthetic.
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When I awoke from my total knee I was surprised to learn I was given general anesthesia when I thought it was going to be some variation of what is described here. Surgeon said I yelled when the knife touched my skin so he said, "just put her out."
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@nowadays, Keene. That means you felt the pain and they numbed the part of you that allowed you to express that.
I’m not sure how accurate the 2/10,000 statistic is. Seems at least transient awareness is common. I was 100% conscious of fighting, struggling, kicking, and trying to scream, of being held down while a endoscopic tube was shoved down my throat. The doctor told me I wouldn’t remember. “Oh, I’ll remember! “ I told him. And I did. In this case, I believe the sedative pooled under the skin in my hand instead of going into the vein. Nobody worried about medical PTSD in 1992, so I was on my own.
Years later I awakened during an endoscopy. The doctor, nurse, anesthetist all chanted, “ Breathe! Breathe!” I did, and went back to sleep.
My husband has awakened at least once during a colonoscopy to complain of pain.
2/10,000? I don’t think so.
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@Abby I'm the author and would really like to know more from you. Please contact me through the link at the bottom of the article. Thanks
Although it may be inconvenient for the doctors, this is real and more research should be done. If it happens to you, you don't care how "unusual" it is. I hate it when doctors ask me that.
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The body remembers. Traumatized tissue is traumatized tissue.
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I woke up too early in the recovery room, in extreme pain. The nurse was as nasty as she could be, assuring me that I wouldn't remember her nastiness. I remember every word and every pain, and because they had my glasses, I couldn't identify her, much to my regret. That was nearly 40 years ago and I am still angry about it.
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@Marty Smith Once when I was working in an ER, they gave a man who'd pulled his replaced hip out of joint by doing a "forbidden" activity (crawling to reach a phone that dropped.) sedation. Once he was under the conscious sedation (basically roofies!), and they were muscling his hip back into the joint, he was inarticulately howling in pain, as the doctor mocked him for not following instructions. Even though everyone assured me that he wouldn't remember it at all, it was horrifying and crass. The other comment from a doctor: that's just what orthos are like.
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The American Society of Anesthesiologists has clearly defined criteria for depth of sedation (light, moderate, and deep); most procedures done in an outpatient setting without anesthesiology professionals are done under moderate sedation as deep sedation risks the need for airway support or intervention such as intubation. The criteria can be found here (https://www.asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesia_); it should be noted that under moderate sedation, a patient should be able to purposefully respond to verbal or light tactile stimulation; in other words, a patient under moderate sedation is basically awake.
I am an anesthesiologist. I think that physicians and other medical providers who administer sedation can do a much better job of setting realistic expectations for our patients based on our desired depth of sedation. I ALWAYS tell my patients that they will be sedated and may be awake for some or all of the procedure, that they may remember some or all of the procedure, and that I will be there with them to make sure that they are safe and comfortable. Knowing what to expect can help alleviate the panic and trauma described in this article.
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@Katie, I have had several of these twilight sedation procedures, with no anesthesiology specialist present. As I posted elsewhere, the time I had a serious problem with the sedation I experienced horrific pain but could not alert the doctor to it. So it was not a problem of the patient having the wrong expectations, but of the doctor have poor sedation skills. And being willfully blind to the obvious fact that his patient was suffering.
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That is certainly a problem! The motto of our professional society is “vigilance;” awareness and awareness during sedation is completely normal, but discomfort should always be addressed!
@Passion for Peaches Hi I'm the author and I agree there may be a big disconnect between what the healthcare provider sees (a patient who might be talking and answering) and how the patient feels (cognitively incapacitated). I would like to hear from you and hope you can contact me through the link at the end of the article.
During my first cataract surgery, the anesthesiologist noticed that I was still too aware of my surroundings—how that was apparent, I don’t know, but she moved in quickly to give me an extra shot of something. I spent the brief period of the surgery feeling relaxed and upbeat, with the “curious fascination” mentioned by the author. I was in such good spirits for the rest of the day that I was said to have been hard to manage appropriately for a post-surgical patient. I felt enthusiastic about the second surgery two weeks later.
The second anesthesiologist paid virtually no attention to me during the procedure and spent his time in a corner of the room chatting with someone. I know this because I was far too keenly aware of what was happening. I had even told him beforehand that I’d needed a second dose the last time, but he seemed unconcerned and obviously didn’t choose to administer it as the first had done.
I was frankly terrified. I kept waiting for the hazy, pleasant feeling from the first surgery to kick in, but it never came. I was sedated just enough and so afraid that I couldn’t seem to speak up, especially in the midst of the surgery itself. It seemed better at the time just to get it over with than prolong what was happening, but the experience left me shaken.
The single difference between the two surgeries was the anesthesiologist. It’s hard not to believe that the attentiveness in this role makes the biggest difference of all.
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I have had conscious sedation 8 times and I remember everything that happened in them except for the first time.
I can at least say that there was no trauma or feelings of being upset in any of them.
I have reported this fact each time I have been sedated, and have been told that it is impossible to remember what happens. Apparently not all anesthesiologists know about this or are simply denying the fact.
I believe the procedure should have defined parameters.
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@me, just me
I've had it twice and don't remember a thing.
@me, just me Thanks for your comments on my story. I'd love to hear more if you could please contact me through the link at the bottom of the article?
Conscious sedation is cheaper and more profitable. As long as the profit motive is part of healthcare delivery, patients beware.
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@em em seven I avoid a general at all costs. The risks of death are higher and there are indications it impairs memory and brain function. I'd rather remember my colonoscopy than be impaired.
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@jjs: You don't have to make a choice - there's no need to remember your colonoscopy NOR to have impaired brain function IF your doctor uses propofol correctly.
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@em em seven Conscious sedation does not require the presence of a Certified Registered Nurse Anesthetist or Anesthesiologist in most states. By allowing a dentist or doctor to both sedate the patient and perform the procedure (which is dangerous IMHO), or allowing that dentist or doctor to direct an RN to give the sedation (usually versed and fentanyl, or the equivalent), they reduce the cost of the procedure. It's not anesthesia, it's conscious sedation. It's all about money, with patient safety and satisfaction falling low on the priority list.
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Long after I became an adult, my mother was discussing a time when I was hospitalized at 18 months old. She said offhandedly that my veins had been impossible to find, so the medical personnel had had to cut an incision in order to start an IV. She said, “Of course, you were much too young to remember that.”
Its true that I don’t remember any details from that time. But it’s obvious to me that there are more ways of remembering than having a mental movie of the event. I have been phobic of doctors and medical procedures for the rest of my life. I am frightened in particular by anything to do with IVs, despite having been “too young to remember anything.”
I think that it must be easier and more comfortable to assume that people won’t remember, when in fact, there are nevertheless consequences other than clear, distinct memories.
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@Lucy Charles
Thank you, a million times thank you. I too have had a severe phobia of doctors, hospitals, needles, etc. my entire life -- so extreme that at 50 years old I have never had blood work and am living with a broken tooth rather than go to a dentist. This terror goes back as early as I can remember despite there being no obvious explanation for it. I think it is because I was born a preemie, at the edge of viability for 1968 technology, and spent the first month or so of my life in the NICU. Something deeply traumatic must have happened then, something I can't consciously remember or name but it left me with a fear so deep I'm unwilling to even try to confront it. I literally would rather die than have major surgery, and my living will says so. I don't think pediatricians consider the possibility when dealing with an extremely fearful toddler (way beyond normal) that there was some sort of trauma they can't describe which makes the reaction rational. Having parents who dealt with it through coercion and punishment cemented it, too.
13
Nikki,
I am so sorry you’ve been through this experience. I wish you all the best.
@Nikki Sorry you've had to endure that Nikki.{{{ }}}
If anesthesiologists can't always tell if a person is conscious or not, it would be more difficult when the patient doesn't expect to be unconscious but is in distress. This sounds like a variation of patients waking up during surgery and nobody bothers to notice. I had several distressing anesthetic situations in my childhood, but it's only recently that doctors discovered that those with red hair experience anesthesia differently. Of course, nobody was interested in my complaints because I was only a child. Most people also won't complain because they are at the mercy of medical personnel and don't want to start an argument when their life could depend on it.
Telling someone that they won't remember sounds like a recipe for permission to torture you but since you won't remember, it won't matter. It was not that long ago that surgeons operated on babies with no anesthetic because they couldn't talk about it later. Conscious sedation without having a well trained person to administer it sounds like yet another danger perpetrated on unsuspecting patient. On the other hand, anesthesia is the most common cause of death from surgery. People should be very wary of any surgery and use it as a last resort. Just because a doctor recommends a procedure doesn't mean you have to submit.
24
I have a long history of waking up under conscious sedation.
When I had my wisdom teeth out in the early 90s, I woke up enough to feel a tugging sensation and be dimly aware of a tooth breaking, if memory serves, but I wasn't frightened.
During an endoscopy in the early 2000s, I remember waking up enough to feel a plastic guard in my mouth to protect the scope, and then blacking out again.
During a colonoscopy around 2013 I distinctly remember feeling pain and groaning; I can picture the room and remember the discomfort. They pushed more sedative and I was out.
When I had general anesthesia for the first time, I warned the anesthesiologist about this and he administered a hefty Versed dose before they wheeled me into the OR. I don't remember anything after that moment, but my doctor later told me I was lucid and distraught on the operating table as they were getting ready to put me under. Apparently I talked with the anesthesiologist after coming out of anesthesia later, but all I remember was waking up in the recovery room. Oddly, I feel more disturbed by that episode—and not remembering it—than by the dim awakenings I experienced with conscious sedation. Versed was apparently successful at causing amnesia but not so good at reducing my fear that day. I sort of wish my doctor hadn't told me about my reaction afterward, because I walked into her office that day marveling at how easy the surgery had been.
10
@Mini - thanks for your stories Mini. I'm the author of the piece and would appreciate hearing more from you. I can be reached through the link at the bottom of the article
Just reading this article started nudging my already anxious state towards panic. I went through electro-convulsive therapy (ECT: very successful in terms of lifting my depression) with very brief general but awoke two times before the paralytic had worn off and felt like I was suffocating. Extremely unpleasant! It left a mark on my psyche that has yet to fully heal, as my response to this article illustrates. Has not kept me from seeking help, or prompted me to avoid necessary surgery, but I would really do better without it, thankyouverymuch.
19
If you are not in pain what is wrong with being conscious during a surgery? It seems preferable to being unconscious - as long as you do not have an anxiety disorder. I recently had surgery and requested only local anesthesia but the doctors would not agree to this request and insisted on sedation as well. I was given fentanyl (among other things) and even months later I am dealing with side effects.
5
@DeeKay You might be surprised by how unpleasant it can be to experience surgery while awake, even without pain. The sounds, the smells, the tugging, the powerlessness, the fear. Even without an anxiety disorder, it can be very frightening.
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@DeeKay
"If you are not in pain what is wrong with being conscious during a surgery?"
Oh, I don't know, the fact that someone is slicing into your organs with a very sharp knife while you lie paralyzed and helpless, knowing that a mistake, while not likely, could be horrific?
8
@DeeKay
Most people are terrified of surgery and what is being done to them. Sometimes the anesthesia is for the surgery team's benefit.
I'm not that kind of patient and I'm actually fascinated about what is going on. One of the doctors I've worked with said that I was the kind of person who would want to watch my open hear surgery (if I had it) on a monitor while it was progressing. She was right...
2
I am an anesthesiologist. A lot of these patients were poorly counseled in my opinion. Life is very much about expectation. If my patient expects absolutely no awareness I tell them I can guarantee this with general anesthesia. If my patient requests or requires MAC/sedation I inform them there are different levels/depths of sedation. Some hand or eyelid procedures and most cataracts for example require cooperation and participation and the patient must follow commands. Some of my patients request no sedation during carpal tunnel surgery and want to watch. The goal is relaxation and complete amnesia (lack of awareness/memory) should not be promised. I talk to approx 1 patient/month who reports awareness from a prior sedation procedure, This is well over the 3/10,000 reported in this article. Proceduralists, nurses, and anesthesia providers should not tell patients that “conscious sedation” guarantees complete amnesia/no memory of events. We will too often fail them. If partial amnesia/relaxation is not going to be sufficient for that individual, an anesthesiologist/CRNA should administer the anesthetic and a general anesthetic or very deep MAC/sedation performed.
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@Pmill With the 3 procedures I've had, I have never been introduced to or talked to the anesthesiologist, never had a conversation about what would be used, consciousness or any of the above. Your points are from the fantasy world of US healthcare. They are irrelevant since it doesn't happen.
14
@jjs you have had 3 procedures. I am an anesthesiologist as well and have personally spoken to every single one of the thousands of patients I've anesthetized prior to taking them to the operating room, and I bet the above commenter has as well.
I can't speak for every practice or for every type of non-anesthesiologist provider who administers sedation for procedures, but I would never take a patient to the OR who had not been examined and had an informed consent discussion with a member of the anesthesia team. And I always see and say hello to the patient myself to make sure that they feel comfortable with the plan, even if a resident or a nurse anesthetist performs the bulk of the discussion.
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@Katie LOL, talk to the anesthesiologist....for my neck surgery where they did 4,5,6 with cadaver shims, a cage, a plate and marrow, the surgeon himself gave me a full 15 minutes, but didn't seem pleased I took up that much time. Never spoke to the anesthesiologist nor was I introduced. NO ONE from the surgical team ever discussed what anesthesia I was getting, if I had options or side effects. They did repeatedly tell me I was lucky to get a surgery slot. Did i sign a consent. I'm sure I did among 6,000 other documents. Was I examined, of course.
In my experience, what you are saying you do, does not happen in the NYC area.
6
I refused any sedation for my cataract surgery last month. The ophthalmologist told me that the procedure would take five minutes, would be painless, and that I was not to move. The surgery was indeed quick and painless, and I had no problem remaining still. Interestingly, afterward the physician told me that he never could have done what I did, but since I don't usually experience anxiety, I trusted that I would not feel anxious in this case. I recommend sedation-free cataract surgery for anyone who does not usually experience anxiety. I'll have my second cataract surgery in a couple of weeks and have already let my ophthalmologist know that I won't accept sedation. This time he seemed very accepting. Maybe we have to educate not only patients, but physicians as well.
14
@Jeanne: You are a very unusual person; very few people can have their eye cut into without getting anxious and squirmy. The several cataract surgeons I know would never agree to this.
4
@Jeanne
When I had cataract surgery no one even offered me sedation. But I asked for it in pre-op and they gave me a light sedative. And then other people asked for a sedative too. I was very nervous in spite of knowing how fast and safe the surgery is: it’s still a surgery, and if you have a complication it’s not a good situation. Two days later I had the second eye done and asked for sedative right away. It made the experience so much better and I find it inexcusable that a sedative wasn’t offered in the beginning. I’m not sure I could have held still otherwise.
2
@Jeanne I had three cataract surgeries and wouldn't dream of not having sedation. That said, I have some moderate claustrophobia and the thought of having my face covered made the choice to have sedation a simple one. I can't imagine there is 1/100 people who would be well-served by having this procedure without sedation.
1
. PharmoGenetics, is the study of people who have unique responses to medications. Europeans Jews are a small genetic group well known to respond differently to many medications, sometimes deadly responses. The information is well documented but has not been integrated into most Physicians practices and even in hospitals they rarely test patients though gene testing is readily available and not that expensive..
I have awaken in several surgeries and what I remember besides the pain is the noise of the operating room and the loud voices of the staff. I now have developed a phobia of even going to any Doctor appointments and refuse most procedures.
11
I had my first colonoscopy and woke up moaning and repeating it hurts. Because of this article now I know that I was under twilight. I wasn't traumatized but I'll never forget it. For my second one, I told my doctor about my experience. As I was getting prepped, I was introduced to the anesthesiologist who would be by my side. In the future, I will always ask for general anesthesia even for a minor procedure.
13
Patients with Obstructive Sleep Apnea should avoid conscious sedation and insist on the presence of an anesthesiologist.
OSA is somehow a bigger challenge than bad memories.
12
@--Jack: can you explain your statement? I would have thought that GA would be more problematic for people with OSA.
1
@Stuffster the sedative medications used for conscious sedation exacerbate obstructive sleep apnea, as do general anesthetics. The difference is that during general anesthesia, breathing is taken over by the anesthesiologist using a ventilator and a breathing tube to protect the airway. Patients with OSA can develop dangerous hypoventilation and airway issues under sedation since the airway and breathing are not controlled.
6
I have always been uncomfortable with the idea that it's fine if a procedure causes pain, fear, and distress, as long as it isn't remembered. I'm glad this is being investigated. This may be even more relevant for procedures on young children. I had a some painful and invasive medical procedures as a toddler, and my parents were told it didn't matter because I was too young to remember it. And indeed I do not remember it, but I wonder how it affected me emotionally anyway. At least an adult has an understanding of what the procedure is and what may occur, but not so with a baby or toddler.
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@TT I had the same experience as an 8 year old being given what now seems a truly barbaric (and dangerous) procedure: A pneumoencephalogram. (It's the same procedure that Linda Blair screams her way through during "The Exorcist" when they're trying to diagnose her. Unlike her character, I was sedated but it was still traumatizing.) Also woke up from the ether anesthesia they gave me when taking out my tonsils at age 5. Those experiences are why I long put off having surgery I needed as an adult.
1
This is disturbing. I've had three colonoscopies under twilight, which, I believe, is propofol. I now require surgery for a small umbilical hernia. One surgeon told me he would do it under twilight, while the other said she would use general anesthesia. I was leaning twilight, now I'm not so sure...
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@Sneeral, if you have done fine with the twilight previously, it will probably be fine again.
Talk about this with the doctor offering you the twilight option. If (s)he takes your concerns seriously, I'd trust him or her to do it right.
3
My mother had cataract surgery and was conscious during one. When I went in to get her she was terrified and told me everything the doctor had been saying or doing. When she asked the doctor about that at her follow up, he was very angry and defensive. Not hard to see how this could be extremely traumatic. The doctor does make a difference.
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@Sally I also was conscious during an unusually long cataract repair surgery and experienced pain in my legs but was ignored by the doctor and assistants. Very upsetting.
7
The author mentions electroconvulsive therapy as a procedure where conscious sedation is used. This is incorrect. Although anesthesia for this procedure is brief, general anesthesia is always required in the US.
19
I was scheduled for a colonoscopy a few years ago, but was told by two friends that they had awakened during their procedures. This frightened me so much that I cancelled my appointment. I have not had a colonoscopy and probably never will. I have had three successful surgeries under general anesthetic, with no problems. Undergoing any surgical procedure while partially awake seems barbaric to me. And, obviously the idea that patients won't remember is a fallacy. My two friends both remembered in detail, as do many who comment here and are mentioned in the article. Too much of medical practice is for the convenience of the doctor, not the comfort of the patient.
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A friend who required regular checks had colonoscopies with no sedation at all until it became the norm to put patients "out" or maybe semi -out. For myself, I believe that mine ( 3, one removing polyps) were done using propofol. No bad experiences, and the effects wore off quickly. I had confidence in the doctor, which might affect levels of apprehension.
Instead of simply deciding not to have one, why not speak to the Dr. who would be performing it about your options?
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@Ms. Pea, you have options. Some doctors will conduct colonoscopies without sedation. You could also be put into deeper anesthesia, if you prefer.
You are more likely to get colon cancer than you are to wake up midway through a colonoscopy. I hope you'll find a gastroenterologist who will discuss this with you, and work with you to find a way for you to get screened comfortably.
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@Ms. Pea, They now have tests that can be done in lieu of the colonoscopy. No sedation required and you can do it in your own home yourself.
Please ask your Dr. if you are a candidate for this, it could save your life as colorectal cancer is more of a possibility as we grow older.
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This is something that needs to be brought into the open. Thank you, Kate. Patients can opt to stay awake and receive local anesthetic, rather than receive conscious sedation. Refusal of sedation is neither brave nor crazy: it can be self protective
As stated in the recent book, My Glory Was I Had Such Friends:But long, hard-earned experience has taught me this: Versed messes with your mind. It’s a powerful, tricky sedative that makes you think you’ve slept through the procedure when actually you were awake the whole time. Versed is, simply, a forgetting drug, but its powers of erasure are im- perfect. Somewhere in your mind (and certainly in your body) there is a flicker of awareness that something happened to you (for instance, you might have been screaming in pain throughout the procedure), but you can’t quite get at it, so an anxious ambiguity scratches at you and festers. There is a cost to not being able to access and process our own pain and suffering—some might call this post-traumatic stress. I’ve experienced it myself, and this is why I’ve come to insist on keeping things where I can see and process them—without Versed.
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@Amy not every procedure can be accomplished with local anesthetic alone, but when possible I am always happy for my patients to choose this option. I also inform my patients who will be receiving sedation that it is normal to remember or experience some or all of the time in the OR, and if they do exhibit signs of discomfort, I calmly and gently reassure them while deepening their sedation. It seems, in my experience (as an anesthesiologist) that managing expectations goes a long way toward alleviating fear and distress around medical procedures.
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@Katie Thanks for that. Often, though, for procedures where drugs like Versed and other such sedatives are used, there is no anesthesiologist present, but rather just the physician and perhaps a fellow, plus a nurse or two. The focus is on the procedure, not on the patient's moment-to-moment comfort and ease. In addition, staying awake means being able to spot errors–and these are not infrequent. And finally, for experienced patients who know certain quirks of their body: staying awake and alert and participatory can be helpful to the physician who is at the helm. But most of all, the problem with conscious sedation is that, as written above, it prevents the patient from remembering what took place—while, at the same time, it does not erase from the body they physical memory of pain and, in some instances, horror. It's not that staying awake is easy or without its own challenges; but a seasoned patient knows that conscious sedation opens up pandora's box.
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@Amy thanks for your comments on my article. I would like to hear more from you if you could please contact me through the link at the bottom? Thanks
I have had the experience of awakening during a twilight procedure, thankfully, without the terrifying repercussions as it was not a major surgery.
My mother has awakened during sedation for multiple procedures including major ones like knee replacement surgery. Prior to her last procedure for pacemaker replacement, we alerted both the doctor and anesthesiologist to her tendency to awaken. I made certain to address them about it myself since my mother often will not speak up for herself thinking the "doctors know best." They brushed us off. Needless to say, she became alert during that procedure as well and the team scrambled to put her back under. I will certainly be looking into the referenced Anesthesia Awareness Registry.
It is frustrating when physicians will not listen to the patients' experience! What point is there in discussing a medical history if the doctors completely dismiss you?
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@CC It sounds like you and your mom have had a frustrating time with this, but I don't think you can assume that the physicians didn't listen to your concerns. The problem is that sedation is not supposed to completely anesthetize people; it is within the normal range of expectations to awaken under sedation. As the article states, it can be difficult to titrate the medications precisely enough to maintain safe breathing and blood pressure while avoiding any awakening, particularly as the stimulation during procedures under sedation can vary significantly from minute to minute. This can be even more challenging in the frail elderly, whose cardiovascular and respiratory systems are often more sensitive to the depressant effects of sedative medications. And since each procedure is different, with different sedation requirements (e.g. the amount of pain or stimulation the patient may experience is different when comparing a knee replacement under regional anesthesia vs a pacemaker placement), what works for one patient for one procedure may not work for them for a different procedure.
All that said, I am sorry to hear that your mother has had bad experiences with sedation.
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@CC- The real problem is that you have no idea if the anesthesiologist you spoke to was anywhere near your mother during the procedure. They like to come by a few minutes before the procedure, stick some consent forms under your nose and ask a few questions. My mother was having the procedures but I always asked if that doctor was going to be handling her care. "No, it's someone from our group." You can't choose. Maybe it's the one with the most malpractice cases. When they did say they were going to be handling her case, I asked if it was every minute or just monitoring. Even if they said it was every minute that doesn't mean it was so. I had no way of checking. Legally, they are allowed to monitor several cases at once. If something goes wrong, too bad for you. How can you prove that they weren't paying careful attention?
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@S.L.
A patient won at least one such legal case when it was shown that the anesthesiologist posted on Facebook during the time the patient was in surgery.
(Not that I think this is common. Just remember, people leave digital footprints everywhere these days, and surveillance cameras are everywhere, too. If you need to prove a doc was not where he said he'd be during your procedure, it might not be impossible to find proof.)
3
I'm a physician with over 25 years experience in administering conscious sedation for cardiac procedures. I've also been a patient for a number of procedures.
As my experience progressed I found that most patients, treated thoughtfully and gently, could safely and comfortably undergo cardiac procedures with no sedation at all. These patients tended to be more relaxed and to report no discomfort or distress afterwards.
When I had upper endoscopy performed on myself (the procedure the author reports here) I requested that no sedation at all be given to me. I found the procedure not to be uncomfortable for more than 1-2 seconds and overall not unpleasant at all. I've had similar experience as a patient with other, more invasive surgical procedures.
Sometimes the solution to this problem may be less anesthesia\sedation rather than more.
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@CAB I do much better without sedation but cannot get doctors to go along. This considering a relative died from anesthesia. Obviously for major surgery it is required but for colonoscopies!
6
@CAB I've had several procedures without anesthesia (colonoscopy, endoscopy, venous ablation, hand surgeries). I find it much easier and quicker than dealing with sedation and its aftereffects. In almost every case, though, my doctors actively discouraged me, implying that I'd regret my decision half-way through.
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@poslug - I suspect that doctors find procedures easier to do when the pt. is out, as opposed to having a potentially moving target, as it were.
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I had a cardiac cath procedure done in December and they used "conscious sedation." There was a problem because they could not get the drugs properly titrated so that they would do what they were designed to do. As a result I was conscious much of the time and in pain, compounded by the necessity to cath both sides of the groin. I have vivid memories of the whole procedure. In contrast, I have no memories of the quad by-pass surgery done two days later.
9
To avoid the issue here, especially with the de facto criminal health care system we have here in America, ie the wealth of billionaire big PHRAMa execs. come over the welfare of the patient or the doctor, don't get sick.
9
@Paul, that's rather like telling you not to get sarcastic.
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@Blue Jay-Thank you for reply and you are right I was being sarcastic.
Sometimes you have to Blue Jay. Our current de facto criminal health care system is like the issue of slavery circa 1865. It is far and away our most important issue and one where we are light yrs. behind our peer countries.
They are in the 21 century. We are in the Middle Ages.
1
@Paul, if I were born in the Middle Ages, I would not have survived infancy. I'm a natural pessimist, but I see no need to brand modern healthcare as Enemy #1. It's a waste of time and energy. I do what I need to do to get the care I require, but don't let myself dive into cynicism about doctors and drug companies. (I reserve that for contemporary politics!)
7
Why is conscious sedation preferred over general anesthesia for procedures that don't require some degree of consciousness?
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It is due to the higher rate of bad outcomes with general anesthesia. Plus, general anesthesia usually has to be performed in a hospital with an anesthesiologist right there and closer monitoring after the procedure.
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@Buckeye Lady general anesthesia is actually very safe, but anesthesiologists and/or nurse anesthetists are required to provide it. Sedation is provided more and more by non-anesthesia providers in non-hospital settings, allowing proceduralists to perform a high number of lucrative cases in any day without having to expend the overhead of hiring anesthesiologists. Many of the bad anesthesia-related cases that we hear about in the news (pediatric dentistry-related deaths, etc) occurred as a complication of sedation, not general anesthesia.
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@Buckeye Lady
none of this is true
1
Having had a vitrectomy (eye surgery where the fluid of the eye is removed and the orbit temporarily taken out of the socket) under conscious sedation where I awoke and saw only what looked like fractured glass, I can tell you that there are few more frightening experiences.
The memory never fades.
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@Dr. Sam Rosenblum
I too awoke during eye surgery - cataract and the spinal anesthesia wore off during childbirth in time for me to feel the stitching up of a Caesarean incision. The trauma of both return to my memory frequently enough to cause distress. I will not undergo surgery again. The only way I will be in an operating room is if I am unconscious and someone else signs. I cannot ever give my okay. Death doesn't scare me more than surgery.
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@BCOC
I also had a vitrectomy and woke up in pain. I had to tell the surgeon that "It hurts."
He told me he was almost done and asked if I could hold on.
Honestly, there is absolutely no reason why a vitrectomy required conscious sedation and it's absolutely ridiculous that I, like Dr. Rosenblum, had to awaken on an operating table, fully aware and cognizant of the procedure.
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@Marie thanks for your comments on my story. I would love to hear more about your experience if you could contact me through the link at the bottom of the piece. Thanks
2
The risks of general anesthesia on cognitive and psychological health were not discussed in the article. I have read some studies and know of anecdotal problems. I know I have had physical effects from general.
I awoke briefly during conscious sedation for shoulder surgery and remember it well even now (over 20 years later). For two recently needed surgeries related to a fracture, I had to ask the anesthesiologist for conscious sedation instead of general. For the first surgery, the doctor was fairly insistent on general, but changed to conscious sedation for the second. For each, I awoke clear headed - and with no anesthesia related physical symptoms.
Since each of us reacts differently to medications, one solution is not appropriate for everyone.
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@Marcy Lebovitz
I agree. a little reminder of the potential costs of heavy sedation was missing. The trend to using reduced sedation exists because of concern for safety, and after-effects, including for some, delirium and long term cognitive interference.
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@Marcy Lebovitz I'd love to hear more from you as I collect patient stories. You can reach me through the link at the bottom of my article. Thanks
@Marcy Lebovitz - most of the drugs utilized for "conscious sedation" are also used for provision of general anesthesia - in different doses/combination and different goals regarding level of ability to respond - in particular the ability of the patient to protect their airway.
There is a threshold - provide enough "conscious sedation" such that the patient loses the ability to protect their airway (in other words will not cough if they vomit and aspirate gastric contents) is the definition of general anesthesia.
3
There are other important issues to consider, such as the major one of keeping the airway open and secure (a secure airway is a big difference between general anesthesia and the various levels of sedation), the training of the people who administer sedation, the struggle with insurance companies (and for years, Medicare) that deny payment to physician anesthesiologists for providing sedation for endoscopies, the range of individual patient responses to the various sedative and anesthetic drugs, and the push to do more procedures in “outside the operatimg room” locations.
Airway is key, and it’s really difficult, and sometimes impossible, to keep a person adequately sedated and breathing without airway support with a breathing tube or other device, especially in patients who have airway abnormalities, obesity, sensitive gag reflexes, etc.
While some sedation providers have taken only weekend courses in how to provide sedation, there are more rigorous courses established by the American Society of Anesthesiologists, and there are also anesthesia providers, such as physician anesthesiologists, anesthesiologist assistants, and certified registered nurse anesthetists, who have had years of training in the continuum of sedation to general anesthesia.
There is little in medicine that is 100%. Results and responses vary, often unpredictability. Unfortunately, people cannot expect every outcome to be perfect.
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I am an anesthesiologist with 25 years experience.
If you request to have your sedation performed by an anesthesiologist, you will not have any awareness.
I do sedation for gastroscopy ( EGD) all the time.
I have never had a patient suffer from this.
When an anesthesiologist provides sedation for EGD, colonoscopy, pacemaker insertion, or minor surgery, we use drugs that others cannot use. Our drugs are stronger, but we have training to prevent problems.
When an anesthesiologist provides sedation it is called
Monitored Anesthesia Care (MAC)
When a nurse provides sedation for a procedure, it is called Conscious Sedation.
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@JAG
One of my two cases of awakening were when anesthesia was administered by an anesthesiologist the other a nurse anesthetist administered. Both were traumatic
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@BCOC I am collecting patient stories and would love to hear from you through the link at the bottom of my story
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@JAG
Propofol used in MAC has a faster onset of action and shaves off a few minutes from the endoscopy. The savings on each case can add a case or two over a day. Anesthesia fees are an added benefit. MAC is great...for the revenue it helps to generate in clinical practice.
In reality, the vast majority of people don't get much value from it over conscious sedation, at least if the latter is administered competently. The problem is that as MAC is taking over, new physicians are not trained well in administering conscious sedation. It is a bit of an art, which requires patience and focus on the patient.
Also, the risk of serious complications, e.g., aspiration, is slightly higher with MAC -- that is published data, not opinion.
Some insurances are getting wise to this, and they do have a point. There is no question that some patients benefit from MAC in endoscopy, but the vast majority don't. There are precious healthcare dollars that could be spent better elsewhere.
3
I’m one of those who woke up under general anesthesia, while undergoing arthroscopic shoulder surgery.
It was truly terrifying, and I can well imagine someone thrashing about in response. I could not, as one of the drugs administered was a neck-down block. I tried so hard to open my eyes, not realizing that they were taped shut. I felt starved for air and could not understand why none of the cheerfully chattering dolts could see that I was dying here! My blood pressure must have soared, alerting the anesthesiologist.
I suspect this all occurred within a matter of seconds, though it seemed much longer. When I later reported it to the surgeon, he did not seem overly concerned, but neither did he pooh-pooh the notion, as I’ve read many physicians do.
Fortunately, I haven’t suffered any long term effects, but it has cured any desire for elective surgery I might have had.
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@Lindah Thanks for your comments. I am collecting patient stories and would love to hear more from you. You can reach me through the link at the bottom of the article.
The author doesn't make this clear but "conscious sedation" and "anesthesia" (which includes Monitored Anesthesia Care AKA MAC usually deep sedation with propofol) are completely different.
Conscious sedation does not involve members of the anesthesia department. It involves the proceduralist (GI doctor, cardiologist, orthopedist) instructing an RN (not a CRNA, which is different) to administer small doses of pain and sedating medication to make the procedure tolerable to the patient. Although many patients don't remember, it is not the expectation that you will be completely out. That's why it's chosen for less painful things like minor finger surgery (where the finger is numbed) or cardiology procedures that involve a small needle stick in the groin.
The author likely received bad counseling about what to expect. Many people can have minor procedures successfully with conscious sedation.
It is becoming more standard for GI procedures in the US(colonoscopies and upper endoscopies) to have anesthesiologists involved and to have deep sedation AKA MAC in which the patient would have no awareness. It's often more comfortable for patients. The downside is it's much more expensive (you have to pay for two physicians' services instead of just one) and deeper levels of sedation have risk (for example, having saliva or other secretions enter the lungs because you are too sedated to cough and cause a chest infection).
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@Anesthesia Provider
Good points. And just to be clear, even a "deep sedation" or "MAC" provided by an Anesthesiologist or CRNA does not aim for complete amnesia. The goal is to provide a lower level of consciousness for more uncomfortable procedures. General Anesthesia is the only method in which the goal is complete unconsciousness. And until we learn magic, no combination of medication and human physiology will ever be 100% predictable or come with any guarantees. Our drugs and techniques are amazing and always improving, but are far from perfect. Every participant in a surgery or procedure must accept this.
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For the 3 in 10,000 who experience this the first time, I recommend deep general anesthesia for future procedures.
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@DHL1943
Right on. And I seriously question that statistic. I have experienced this, as have several members of my family and some acquaintances--and judging from the responses here, I'd wager this microscopic number of affected people will change as more discussion and study on this topic ensues.
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