I feel like we do a crappy job sometimes of telling patients what to expect or differences in things like sedation vs general anesthesia. Sedation is just ‘makes you sleepy’ but you can wake from that sleep.
General anesthesia you’re out, and you stay out until the doc pushes the drugs to wake you up.
I think the vast majority of stories about waking up in the middle of surgery involve the kinds of surgery where that’s semi-expected. Like, we’re typically not going to give general anesthesia for something like a toenail ablation or other more minor stuff. People wake up during those - usually we have a drape over them, so thay can’t see the the actual surgical site, but they often need to be oriented - “Hey Mr. Jones, you’re at the hospital for your toe surgery remember? You’ve been asleep for about 15 mins - we’ve got a couple left to go, then we’ll get some dressings on and you’ll be good to go!” …completely normal. They won’t actually feel what we’re doing because of a nerve block or local anesthetic.
But, ^that after a few rounds of telephone game becomes some horror story about waking up in the middle of a big open abdominal surgery, feeling all the cuts but not being able to speak or move. Can that shit actually happen? Probably, idk… our physiology is super finicky and there’s always the chance you’re the next one-in-a-billion unlucky bastard with a previously unheard of weird response to one of the meds they use for general, but I suspect most of these tales are, again, telephone-game type deviations from something completely different, or just pure bullshit from square one.
There are 100% people with a gene that makes them metabolize anesthesia super rapidly, myself included. It’s linked to the gene for red hair, but red hair isn’t a requirement (I have it and I’m not a redhead, although my mom is).
I’ve 100% woken up during surgeries I should not have been conscious for, because the anesthesiologist didn’t believe me. Those include a pediatric colonoscopy, surgery to set a broken arm, my TEE (I was conscious, but in twilight sleep. Took 3 vials of versed and I still remember it), and my septoplasty.
And it’s not just general anesthesia either. It takes a fuck load of local anesthesia for me to feel it. My last filling they had to give me so much it paralyzed half my face for a while. Also, I wish my urologist had believed me when I said I wasn’t numb for my vasectomy.
What’s up cousin! I have this gene. Also have EDS and we have a ton of red hair in our family.
I also woke up during a pediatric surgery! Mine was a facial surgery. I was out for a bit and near the close end I woke up and was aware of everything except the pain.
Thanks for letting me know about the vasectomy pain because those are supposed to be easy! Yikes sorry man.
I wish we could add this to our medical files. Like it should be easy to do but for some reason it always comes down to the patient and whether the doctor feels like believing them that day.
Bonus: We also process opioids rapidly. So, those don’t work on us either. But the trade off is we have higher pain thresholds than normal people.
Tolerance to pot equates to tolerance to a lot of anesthesia meds, and I think cocaine can fuck with it too, but idr why.
My advice: tell your healthcare team everything. Regular OTC meds, any supplements or herbals you use, alcohol/tobacco use, and a 100% accurate picture of any illegal shit you use. If you snort a whole gram every single night, tell them you snort a whole gram every single night.
Your anesthesiologist isn’t a cop: he doesn’t give a flying fuck about whether or not you broke the law. He does give a fuck about the chemistry currently swimming around in your body and how that effects your physiology / how it interacts with his own chemistry cocktail he’s about to squirt into your veins.
Full disclosure, if you admit to violent crimes, especially ones that are ongoing, he will have to report that to the cops (at least in my state - that could vary).
I straight up told mine I require significantly more anesthesia because of my genetics. He made the incision, asked if I felt it, I said yes, then he started.
I did find out that I have an enormous pain tolerance, though. Fortunately the recovery was a breeze, so I guess I speed ran the pain.
IDK shit about peds, but adult colonoscopy and TEE are both under sedation, not general. Broken arm depends on how they fixed it - if it was a closed reduction then it might have been sedation, but anything open would be general. Septoplasty is always general afaik.
Filing and vasectomy are usually just local anesthesia (numbing). That’s a whole different battle: docs can be impatient and like to start working before the numbing actually starts. You say OW! They get annoyed and push more local, wait 10 seconds, start working again, you say OW, they push more, etc. 10 mins into the torture, the initial dose is finally doing it’s job… but then the other 5 doses kick in and your entire head goes numb. I have that issue with local too - I don’t need more of it, I just need to give it more time to work its magic; so when I need a filling or something I’ll tell the doc to push the local, then take a coffee break or something and check back on me later.
Anyway, you kinda showcase my point: of the operations mentioned, only one stands out as for sure needing general anesthesia, so it sounds less like your anesthesiologist didn’t believe you and more like he just did a shitty job of explaining the kind of anesthesia you’d be receiving.
LOTS of people think they should be asleep for any and every surgery. I’ve had dozens of patients in the operating room nervously ask “shouldn’t I be asleep for this part?” and the nurse shoots an evil eye at the anesthesiologist as she explains “No, you won’t be asleep for any part of this.”
I blame office staff- when I had my wisdom teeth removed, it was going to be a shit show, so they sold me on “putting me under”- insurance would only cover local, but “you don’t want to be awake for all the digging and prying” which did not sound like fun so I agreed, at a cost of $400. Of course I woke up in the middle of it, and got to experience the digging and prying… Didn’t hurt at all, but it was still disconcerting. I found out later this wasn’t anything unusual. Had I known I would have been awake, I wouldn’t have spent the extra money.
Yeah that’s super fucked up, and kinda roots back to your right as a patient to informed consent. Office staff shouldn’t be giving any kind of medical advice - if you have a question about a med, that’s their cue to call in a nurse or doc to come talk to you.
like, you can just switch me off with a drug, and after a while I come back? weird, bizzar, and yet also practical. and (as far as I understand) it’s universal. Works on every living thing. They’ve anesthetized plants
Typically it’s just the epidural - they don’t even need local since once the epidural is done, they can’t feel any pain from the abdomen-down… they will still be able to feel pressure, which is fairly extreme given that it literally involves ripping major abdominal muscles in half; and the discomfort from that much pressure vs the discomfort from pain is kinda splitting hairs. Anyway… General anesthesia in a C-section means there’s some kind of emergency on the mother’s end, and once the drugs are administered the surgery needs to be done FAST because they can effect the baby.
Rummaging through a purse is a hilariously polite way to put it, lol.
General anesthesia in a C-section means there’s some kind of emergency on the mother’s end, and once the drugs are administered the surgery needs to be done FAST because they can effect the baby.
Yeah… its a scary af time. Especially since the general can take a long time to wear off and the mother stabilize.
But, ^that after a few rounds of telephone game becomes some horror story about waking up in the middle of a big open abdominal surgery, feeling all the cuts but not being able to speak or move. Can that shit actually happen? Probably, idk…
It can happen. When giving general anaesthetic there are three components. An anaesthetic to puts you out and makes you forget whats going on, pain relief and a muscle relaxants so that you go limp and don’t try to fight the ventilator when they take over your breathing. If you are resistant to the anaesthetic or not enough was given then you can wake up while still under the effects of the muscle relaxants unable to do anything to let anyone know. Scary stuff if you ask me.
The thing is there are a lot of signs that start popping up when the anesthesia isn’t doing its job, due to tolerance or not having enough pushed. Your body starts to respond to the surgery way before your brain does, and we’ll start seeing muscle twitches or their vitals start to go nuts.
Not terribly uncommon for a surgeon, well into the operation to poke or cut something and the leg or whatever we’re cutting on recoils a bit. Surgeon gets annoyed and snaps at the anesthesiologist “Hey he’s getting a little light - we still got at least 40 minutes!” and the anesthesiologist will push a little more sauce and the signs stop pretty quick.
Point being, by the time you’d be aware of anything, your body will have been reacting to it increasingly dramatically.
Surgery aside - let’s say you’re sleeping normally and someone tickles your nose with a feather or something. Not enough stimulation to wake you up, but your nose might twitch or flare in response; with enough irritation you might even reach up to scratch your nose or move your head all without ever waking up - though by that point your very close to regaining consciousness.
Again, our physiology is weird, and meds do weird things to it, and I’m just a tech so I don’t know the nitty-gritty details, so I’m definitely not in a position to say it’s impossible. But those kinds of claims definitely fire off the bullshit detector enough that I’d be hesitant to take them at face value without a breakdown of how the patient’s physiology is different from everyone else’s or how the anesthesiologist managed to come up with a cocktail of whatever he pushed to allow for mental perception of being sliced open without any change to things like vital signs.
I agree they’re warning signs that you are awake and a good anaesthetist should pick up on it but, I am also saying that it’s possible, rare, but possible given the nature of GA to not have enough anaesthetic onboard while having a decent does of muscle relaxant. So you can look like you’re out of it from the end of the bed but still be aware. A good anaesthetist should honestly be paying attention to the patients physiology and noticing the blood pressure and heart rate spiking before this happens though. Maybe evening using something like a BIS to help confirm anaesthesia.
I think I have to clarify something. The whole thing was not as bad as it sounds. I had a local anesthesia in my arm (which was operated) and was sedated with propofol (i think).
My focus wasn’t as much on waking up, which i guess from the comments can just happen.
It was more on my inability to speak up if something is wrong.
Maybe they even noticed, and thought its alright. There was no pain, just an unsettling feeling.
I can’t stress enough that I’m a tech, the rock bottom of the OR foodchain, so my understanding is limited …and even if I was claiming to be some kind of doctor, I’m still just a random internet stranger, so some healthy skepticism is encouraged regardless. BUT I’ve spent most of the past decade working in rooms full of brilliant people, so I’ve picked a few things up during that time, so: some of what you’re describing is normal, like waking up during sedation, but some of it has me scratching my head. Like, there shouldn’t (dangerous word, I know) be a situation where you’re sedated and paralyzed, cuz that’s a recipe for the nightmare fuel this thread is talking about. If you wake up from sedation, you might feel groggy and like heavy limbs or not just lack the desire to move like when your alarm is going off in the morning and you’re just lying there in a state of apathy for a minute mourning the loss of your sleep… but… if you make a conscious effort to move or speak, you should (*) be able to.
And again, not saying none of that ever happened; it’d just be super abnormal to the extent of suspecting some kind of literal physiologic anomaly (which is possible!) or some kind of borderline criminal incompetence (or actual malice) on the part of your anesthesiologist.
I never said I was paralyzed. I didn’t speak because the situation was too awkward for me to say something. Nobody from the medical staff made a mistake.
I feel like we do a crappy job sometimes of telling patients what to expect or differences in things like sedation vs general anesthesia. Sedation is just ‘makes you sleepy’ but you can wake from that sleep.
General anesthesia you’re out, and you stay out until the doc pushes the drugs to wake you up.
I think the vast majority of stories about waking up in the middle of surgery involve the kinds of surgery where that’s semi-expected. Like, we’re typically not going to give general anesthesia for something like a toenail ablation or other more minor stuff. People wake up during those - usually we have a drape over them, so thay can’t see the the actual surgical site, but they often need to be oriented - “Hey Mr. Jones, you’re at the hospital for your toe surgery remember? You’ve been asleep for about 15 mins - we’ve got a couple left to go, then we’ll get some dressings on and you’ll be good to go!” …completely normal. They won’t actually feel what we’re doing because of a nerve block or local anesthetic.
But, ^that after a few rounds of telephone game becomes some horror story about waking up in the middle of a big open abdominal surgery, feeling all the cuts but not being able to speak or move. Can that shit actually happen? Probably, idk… our physiology is super finicky and there’s always the chance you’re the next one-in-a-billion unlucky bastard with a previously unheard of weird response to one of the meds they use for general, but I suspect most of these tales are, again, telephone-game type deviations from something completely different, or just pure bullshit from square one.
There are 100% people with a gene that makes them metabolize anesthesia super rapidly, myself included. It’s linked to the gene for red hair, but red hair isn’t a requirement (I have it and I’m not a redhead, although my mom is).
I’ve 100% woken up during surgeries I should not have been conscious for, because the anesthesiologist didn’t believe me. Those include a pediatric colonoscopy, surgery to set a broken arm, my TEE (I was conscious, but in twilight sleep. Took 3 vials of versed and I still remember it), and my septoplasty.
And it’s not just general anesthesia either. It takes a fuck load of local anesthesia for me to feel it. My last filling they had to give me so much it paralyzed half my face for a while. Also, I wish my urologist had believed me when I said I wasn’t numb for my vasectomy.
What’s up cousin! I have this gene. Also have EDS and we have a ton of red hair in our family.
I also woke up during a pediatric surgery! Mine was a facial surgery. I was out for a bit and near the close end I woke up and was aware of everything except the pain.
Thanks for letting me know about the vasectomy pain because those are supposed to be easy! Yikes sorry man.
I wish we could add this to our medical files. Like it should be easy to do but for some reason it always comes down to the patient and whether the doctor feels like believing them that day.
Bonus: We also process opioids rapidly. So, those don’t work on us either. But the trade off is we have higher pain thresholds than normal people.
How interesting! Does this apply to alcohol/other “recreational” drugs too, then, or only sedative ones?
Tolerance to pot equates to tolerance to a lot of anesthesia meds, and I think cocaine can fuck with it too, but idr why.
My advice: tell your healthcare team everything. Regular OTC meds, any supplements or herbals you use, alcohol/tobacco use, and a 100% accurate picture of any illegal shit you use. If you snort a whole gram every single night, tell them you snort a whole gram every single night.
Your anesthesiologist isn’t a cop: he doesn’t give a flying fuck about whether or not you broke the law. He does give a fuck about the chemistry currently swimming around in your body and how that effects your physiology / how it interacts with his own chemistry cocktail he’s about to squirt into your veins.
Full disclosure, if you admit to violent crimes, especially ones that are ongoing, he will have to report that to the cops (at least in my state - that could vary).
I’m pretty resistant to stimulants, but I have ADHD so that skews this.
I was undersedated for that one too. Hurt like a mother, but I never realised I may be under sedated so I just challenged through.
No issues in the end though. Just a firm reminder to ask for a double dose next time.
I straight up told mine I require significantly more anesthesia because of my genetics. He made the incision, asked if I felt it, I said yes, then he started.
I did find out that I have an enormous pain tolerance, though. Fortunately the recovery was a breeze, so I guess I speed ran the pain.
IDK shit about peds, but adult colonoscopy and TEE are both under sedation, not general. Broken arm depends on how they fixed it - if it was a closed reduction then it might have been sedation, but anything open would be general. Septoplasty is always general afaik.
Filing and vasectomy are usually just local anesthesia (numbing). That’s a whole different battle: docs can be impatient and like to start working before the numbing actually starts. You say OW! They get annoyed and push more local, wait 10 seconds, start working again, you say OW, they push more, etc. 10 mins into the torture, the initial dose is finally doing it’s job… but then the other 5 doses kick in and your entire head goes numb. I have that issue with local too - I don’t need more of it, I just need to give it more time to work its magic; so when I need a filling or something I’ll tell the doc to push the local, then take a coffee break or something and check back on me later.
Anyway, you kinda showcase my point: of the operations mentioned, only one stands out as for sure needing general anesthesia, so it sounds less like your anesthesiologist didn’t believe you and more like he just did a shitty job of explaining the kind of anesthesia you’d be receiving.
LOTS of people think they should be asleep for any and every surgery. I’ve had dozens of patients in the operating room nervously ask “shouldn’t I be asleep for this part?” and the nurse shoots an evil eye at the anesthesiologist as she explains “No, you won’t be asleep for any part of this.”
I blame office staff- when I had my wisdom teeth removed, it was going to be a shit show, so they sold me on “putting me under”- insurance would only cover local, but “you don’t want to be awake for all the digging and prying” which did not sound like fun so I agreed, at a cost of $400. Of course I woke up in the middle of it, and got to experience the digging and prying… Didn’t hurt at all, but it was still disconcerting. I found out later this wasn’t anything unusual. Had I known I would have been awake, I wouldn’t have spent the extra money.
Yeah that’s super fucked up, and kinda roots back to your right as a patient to informed consent. Office staff shouldn’t be giving any kind of medical advice - if you have a question about a med, that’s their cue to call in a nurse or doc to come talk to you.
general anesthetics are so neat
like, you can just switch me off with a drug, and after a while I come back? weird, bizzar, and yet also practical. and (as far as I understand) it’s universal. Works on every living thing. They’ve anesthetized plants
Caesarians don’t get general or sedation, do they? Just local and epidural fent?
My wife described it as rummaging through a purse, from the perspective of the purse.
Typically it’s just the epidural - they don’t even need local since once the epidural is done, they can’t feel any pain from the abdomen-down… they will still be able to feel pressure, which is fairly extreme given that it literally involves ripping major abdominal muscles in half; and the discomfort from that much pressure vs the discomfort from pain is kinda splitting hairs. Anyway… General anesthesia in a C-section means there’s some kind of emergency on the mother’s end, and once the drugs are administered the surgery needs to be done FAST because they can effect the baby.
Rummaging through a purse is a hilariously polite way to put it, lol.
Yeah… its a scary af time. Especially since the general can take a long time to wear off and the mother stabilize.
It can happen. When giving general anaesthetic there are three components. An anaesthetic to puts you out and makes you forget whats going on, pain relief and a muscle relaxants so that you go limp and don’t try to fight the ventilator when they take over your breathing. If you are resistant to the anaesthetic or not enough was given then you can wake up while still under the effects of the muscle relaxants unable to do anything to let anyone know. Scary stuff if you ask me.
The thing is there are a lot of signs that start popping up when the anesthesia isn’t doing its job, due to tolerance or not having enough pushed. Your body starts to respond to the surgery way before your brain does, and we’ll start seeing muscle twitches or their vitals start to go nuts.
Not terribly uncommon for a surgeon, well into the operation to poke or cut something and the leg or whatever we’re cutting on recoils a bit. Surgeon gets annoyed and snaps at the anesthesiologist “Hey he’s getting a little light - we still got at least 40 minutes!” and the anesthesiologist will push a little more sauce and the signs stop pretty quick.
Point being, by the time you’d be aware of anything, your body will have been reacting to it increasingly dramatically.
Surgery aside - let’s say you’re sleeping normally and someone tickles your nose with a feather or something. Not enough stimulation to wake you up, but your nose might twitch or flare in response; with enough irritation you might even reach up to scratch your nose or move your head all without ever waking up - though by that point your very close to regaining consciousness.
Again, our physiology is weird, and meds do weird things to it, and I’m just a tech so I don’t know the nitty-gritty details, so I’m definitely not in a position to say it’s impossible. But those kinds of claims definitely fire off the bullshit detector enough that I’d be hesitant to take them at face value without a breakdown of how the patient’s physiology is different from everyone else’s or how the anesthesiologist managed to come up with a cocktail of whatever he pushed to allow for mental perception of being sliced open without any change to things like vital signs.
I agree they’re warning signs that you are awake and a good anaesthetist should pick up on it but, I am also saying that it’s possible, rare, but possible given the nature of GA to not have enough anaesthetic onboard while having a decent does of muscle relaxant. So you can look like you’re out of it from the end of the bed but still be aware. A good anaesthetist should honestly be paying attention to the patients physiology and noticing the blood pressure and heart rate spiking before this happens though. Maybe evening using something like a BIS to help confirm anaesthesia.
I think I have to clarify something. The whole thing was not as bad as it sounds. I had a local anesthesia in my arm (which was operated) and was sedated with propofol (i think). My focus wasn’t as much on waking up, which i guess from the comments can just happen. It was more on my inability to speak up if something is wrong. Maybe they even noticed, and thought its alright. There was no pain, just an unsettling feeling.
I can’t stress enough that I’m a tech, the rock bottom of the OR foodchain, so my understanding is limited …and even if I was claiming to be some kind of doctor, I’m still just a random internet stranger, so some healthy skepticism is encouraged regardless. BUT I’ve spent most of the past decade working in rooms full of brilliant people, so I’ve picked a few things up during that time, so: some of what you’re describing is normal, like waking up during sedation, but some of it has me scratching my head. Like, there shouldn’t (dangerous word, I know) be a situation where you’re sedated and paralyzed, cuz that’s a recipe for the nightmare fuel this thread is talking about. If you wake up from sedation, you might feel groggy and like heavy limbs or not just lack the desire to move like when your alarm is going off in the morning and you’re just lying there in a state of apathy for a minute mourning the loss of your sleep… but… if you make a conscious effort to move or speak, you should (*) be able to.
And again, not saying none of that ever happened; it’d just be super abnormal to the extent of suspecting some kind of literal physiologic anomaly (which is possible!) or some kind of borderline criminal incompetence (or actual malice) on the part of your anesthesiologist.
I never said I was paralyzed. I didn’t speak because the situation was too awkward for me to say something. Nobody from the medical staff made a mistake.