awake and under the knife...ever happen to you?

[strmrdr]

no problems first 3 times.
4th had opposite problem couldn't wake me up because the counter agent gas set my asthma off so had to wait it out.

novocaine for wisdom tooth extraction, it hurt a bit for a short time when he cut the bone but wasn't too bad.
will do the same for the other 2 eventually.

 

[fisherofmengirly]

style="WIDTH: 99%; HEIGHT: 223px">My story wasn''t pleasant, but nothing I would ruin someone''s practice over...it just wasn''t THAT bad, or traumatizing, I guess. So what constitutes a traumatic experience? Why do I feel like it wasn''t that big of a deal? Have I taken my experience too lightly or something? Am I some sort of glutton for punishment, lol? (If your face was being hammered open and you woke up right in the middle of it without being able to run away, would you be pi$$ed?)

As far as reactions, period...do you think that experiences shape us, or do our attitudes shape our experiences? ???

Interesting post. I''m sorry you have that memory of a mallet and a hammer. I''d be terrified!!

I think that a lot of how we react to situations has to do with our personalities. I tend to thrive (a little too much, at times) on drama, and as such, I create drama in every day life. I can still remember when I had to go to the dentist and they gave me that laughing gas stuff when I was a little girl, and it had NO effect on me. I told them so, they didn''t believe me. My mom heard me screaming from her seat in the waiting room, and they told her I was fine. I came back to her covered in bruises as they made me be still, even though I felt ALL of getting my first filling. Horrific. So, since I have a flair for drama, I can still recall vivid details. I think that''s why I can recall it, anyway.

I also have NO tolerance for pain, so that could be part of it, too!!

I think our attitudes shape our experiences more than our experiences shape us, at least by the time we reach the age of a teenager or adult. I think by that time, our personalities are more solidified, and we tend to make the best of a situation, the worst of a situation, the funniest story of a situation, or the most gripes about a situation. Still, an awful experience (or a WONDERFUL experience) can help us to break free of the personality we hold to and merge into someone different--- for better or worse.

I really like this post. Psychology and all that nurture vs. nature stuff intrigues me. I love to see it from other''s points of view. Thanks for posting!!

 

[basil]

Doctors really need to do a better job educating people what to expect and the differences between local, MAC, and general anaesthesia.

It''s extremely rare to wake up during general anaethesia. General anaethesia is when you have a tube down your throat and the machine is breathing for you. This is necessary for many major surgeries.

MAC (monitored anaesthesia care) is when you get sedation and local anaesthetic, plus or minus an amnestic agent. A lot of people sort of drift off to sleep, and don''t remember much later. You have to be conscious enough to wake up and follow commands though, by definition. If not, you would stop breathing and your throat would close up. Procedures that they use this for include oral surgery, eye surgery, colonoscopies, and tons of others. If you were planning to sue because you "woke up" during this, then I''d say you wouldn''t have a leg to stand on since you aren''t supposed to be asleep anyways.

For the record, I''ve never had general anaesthesia, but I did have a neck surgery done under MAC. I didn''t "wake up" until well after I was in the recovery room, though I had transferred myself between beds and been responsive to the nurses commands throughout the surgery.

My mom had thyroid surgery under general anaesthesia and was disappointed because she was curious as to what was being done, and what it was like in the operating room!

 

[monarch64]

Basil, thank you for the clarification!

Fisher, yes it is so interesting to hear others'' experiences and the idea that our personalities have so much to do with react to things I think is very true. I guess I have a little drama queen in me, but it''s more positive drama than negative... I''m a pretty positive attitude person in general, and I think that''s why I wasn''t really freaked out or upset whereas I think some people with less positive temperments might have raised hell in a similar situation to mine.

To everyone who fears going under the knife and who I have scared the crap out of now, I apologize. I figured the title of this thread was telling, so ya know, you were warned, hee hee.

 

[sera]

I've had three surgeries. When struggling to come out of the anesthesia from one of them I heard the medical staff discussing a patient and I thought they had meant me. I was freaked but at the time I could not yet move, open my eyes or speak... I could just lay there and listen! OY!

As for this post... as if I wasn't freaked out by the dentist and possible oral surgeries enough! It just totally freaks me out and I can't control it - I had a root canal and the Novocaine and Lidocaine did not work 100% so I FELT the dentist pulling on the nerves! So, even though my current dentist is awesome and I've never been hurt, I just totally anticipate feeling that pain again. Luckily I'm not my dentist's worst patient... I'm only the second worse. At least I stay in the dentist's chair...barely.

 

[lumpkin]

Date: 12/13/2007 7:46:33 PM
Author: basil
Doctors really need to do a better job educating people what to expect and the differences between local, MAC, and general anaesthesia.

It''s extremely rare to wake up during general anaethesia. General anaethesia is when you have a tube down your throat and the machine is breathing for you. This is necessary for many major surgeries.

MAC (monitored anaesthesia care) is when you get sedation and local anaesthetic, plus or minus an amnestic agent. A lot of people sort of drift off to sleep, and don''t remember much later. You have to be conscious enough to wake up and follow commands though, by definition. If not, you would stop breathing and your throat would close up. Procedures that they use this for include oral surgery, eye surgery, colonoscopies, and tons of others. If you were planning to sue because you ''woke up'' during this, then I''d say you wouldn''t have a leg to stand on since you aren''t supposed to be asleep anyways.

For the record, I''ve never had general anaesthesia, but I did have a neck surgery done under MAC. I didn''t ''wake up'' until well after I was in the recovery room, though I had transferred myself between beds and been responsive to the nurses commands throughout the surgery.

My mom had thyroid surgery under general anaesthesia and was disappointed because she was curious as to what was being done, and what it was like in the operating room!

I should clarify that I would not sue for this. I wouldn''t sue if I were having brain surgery, either, because you HAVE to be awake for that. However, if I were having open heart surgery or some major surgery done anywhere to my face or vital organs and the one drug that is supposed to keep you unconscious totally didn''t work and I was paralized, in major pain, and scared out of my wits for hours at a time, yes, I''d sue. I would need the money for the extensive therapy it would take to recover from something like that.

 

[bee*]

I had a General Anaesthetic for oral surgery and thankfully I didn''t wake up! It must be so scary!

 

[brgirl]

Ahhh...it makes much more sense now. Thank you for the information! I agree - they should explain it better. For my oral surgery, I only remember having to choose between local (and being awake) or not. I chose ''not.''

 

[Girlrocks]

I had major chest surgery at Georgetown Hospital in Washington DC and I woke up while they were sewing me up, still on the ventilator with the tube down my throat. I remember feeling excrutiating pain, choking on the tube and fighting to breathe, and seriously freaking out...the nurse grabbed my hand and I can remember about 3 seconds of her telling me to take deep breaths, relax...then I went out again. The chief anesthesiologist came to my room the next day and told me that if I have any future surgeries to make sure that I tell the anesthesiologist that my body metabolizes the drug quickly. They normally stop the drugs a few seconds/minutes I suppose before they expect the person to come out of it, however I awoke instantly. Very scary. I HATE being put to sleep anyway, and only had this surgery because I had a tumor in my chest that needed to be removed. But I have serious fears about every having surgery again.

 

[Kay]

I have had general anaesthesia for 4 surgeries and MAC for my wisdom teeth. I do not remember waking during any of those procedures. The most traumatic part for me was when they inserted and removed the IV. I''m a big baby, and it really hurts when they take it out, at least if it''s in your hand.

 

[Linda W]

Yes!!! I woke up during my knee surgery a few years back. I started waving my arm and last thing I remember I fell back to sleep. Scared me to death. I remember feeling that awful tube down my throat.

Linda

 

[drk]

Well, this is a pretty interesting thread. It's pretty upsetting to me that so many people have had bad experiences under anesthesia, as it really is supposed to be a rare occurrence. Basil's explanation of the different types of anesthesia was really good.

I'm an anesthesia resident, and have also had a couple operations in the past. No problems with either. Had my wisdom teeth out at 18, under what I'm pretty sure was MAC anesthesia. I remember them injecting something into my IV, and then "waking up" (probably just coming out from the amnestic drug) while someone was walking me to the recovery area. That was a fantastic anesthetic, since I'd had 4 permanent molars pulled under local when I was about 12, and I really didn't want to remember the tugging and head-jerking and crunching again. None of it had hurt, but I didn't like the rest of the feelings associated with someone wrenching a molar out of my jaw. My other operation was a hysteroscopy + D&C, which was done under GA (general anesthestic). They didn't give me any other option (like a spinal). I don't even really remember getting my IV put in, though I'm sure that was done while I was awake. Once again for that OR I remember being assisted across the hall to a strecher in the recovery area when everything was done. I didn't have a sore throat at all, so I may not even have been intubated for that. As a healthy patient with no reflux, they probably just held a mask for the 15min the surgery likely took.

I found a link from our Ontario anesthesia website that answers a few questions about awareness: http://ontarioanesthesiologists.ca/awareness/index.cfm

It's become a big topic among anesthesiologists these days, especially given the movie. Anesthesiologists and anesthetics aren't exactly portrayed correctly in the media for the most part, which is pretty annoying to me. There was an episode of Grey's Anatomy in the last couple months where they had some patient who was "allergic to anesthesia" after he supposedly had a malignant hyperthermia reaction to the GA. Of course on TV he made a miraculously quick recovery from the MH reaction, and then was told that he couldn't have the bypass surgery he needed because he'd need a GA. Lucky for him, one of the brilliant surgeons decided that they could do it with a thoracic epidural (I guess the anesthesiologist couldn't work out an alternative??). But of course he couldn't get any sedation either, because of his allergy, which meant that Izzy had to stop assisting with the surgery to help him calm down. What a load of BS! MH means that you can't be given one of the muscle relaxants (succinylcholine), nor any of the anesthetic vapours. We do GAs for patients who are MH-susceptible all the time - it just means that we do a total intravenous anesthetic (TIVA), and is really no big problem at all. The guy on Grey's could have had that, and he certainlyl could have had a short-acting version of valium so that he wouldn't feel anxious and wouldn't have remembered the operation either. The Grey's episode with the bomb threat where the anesthesiologist was the first to take off wasn't a flattering portrayal either.

Like the website says, the high-risk operations are emergencies like traumas, crash cesarian sections, or operations on very sick people, where you truly do risk killing them if you give them a good dose of the usual anesthetic drugs. C-sections are even more of a challenge, because drugs that are good for mom (narcotics, amnestic/sedative drugs) are bad for the baby that will be out in a couple minutes. And although BIS monitors are out there, I don't think that they have really been proven to be of that much benefit - if they had been they'd have been universally adopted in a pretty short time. At the hospital I'm currently at, one of the top peds hospitals in Canada, we don't have BIS. For surgeries that require neuromonitoring anyhow to make sure that the surgeons aren't damaging any nerves (spinal surgery, some neurosurgery), the neuromonitoring people inevitably add a few leads for EEG so that they can tell us what our depth of anesthesia is pretty reliably. The manpower and equipment isn't there to do that for everyone though.

Most of the time, we have to rely on other signs to tell us the depth of anesthesia. We've got monitors on the anesthetic machines that measure the amount of anesthetic vapour that is being inhaled and exhaled by the patient. So that one woman on Larry King who was told there was a vapourizer malfunction that ended up delivering only 5% of the vapour she was supposed to be getting couldn't have had that happen on our current machine. We use that vapour reading to gauge our depth of anesthesia. We also watch heart rate and blood pressure and movement (in those patients where muscle relaxant is not required for the surgery). Eyelids are carefully taped shut during GAs so that we don't risk damage to the patient's cornea while they're under anesthetic and unable to protect themselves.

In most adult anesthetics I've been involved in, versed (a short-acting amnestic drug) is given at the start of anesthesia to help prevent awareness "just in case". I can see awareness occurring if the anesthetist accidentally forgets to turn the vapor back on after the patient has been intubated, or if there were a machine malfunction during the case (extremely unlikely, as alarms would be going off like mad on the machine), or if the vapour were to wear off more quickly than expected at the end of the case. We constantly live under time pressure to move things along quickly (or someone's operation could end up being cancelled at the end of the day). This means that we need to gauge how fast the vapor will wear off as compared to how long it will take for the surgeon to finish closing the incision and dress the site. It sounds like that timing was misjudged for Girlrocks. If her pain had been under control, it probably wouldn't have been such a horrible experience, as more narcotic could have helped her tolerate the breathing tube better too. Most anesthetists want patients to be awake enough with the tube still in to open their eyes on command, in order to prevent them from aspirating fluids that can collect in the back of the throat into their lungs, which can cause real problems. Luckily, I think most patients don't remember that part of the anesthetic in the end.

Sorry for the really long post, but I feel like anesthesia is getting a bad rep that isn't deserved in most cases. Obviously awareness does happen occasionally, and can be very traumatic for those who have experienced it. I think part of the problem is that anesthesia is not always explained well to patients, and a patient may not realize that it's reasonable for them to be aware during something like a cataract operation. When I've done the anesthetic for those, the surgen does the local anesthetic, and I give some amnestic +/- sedative drugs. But I'm sure to tell my patients that they'll be awake but frozen, and that I'm there beside them the whole time. I tell them that if they feel they need more sedation, all they have to do is wave their hand and they'll get it.

For those who've had a bad experience in the past and have surgery coming up, or for those who are just worried about anesthesia based on what they've heard, it's probably best to arrange for a preop meeting with the anesthesiologist in order to discuss these fears and what can be done to prevent a reoccurrence of the previous experience.

Kate

 

[somethingshiny]

drk~

Thanks for the info. I definitely don''t mean to give anesthesia (or the anesthesiologists) a bad rap.

I had an emergency c-section that was able to be performed quickly and easily because I had such a good anesthetist.

I''ve always wondered how accurate some of those medical shows were...

 

[drk]

I definitely didn''t mean anyone here was giving anesthesia a bad rap - everyone is just talking about their own experiences.

The media however doesn''t portray us well, and I don''t feel like that anesthetist on Larry King did a very good job of representing the profession. Focus groups have shown that a lot of people dodn''t even realize anesthesiologists are doctors, nor did they really understand what it is that we do or how vital a role we play. I''d hate for the current media madness to give people the wrong impression of anesthesia and how safe it really is these days, and I''d hate to see anyone not have necessary surgery because of a fear of something that''s pretty rare happening.

Any other stories out there?

Kate

 

[icekid]

I think Kate and basil already did a lovely job of explaining the different types of anesthesia and why problems can occur. Anesthesia can be a very difficult thing to predict. For example, those who use alcohol frequently metabolize the drugs used for anesthesia much more quickly than normal. I have seen one person wake up under general, and he fit into that catefory. Otherwise, people genetically metabolize things differently and the docs, of course, want you to remain sleeping, but at the same time they also want you to keep breathing (weird, right?)

I can understand that it is seriously unpleasant to be aware of what is going on in your surgery, but cut your anesthesiologists a little slack! It is a difficult job and Dr. K is over there working hard to keep you sleepy and help you to not remember too.

And, for those eyelid and other ophthalmology cases (cataract), the patients are often sleepy but aware, like Kate mentioned. I agree that the docs need to do a better job of helping the patients understand just what to expect during their surgery.

I''ve had both general and MAC without problems myself