I have heard several stories of people "waking up" during surgery under General Anesthesia. These people say they can feel everything, painfully so, but are unable to speak or move to let the doctor know. In most cases, the patient has a tall sheet in front of their face so they can`t see what is going on, but at the same time nor can the doctors see the patients face and in these particular stories that was one of the major problems, the only thing the person could do is blink, but the doctors were doing their thing and not even looking at him/her. 

From reading the other comments, I`m guessing this person couldn`t talk or move most likely because of a muscle relaxer drug. I am VERY nervous about going under, I feel totally vulnerable, I don`t like not having control, and it scares me half to death to hear stories like this, that once I`m under the doctors may never pay attention to my consciousness at all. 

So how much attention is actually given to the patients consciousness level? And isn`t there some way to monitor a level of consciousness so that the anesthesiologist can detect if the person is awake and feeling pain? 

I understand and appreciate your concern about being awake during surgery under general anesthesia. It is hopefully a bit reassuring that awareneness under anesthesia is quite rare - about 1-2 per 1000 cases. When it does occur it is often associated with particular high risk cases, including obstetrics, cardiac surgery and trauma. In "run-of-the-mill" surgeries in healthy people the incidence is less. Finally, in the large majority of documented cases of awareness under anesthesia the patient did not experience physical pain. 

It is true that a barrier - a sterile surgical drape - is placed between the patient and the surgeon. This is to isolate the surgical field, which must remain sterile during the operation. Very often, additional drapes are placed around or on top of the patient's head to maintain warmth and normal body temperature - important for the prevention of infection. Depending on the type of surgery, the patient's face can be seen by the anesthesiologist who is normally stationed at that end of the operating table. The face can be checked by lifting the drapes or through the use of transparent drapes. The anesthesiologist then has the opportunity to periodically check the patient for movement, tearing of the eyes, sweating or grimacing, all of which may be signs that not enough anesthesia is being given. Having the patient's face, or at least part of the face, exposed is therefore good anesthetic practice. 

Finally, there are indeed monitors available which measure electrical activity of the brain which does correlate with whether the patient is deeply unconscious, lightly sedated, or awake. Such monitors have not become the standard of practice in the United States as there is debate on how effective they are in the prevention of awareness. 

There is unfortunately still no completely reliable and inexpensive way of measuring consciousness which reflects our relative ignorance about the way the brain works. 

I am going in for yet another outpatient surgery this upcoming week. I have been given Versed prior to the surgeries in the past, and the 2mg that they give me never seem to have any effect. Is this normal? And what exactly is Versedﾠand what does it do? I`m always concerned prior to a surgery because I woke up during a tubal back in 2001. Thanks so much for your time. 

Versed isﾠthe trade name for midazolam. Midazolam is a drug in the same class as Valium (diazepam) - it is a benzodiazepine. Midazolam is a very useful drug given before and during surgery because it acts quickly (within minutes) to relieve anxiety and cause sedation. Midazolam also has amnestic properties, that is, it suppresses the formation of memory. In this case it can prevent patients from having memories of unpleasant experiences, such as medical procedures. In common with many other drugs used for sedation and anesthesia, the dose of midazolam needed to achieve a particular effect can vary a lot between individuals. A 2 mg dose of midazolam in the average adult will provide mild sedation and take the edge off the common feeling of anxiety before a surgical procedure. In some patients, this usual dose will have practically no effect. In this circumstance, your anesthesiologist will adjust the amount of medication, and give more until the desired effect is achieved. This might involve giving 3 or 4 times as much midazolam as the average. I assume your tubal surgery was done under general anesthesia. If you woke up during the operation then it is not surprising that you are concerned about your upcoming surgery. This could have happened because you are less sensitive to anesthetics than usual, but there are other reasons why it might have occured. Awareness under anesthesia is thought to occur in about 1 or 2 cases in every 1000. What you need to do is tell your anesthesiologist on or before the day of surgery about your previous experiences. Your story does suggest that you may have a higher requirement for anesthetic medications than average. Unfortunately there is no way to absolutely guarantee that your experience will not be repeated. The good thing is that your anesthesiologist can now make sure that the drugs you are given are appropriately adjusted, which will make the risk of a repeat very low indeed. Depending on the procedure you are to undergo, and the resources available in your hospital, your anesthesiologist might consider using one of the recently developed brain monitors, such as the BIS monitor. These monitors might help prevent awareness under anesthesia, although the opinion of professionals is divided on whether they really provide this benefit and on whether they should be used routinely. The American Society of Anesthesiologists has just published guidelines on this issue which you might be interested to read.ﾠ 

Hi, I`m scheduled to undergo a surgery to remove my galbladder. I am extremely nervous about the articles I`ve read and news reports ive heard about patients experiencing anesthesia awareness where they`re not fully unconscious, and experience pain and awareness of whats going on, but are unable to make the surgeons aware. I know this isn't overly common but it terrifies me, and what makes it even scarier is the fact that i've had to have alot of dental work done recently and everytime i've gone in, it has taken the maximum safe amount of novocaine to numb me, and then sometimes I still was not numb. I do not seem to respond to drugs as many people do (novocaine, painkillers that knock many people out, ect). They just don't have much of an effect on me. I don`t know if this would have anything to do with the type of anesthesia i will be receiving but I am very worried about this and any feedback you have would be really really helpful in putting my mind at ease. 

Iﾠhad a polyp removed from my vocal cords in March of this year. BeforeﾠI was put to sleep the Dr. gave me a paralysing drug I could not breath or speak my entire body was paralysed. WhatﾠI need to know is if this causes muscle pain along with mental confusion now I know what it feels like to be paralysed all over. 

ﾠIt sounds as though you have had a very upsetting experience. The information you have provided is not quite enough for me to understand exactly what happened or why it happened, but I would like to offer you a few comments that may be helpful. First of all, you should know that the use of paralyzing drugs, also called, a bit less threateningly, "muscle relaxants", is a common and normal part of anesthesia. Muscle relaxants are not always given with general anesthesia, but are usually needed when a breathing tube is required or in certain types of surgery including procedures done on the vocal cords. Secondly, a number of people who receive muscle relaxants do experience muscle pains afterwards, during the recovery period. These muscle pains can last several days and be extremely uncomfortable. The pain does go away with time or simple treatment with pain relieving medication. Muscle pains are relatively common when a drug called succinylcholine is used but occasionally they occur even without the use of muscle relaxants. Third, based on your description, you have probably had what we call "awareness" under anesthesia. It is today estimated that 1 - 2 patients in every 1000 undergoing general anesthesia may have some degree of awareness during the anesthetic. This is higher than we thought previously and has been the subject of a lot of recent research and publicity, as well as renewed efforts to prevent it from happening. It turns out that a few patients have awareness during the anesthetic and surgery despite being given "normal" amounts of anesthesia. Most patients who have awareness are able to recall some part of the operation, such as words spoken by the personnel in the operating room. The vast majority do not have any pain during this period of awareness, but naturally enough for a significant number it is a very distressing experience. It may even have prolonged psychological effects, especially if patients come to think that their perceptions of being aware are wrong or even "crazy". Finally, the important thing at this point is for you to contact your anesthesiologist to talk about what has happened. I feel confident that the anesthesiologist will be sympathetic. You should expect the anesthesiologist to examine the medical records and in particular the record of your anesthesia to try to discover whether what we have discussed here did in fact happen. It may be helpful for your doctors to refer you to appropriate counseling to recover from this upsetting experience. Rest assured that this problem need not happen again if you require anesthesia in the future. It would be very important in such circumstances to bring what has happened to the attention of your surgeon and to the anesthesiologist. If possible you should obtain copies of your records and bring those with you to the hospital so that your doctors can plan your care to prevent problems from happening again. 

I recently had to have an endoscopy; I was told that it would be done under conscious sedation. Despite receiving fentanyl 100mcg and midazolam (sorry, I don`t know the dose) I was wide awake through the entire procedure; it was very distressing, not to mention frustrating because the gastroenterologist got exasperated with me because I couldn`t stop gagging. The same thing happened to me about 15y ago when I had the same procedure. I am not taking any medications that would have interacted with the sedation. There was no anesthesia provider present during the procedure; the meds were given by an RN. Any suggestions for the future if I have to have a repeat endoscopy? I really would rather not go through that again. 

I'm sorry you had such an unpleasant experience with your endoscopy.ﾠ If you need another endoscopyﾠyou should have a good talk ahead of time with the doctor performing the procedure,ﾠso that you canﾠexplain what happened to you. ﾠIdeally, you will get a copy of the records of your recent procedure, including the doses of sedative medication that you received, and share those records with the doctor. There is a lot of variation in the amount of sedation that different people need for endoscopies and similar procedures. ﾠFor example, a skinny, teetotal, 80 year-old woman with heart problems will usually need a tiny dose of a drug such as midazolam to tolerate an endoscopy.ﾠ A robust, healthyﾠ20 year-oldﾠmanﾠwill probablyﾠneed several multiples of that, plus a drug such as fentanyl.ﾠ You are perhaps someone with a higher tolerance for these medicines, needing a larger dose to adequately sedate you thanﾠthe "standard" dose of, say, midazolam 2 milligrams, which you mention. Another anesthetic drug, propofol, can provide excellent sedation for endoscopy, and rapid recovery afterwards, but is best given by an expertﾠin the use of such drugs -ﾠan anesthesiologist. Propofol-based sedation is probably the "gold standard" for sedation for minor procedures. The great thing about well-performed sedation is that its a win-win - the patient has a comfortable experience, and the doctor has ideal operating conditions and can concentrate on the task at hand, instead of trying to complete the procedure as quickly as possible on a squirmy, anxious patient.ﾠ It has even been shown that the rate of detection of abnormalities during endoscopy is higher in patients who receive this kind of sedation/anesthesia. Of course the reason why you may have received only a standard dose of sedative medication is that these drugs can produce an over-sedated, even unconscious patient who then requires resuscitation.ﾠ This is the reason why hospitals are require to "credential" non-anesthesiologists to provide sedation - making sure that they have the skills necessary to "rescue" patients who become inadvertently sedated to excess.ﾠ The RN providing you with sedation may have been concerned about giving you too much. One option for your next endoscopy is to have it in a facility that uses an anesthesia professional, who will tailor the sedation to your needs, and do it safely. ﾠIf this is not available to you, you could simply explain to the doctor what happened, and suggest that additional sedation beyond "standard" doses be used.ﾠ At the end of the day however, your doctors, who understand your medical condition,ﾠare the ones that must be trusted to make appropriate medical decisions with your input and your assent. 

My mother just had outpatient surgery for a blocked tear duct, and had MAC anesthesia. She was told point-blank before going into the operating room that she would be asleep, yet she states that she was aware and awake during the whole thing. She remembers bones crunching (or a sound like it), pulling, pushing, suturing, etc., and stated that time went very slowly. The promised state seems MUCH different that the reality. What`s going on? I had a colonoscopy under MAC, stated beforehand that I did not want to be aware, and only woke up when it was done. This sure makes me not want to ever have MAC again if it is not dependable for comfort during surgery. 

This is a really good question because it raises a very common concern - thank you! MAC anesthesia is a term which stands for Monitored Anesthesia Care. What does that mean? Well, rather than "just putting you out", the use of anesthetic medications results in a range of anesthetic states, or "levels of sedation". Which level you get to depends on a number of things, including the age and general condition of the patient, genetic factors, and the choice and amount of anesthetic drug. The American Society of Anesthesiologists (ASA) has defined four levels of sedation: (1) minimal sedation, (2) moderate sedation (conscious sedation), (3) deep sedation, and (4) general anesthesia. Official definitions are reproduced below. As sedation is increased, or deepened, the patient becomes progressively more sleepy (less easily roused) and more able to tolerate painful or uncomfortable procedures, (in the definitions this is assessed by the response to stimulation or verbal command), ending in the state of unconsciousness known as general anesthesia. What is not always realized by the lay public is that as sedation becomes deeper, the patient also gradually loses the ability to breathe normally. This is usually accompanied by a depression of heart function and blood pressure. You will notice that MAC does not appear in this classification. It is a term which has fallen out of favor somewhat, but probably corresponds most closely with levels 2 and 3 - moderate and deep sedation. Given that most patients prefer to be unaware during their surgery, one may ask why a lesser or lower level of sedation is desirable. The answer is that recovery is quicker, and, as I have said above, that there is less depression of the heart, blood pressure and breathing from the anesthetic agents at these lower levels of sedation. Problems arise when patients do not understand the type of anesthesia they are to receive. It is important for the anesthesiologist to clearly communicate the intended level of anesthesia and sedation, and for the patient to anticipate what is likely to happen. It is also important to offer an explanation, as the ASA points out, that "because sedation is a continuum, it is not always possible to predict how an individual patient will respond". Problems occur when patients do not respond in exactly the way intended or expected. That is, they get either too light (less sedation) or too deep (too much). In the case of anesthesia that is too light, the patient may become aware or awake, as you so vividly describe. (What is surprising to many is the fact that recent studies show that even with general anesthesia, there is an incidence of unintended awareness of around 2 per 1000 cases). If a patient wants to be unconscious during a procedure (general anesthesia) this may be possible but there are trade-offs - more drugs, slower recovery, more risk of nausea afterward, need for a breathing tube, greater risk of depression of the heart. For a procedure such as a colonoscopy, what is typically offered is minimal or moderate sedation. The drugs used, such as midazolam, have the happy benefit of causing amnesia. In other words, patients forget almost the entire experience, despite having been awake enough during the colonoscopy to respond normally and purposefully to commands or conv ersation. This perhaps was your experience. For your mother on the other hand, undergoing a more invasive procedure, the results were less desirable. It sounds as though she experienced no pain during the surgery but was distressingly aware of certain unpleasant aspects of what the surgeon was doing. The outcome could have been different perhaps if your mother had been told that during the anticipated state of moderate sedation she was likely to feel some of what the surgeon was doing, but would experience no pain. Your mother may then have been more willing to accept what she was experiencing in the knowledge that she would, in return for her tolerance, be able to leave the facility more quickly, recover with fewer side-effects, and have less risk of heart or breathing complications. Finally, if during the procedure she was really uncomfortable she could have expressed this to the anesthesiologist who may have been able to administer more medication to increase her comfort. Perhaps this vital aspect was not explained to her before the procedure took place. I hope that your mother has no need of further surgery. But in the event that she does undergo another procedure lets hope she has a more satisfactory experience with anesthesia. Be sure to discuss your concerns with your anesthesiologist who will be glad to explain all of this in more detail and to tailor your anesthetic to your needs, always with safety in mind. American Society of Anesthesiologists Definitions of Levels of Sedation 1. Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. 2. Moderate Sedation/Analgesia ("Conscious Sedation") is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. 3. Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. 4. General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable even by painful stimulation.