A general anesthetic is supposed to make surgery painless. But now there’s evidence that one person in 20 may be awake when doctors think they’re under.
When Carol Weiher was having her right eye surgically removed in 1998, she woke up hearing disco music. The next thing she heard was “Cut deeper, pull harder.”
She desperately wanted to scream or even move a finger to signal to doctors that she was awake, but the muscle relaxant she’d received prevented her from controlling her movements, reports cnn.com.
“I was doing a combination of praying and pleading and cursing and screaming, and trying anything I could do but I knew that there was nothing that was working,” said Weiher, of Reston, Virginia.
So she remained frozen and helpless on the operating table as the surgeon probed her body, while she experienced indescribable agony.
Weiher is one of few people who have experienced anesthesia awareness. Although normally a patient does not remember anything about surgery that involves general anesthesia, about one or two people in every 1,000 may wake up during general anesthesia, according to the Mayo Clinic.
Most of these cases involve the person being aware of the surrounding environment, but some experience severe pain and go on to have psychological problems.
The surgical tools didn’t cause Weiher pain — only pressure — but the injections of a paralytic drug during the operation “felt like ignited fuel,” she said.
“I thought, well, maybe I’ve been wrong about my life, and I’m in hell,” she said. The entire surgery lasted five-and-a-half hours. Sometime during it she either passed out or fell unconscious under the anesthetic. When she awoke, she began to scream.
“All I could say to anyone was, ‘I was awake! I was awake!’ ” she said.
The use of general anesthesia is normally safe and produces a state of sedation that doesn’t break in the middle of a procedure, doctors say. The patient and anesthesiologist collect as much medical history as possible beforehand, including alcohol and drug habits, to help determine the most appropriate anesthetic.
You may think of it as “going to sleep,” but in terms of what your body is doing, general anesthesia has very little in common with taking a nap.
During sleep, the brain is in its most active state; anesthesia, on the other hand, depresses central nervous system activity. On the operating table, your brain is less active and consumes less oxygen — a state of unconsciousness nothing like normal sleep.
Doctors do not know exactly how general anesthesia produces this effect. It is clear that anesthetic drugs interfere with the transmission of chemicals in the brain across the membranes, or walls, of cells.
But the mechanism is the subject of ongoing research, Dr. Alexander Hannenberg, anesthesiologist in Newton, Massachusetts, and president of the American Society of Anesthesiologists.
Patients who remember falling unconscious under the anesthesia generally have a pleasant experience of it, Hannenberg said, and the period of “waking up” is also a relaxed state, Hannenberg said.
Anesthesia awareness may relate to human error or equipment failure in delivering the anesthetic, Hannenberg said.
There are patients for whom doctors err on the side of a lower dose because of the nature of their condition, Hannenberg said. Someone who is severely injured and has lost a lot of blood, a patient with compromised cardiac function, or a woman who needs an emergency Caesarean section would all be at risk for serious side effects of high doses of anesthetic.
It is every patient’s worst nightmare. You are prepped for surgery, you’re given a general anesthetic and you drift off into sleep. But then you regain consciousness prematurely, during the surgery. That’s a real-life horror story. Fortunately, this does not happen often.
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