The Terrifying Ordeal Of Anesthetic Awareness

Anesthesiologist Holding Mask
“Cut deeper, pull harder.” —Words heard by a patient who awoke during surgery

In A Nutshell

You’re in the middle of surgery, and you know it, but you’re unable to move or to tell anyone that you know what’s going on. It’s previously been estimated to happen to 1 in 500 patients who undergo anesthesia, but now estimates have become more along the lines of 1 in 15,000. Those that it does happen to can often describe the doctors’ and nurses’ actions and the surgery in frightening detail. Many later suffer from post-traumatic stress disorder, a condition that can last for the rest of their lives.

The Whole Bushel

Surgery itself is a frightening thing, no matter what it’s for. The idea that the anesthetic might not work in its entirety, that you might wake up partway through, paralyzed from muscle relaxants and unable to communicate to anyone that you’re awake, aware, and you can feel them poking around in your insides: That’s the stuff of nightmares.

It’s the stuff of horror movies, too, but unlike some horror fodder, it really does happen. It’s not well understood—anesthetic, the human mind, and the human consciousness aren’t all that well understood, even doctors will admit—and there have been some fascinating attempts to figure out how often it happens, why it happens, and the consequences.

When reports first started being assembled on the phenomenon, there were some bone-chilling numbers thrown around with it. Originally, it was said that you had a 1 in 500 chance of being conscious during surgery. With about three million people administered anesthetic each year in the UK alone, that means there would be a lot of people who have experienced it.

More recent studies suggest that it’s nowhere near that common. In 2011, the British Journal of Anaesthesia published their findings that it was only about 1 in every 15,000 people that had moments of consciousness during surgery. These episodes, they stressed, generally weren’t painful and were, for the most part, very brief. And many of those happened at the very beginning or the very end of the surgical procedure, not when the really nasty bits in the middle were happening.

While it’s sometimes likened to going to sleep, anesthetic has little to do with what’s going on in our brains when we’re sleeping. Anesthetic depresses our entire nervous system, but our brains are still active when we’re sleeping. Not so with anesthetic, as everything slows down and uses less oxygen. And doctors really aren’t sure why or how it works, just that it does. On a scale of 0 to 100 (0 being brain-dead and 100 being wide awake), anesthetized patients are functioning between 45 and 60.

Somehow, that makes it even more terrifying, and that’s even before we recount cases like Carol Weiher, who was conscious through a 5.5-hour operation to remove her right eye. When the anesthetic and muscle relaxants finally wore off, she woke up screaming.

So what happens to people who wake during their surgery? Most of them describe being able to hear people talking, recognize whatever music is playing, and hear the clink of surgical equipment. Sometimes they describe pressure instead of pain. They can hear the sounds their organs are making, and they can feel fingers prodding around inside them. And they know that no one else knew that they were awake.

Follow-up studies done on those that became aware during surgery found that about half the people who’d had the experienced felt a very definite sort of distress about the whole ordeal, and 41 percent of those surveyed had long-term, psychological effects that stemmed from the experience. Those effects were described as a post-traumatic stress reaction, which could last anywhere from a few weeks to the rest of their lives.

Only about 85 percent of people report their experiences after surgery, and now, medical organizations are looking at the necessity of providing post-surgical care for those that woke up during their surgeries to help people find a way with dealing with this incredibly bizarre, terrifying experience.

Show Me The Proof

ScienceDaily: New survey reports low rate of patient awareness during anesthesia
CNN: Awake during surgery: ‘I’m in hell’
The Atlantic: The Distress of Waking Up Under Anesthesia