Waking up during surgery? The truth about general anesthesia & how awareness is prevented

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Published 2021-02-20
How do anesthesiologists know that patients are actually unconscious while under general anesthesia? In this video, I explain what goes into assessing anesthetic depth and address the misconception that a patient who's moving is "awake."

0:00 Start
0:35 A familiar scenario
3:09 Levels of anesthesia
6:21 Components of general anesthesia
8:29 Movement =/= awake
13:37 Judging anesthetic depth
17:12 Bispectral index monitoring
21:19 Awareness with recall

Music: Subtle Swagger by Ron Gelinas: soundcloud.com/atmospheric-music-portal

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.

#Anesthesiology #Residency #MedicalSchool

All Comments (21)
  • I am a Chronic Pain Patient and extremely tolerant to anesthesia. Once during internal surgery i woke up (to an extent) while they were inside my body with me completely opened up. I could hear everything they were saying, and the lights were very bright, but I could not open my eyes, or speak. I felt absolutely no pain, but I found the situation odd to say the least. I managed to flap my arms somewhat, and they freaked. I remember them saying, We understand! We understand! They put me under then. Since I felt no pain and was stoned out of my mind, I found it quite amusing.
  • @shellyrae777
    I remember my wake up test during my cervical spine surgery. I had complications and they needed me to move my arms & legs. I had a tube down my throat. It felt so weird to not have to breathe out of my mouth, I could feel the air pass into my lungs. The Doctor’s authority in his voice kept me calm, he explained what was happening and that I was ok, I felt ZERO pain. Then they said I was going back to sleep and they’d see me soon. It was really no big deal and kinda neat .
  • I was most afraid of the anesthesia before my surgery last August; I'd never been under general anesthesia before, and of course one hears horror stories. I met the anesthesiologist before surgery, and he was so nice and calm that I felt like I was in good hands. Everything went fine. I remember breathing in the gas and everything going fuzzy, and then waking up in the recovery room with my chest on fire and a nurse ordering pain medication for me because I was moaning like a zombie.
  • @1cut1kill
    Total unawareness is not "total".. I know from personal experience. In the middle of lung surgery, I became aware of the conversation of the surgeons. While working on one side, they discussed opening me up on the other side but decided against it. Later I learned they were a little concerned about some additional infection in the other lung. The surgery was for damage left by Histoplasmosis from which I nearly died. They removed the lower third of the right lung. The remaining infection did clear up on it's own with meds. I was 19 at the time. I'm 70 now and in pretty good health and no lung problems.
  • I had bunion surgery on both my big toes. While they were still working on my I heard them talking about Christmas shopping, since it was Christmas time. I joined in the conversation talking about a gift I was having trouble finding for my granddaughter, they were quiet then I went out again. I felt no pain nor did I have any negative feelings, I was just happy joining the conversation
  • @lovintexas2730
    I remember saying to my anesthesiologist "Nice beard". He smiled and said "Good night". That was it. He also had nice teeth, btw.
  • @wangofree
    I woke up during oral surgery when I was 14. I told them so later and they tried to convince me I dreamed it, but I know what I felt. Made me not only terrified but mistrusting of all doctors to this day. I'm 58 now.
  • I experienced recall during surgery (hysterectomy) and remember desperately trying to blink or move. It was horrifying.The doctor downplayed my reaction until she finally said “ I think she needs more medication”. Afterwards I did repeat a conversation, so it was real. The next time I had surgery, two anesthesiologists were with me. I was a staff RN at this hospital, and administered conscious sedation to patients undergoing tests, so they did believe me!!
  • I remember when I had my surgery years ago, my first and only thus far, my biggest fear was awareness during my surgery. I looked at my anesthesiologist, and I told her as such. I must have looked really frightened and concerned, because she got such a compassionate look on her face, and smiled at my reassuringly. She said "Oh, honey, I promise that won't happen." It didn't. I wasn't aware of a thing. The first thing I remember was being on an elevator, being taken up to a room. She made me feel so much better.
  • @TimoMeijerify
    What's scary to me is that making memories is somewhat decoupled from feeling pain. It means that theoretically you could be in terrible pain in the moment, yet not remember anything afterwards, which is a terrifying idea to me
  • @thomashuston9180
    Woke up during one of my surgeries to the sound of WXPN and the doctor and nurses talking about their plans for the weekend. Sounded like a bunch of really great people. Pain, sure, but the conversation was so pleasantly distracting it wasn't an issue. When I finally asked 'should I be awake right now?' .... Well, that's all I remember.
  • I was totally awake during general anesthesia for a c-section about 30 years ago. I was awake at all times from the paralysis through the intubation, cutting of the skin and right through my son being removed, closing up and extubation. I was totally paralyzed unable to breath, unable to move and unable to get the attention of surgeon. So I made certain I remembered what everyone said during the surgery. I was able to tell the surgeons what they did on vacation and what the nursing staff said such as the time my son was born , his apgar scores and what my coach said about his cuteness. The anesthesiologist never apologized and just said " sometimes people wake up". I felt anxiety over being unable to breath, the sharp pain of the scalpels the tugging and pulling to get my baby out and the pain of the suture placement. I had the emergency surgery because of pre-eclampsia. My B/P was over 250/190 until my baby was pulled out then my B/P dropped down to 110/60 . Because I am a nurse, I originally thought I was hallucinating, however the pressure and the burning pain of the scalpel changed my mind. I thought about the Twilight Zone episode about the man who was paralyzed and about to get autopsied and what he did to get the doctor's attention. He cried. I couldn't cry despite my eyelids being partially open. My pain was real and lasted the whole surgery, I made memories and I was pissed off that I was treated like "awareness was no big deal". Maybe today , 30 odd years later anesthesia is better but don't dismiss those of us that went through that torture. My surgery started at 1800, my son was born at 1835 and I was extubated at 1905. I'm now 66 years old and the memories are as sharp as that scalpel was.
  • I had an ovarian cyst removed. I swear it seemed like a blink of an eye from the time I went into the OR to the time I woke up in the recovery room. I even remember asking the nurses when I was gonna have surgery and they said that I already had surgery and that I was in the recovery room.
  • @frozenwolfca
    My mom had 2 invasive surgeries, 1 of them she woke up in, she was crying. She felt it all, even though she could not move or open her eyes. Even remembered what they were talking about. They finally realized and knocked her out again. This was the 80s.
  • Watching this has been really helpful in piecing together my memories of laparoscopic abdominal surgery I had in August 2022. I had a huge ovarian cyst and I knew going in that if it was cancer, the surgery would be quite long (5+ hours at the worst, I think) and only a couple hours if it wasn't. I very distinctly remember being brought back awake and clearly asking what time it was. I didn't know til I watched this video that I was still with my anesthesiologist at that point; he told me what time it was and I was very happy. I do not remember being taken to the recovery area at all. Our bodies are pretty amazing. And I'm really grateful to my anesthesiologist (and surgeon, and nurses, etc) for putting me at ease and making a terrifying experience less terrifying. (It wasn't cancer.)
  • @ivito514
    I'm not a student nor a patient, but I find your content very interresting, you speak in clear and easy to understand terms and it helped me better understand what happened 45 years ago when I had my tonsils removed :)
  • I’ve had over a dozen surgeries, and was gutted like a fish each time. Luckily most of them went ok. I’ve had four transplants. During my second transplant, which was a multi visceral transplant of both a kidney and small intestine, I woke up. My intestines were on the table. The paralytic did not wear off, thus it took a few minutes for them to notice I was awake. I was split from my mid chest down to my privates and across my lower abdomen as well. It was a 28 hour surgery. The pain is something indescribable, and I know pain. I had a midgut volvulus and mal rotation around the mesenteric artery, cutting off the blood supply to my small bowel. Basically my entire small intestine died and turned gangrene while I was awake and it was truly hell on earth. That’s how I originally got sick. But even that, when I thought I was dying, wasn’t as bad as waking up during the double transplant. I still have ptsd from it, with constant flashbacks of that moment of waking up. There were a lot of apologies from nurses and others, but not from the doctor. The anesthesiologist never even came to speak with me. I’ve had many surgeries since and have been fine, as I’ve spoken in detail to my doctors about what happened. They now make doubly sure I’m out, as I have a very high tolerance. That was almost twenty years ago. I still have that small bowel, but later rejected the kidney I got during that awful surgery. Eleven years ago I got a second kidney, a living donor the second time; my best friend saved my life. I’ll always be grateful I’m still here and especially that I’m still here for my daughters, but I’ll never get the image, terror and pain out of my mind. I pray no one else ever experiences what I did-waking up during a transplant. I feel it will continue to terrorize me for the rest of my life.
  • When I woke up in heart surgery my chest felt like it was on fire. It was horrific. I could hear the nurses talking in the background to each other. Also heard what sounded like metal instruments being dropped into a metal container. The pain was unimaginable and the memory of this has caused much stress. This happened 8 days after my cabg 2 surgery when I had to go in for a second open heart surgery because I was bleeding which had been caused by a clip that nicked the heart plus blood thinner. The Pericardium was full of blood and pressure was on the heart. Several clots were removed. I understand this is a complex operation and I have made it through all of this.
  • During an outpatient carpal tunnel surgery I became aware, during the final stitching of the incision. The surgeon and two others in the room were discussing Stephen King novels. At the time I was a big fan and had read all of King's novels. I came too hearing one say he had read most of Insomnia, one of my favorites, and had never finished it. I piped in and said, "oh I loved that novel want me to tell you how it ends?" I could barely see the three of them look at each other. Then my surgeon said, " sure". I felt absolutely no pain and my sight was so blurry I could only make out vague shapes. I know there was a bright light but everything was so dim. It was the audio that was so crystal clear. What I find so strange is that my memory has me looking at my surgeon working on my left hand but it was my right hand that had the surgery. I suspect that I didn't actually see anything at all and my addled brain put the scene together simply from the audio. I've had two other instances of breaking through anesthesia. I was told I metabolize anesthesia quicker then most. My daughter inherited this. This was 1998
  • I recently had surgery on a torn rotator cuff. The last thing that I remember is a small mask being put on my face in the operating room and the next thing I know I am in recovery with the doctor showing me pictures of my surgery. It was a pleasant and painless experience. My thanks to the Anesthesiologist, surgeon and everyone involved.