Remembering awareness and pain during IV sedation

[AnesthesiaMD]

Originally Posted by emmemmx3

I wouldn't advise reading this if you're having IV sedation for a surgery or wisdom tooth removal in the near future, OR if you are easily made squeamish by mentions of surgical things.

I wasn't really sure where else to put this, but I am pretty upset about it. I had my wisdom teeth out yesterday and the doctor told me that during IV sedation I would be technically aware, but I wouldn't feel pain and I wouldn't remember anything. I don't remember the first half of the surgery but on the 3rd tooth i became aware of what was happening and started panicking. I could feel some pain and I could feel the woman holding my head still and I could feel as he was breaking my tooth to make it easier to take out. I remember the whole thing, even if it's kind of vague and hazy.

Has anyone else had this happen? I'm pretty traumatized by it. I haven't found anyone else on the internet who has experienced the same thing.

Sedation is sedation. With sedation, there is no guarantee that you will not remember anything or that it will be totally pain free. Especially when the sedation is given by someone other than an anesthesiologist. If that is what you are looking for, you need to request general anesthesia.

Originally Posted by Hedgehog_Mom

When I had a c-section, I was supposed to be numb, but I could feel all of the pressure, cutting and tugging. I just couldn't feel the pain.

This is quite common. Spinal anesthesia only numbs the nerves that carry pain and temperature, not pressure or touch. Many women feel nothing at all, but when that happens, it is just a bonus. I know it is a strange sensation, and women who are more anxious to begin with really don't like that feeling, but as long as you didn't feel pain, the spinal did what it was supposed to do.

Originally Posted by SouthernBelleInUtah

By any chance, are you a redhead? Medical litt has recently reported that redheads are more resistant to pain med and anesthesia than other hair colors.

Not so recent. We have known about this for quite a while. In fact, it was one of my board questions 15 years ago.

Originally Posted by katjonjj

I had an experience where I don't remember anything during but after I woke up, I promptly remembered all the pain I shouldn't have felt. It was the weirdest thing. I literally shot up off the bed and told them to put the IV back in. It took another 30 minutes of less and less before I felt back to normal. It could be that they gave me too much then when it was abruptly cut off, my pain soared but it felt like I'd experienced the whole operation in a matter of seconds.

I dont understand what you mean. You were asleep during the operation but you remembered the pain after you woke up? Or you woke up in severe pain? Some people wake up in severe pain because people have very different pain thresholds. People with a low pain threshold require a lot of narcotics upon awakening. The problem with narcotics is they cause you to stop breathing. Most people have a decent sized window between the amount they need for pain relief, and the amount it takes to make them stop breathing. People with low pain thresholds have a very small window. It makes it very difficult to give just the right amount of narcotics to hit that sweet spot where the patient is not feeling pain and is still able to breath on their own. Most of the time you hit it, but sometimes you don't. At that point you just have to give more, little by little until they are not feeling pain any more. Not always so easy. These are the same patients that get zonked out in the recovery room, almost to the point of not breathing, then they wake up screaming, and before you can even give them any more medication, they are zonked out again, only to briefly wake up again complaining of pain, and the cycle repeats.

Originally Posted by Mattie

I was not given enough anesthesia for my 2nd c-section. It was a terrifying experience. I could feel what was happening, but couldn't move, or speak. Fortunately, the anesthesiologist was alert enough to see the absolute panic in my eyes, and quickly put me back under.

I dont understand this either. You were asleep and you woke up in a panic? Why didn't they use a spinal for your c section? It is safer for the baby. Occasionally, I have a patient that tells me the last 2 spinals they had didn't work. That worries me because the 3rd one likely won't work either. For those patients I always am ready with the general anesthesia on hand in case of a situation just like yours.

Originally Posted by PeachSalsa

Propofol is not an instant out for everybody. My son was in the ER for a broken bone and they needed to give him propofol so they could do their thing. They told him it should take x amount, but after 4x amount, he was still very much alert and aware. They finally supplemented with something else (I don't remember what) to get him sedated adequately.

Kids can be tough. Especially after breaking a bone. They put out a lot of adrenaline after a trauma like that. It can last for a day or more, which requires a much higher dose of anesthesia than normal for their weight.

Originally Posted by cindersslipper

I had a friend who was awake during surgery.

She was paralysed and couldn't make a sound but she felt them cutting her.

True nightmare.

I hate hearing about when this occurs. It is every anesthesiologist's nightmare. Thankfully, it is the rarest form of recall during general anesthesia. When recall does happen, it is usually just auditory recall. They remember hearing conversations, but do not remember feeling anything. This type of recall is extremely rare with general anesthesia, but it does happen.

Originally Posted by lvoc

One more fun story. Youngest brother was pretty sure he was having a heart attack and drove himself to the nearest full boat emergency room. He is a retired attorney who did much malpractice cases and was well aware of the medical capability of the various hospitals.

They decided he was indeed have a heart attack and took him to the cath lab to clean things up and place a stent or two. He was taken out in the normal fashion and they went to work and blew it. Tore a major vessel open with a stent. Code Blue and all the surrounds...and my brother wakes up...perhaps beckause the anesthesiologist is jumping into the life saving rather than the anesthesia.

To make a long story short they cracked his chest with him quite awake and stopped the bleeding. But he got to hear it all go down. They hauled him open chested to an operating run and fixed it and put him in a coma for 3 or 4 days. He just made it but ended up without apparent damage. But when he finally came around he had full memories of the whole thing. No apparent pain by the way. Not there or cloaked by the fear and excitement.

It must be fascinating to hear a code blue and know it is you.

Well, yes, we are in life saving mode at that point. But it is not likely that he forgot to give the anesthesia. When something like this happens, MORE anesthesia is the opposite of what you want. When a patient becomes instantly unstable like this, the anesthesia can only make them more unstable. The first thing you do is turn off the anesthesia. There comes a point when you just have to make the decision that the benefits of anesthesia are outweighed by the risks of giving it.


What I wish more of the general public understood is that everybody reacts to anesthesia differently. There are so many factors that are in play that there is not a single formula that works for everybody. Pain tolerance, heart conditions, lung conditions, liver, and kidney conditions, age, and medications they take, all play a roll. We all like to think that everybody else is just like us, but that couldn't be further from the truth. The anesthesiologist has to take into account your whole history and then formulate a plan unique to you. I think most people think it is much more cookie cutter than it actually is.

[katjonjj]

Originally Posted by AnesthesiaMD

Sedation is sedation. With sedation, there is no guarantee that you will not remember anything or that it will be totally pain free. Especially when the sedation is given by someone other than an anesthesiologist. If that is what you are looking for, you need to request general anesthesia.

This is quite common. Spinal anesthesia only numbs the nerves that carry pain and temperature, not pressure or touch. Many women feel nothing at all, but when that happens, it is just a bonus. I know it is a strange sensation, and women who are more anxious to begin with really don't like that feeling, but as long as you didn't feel pain, the spinal did what it was supposed to do.

Not so recent. We have known about this for quite a while. In fact, it was one of my board questions 15 years ago.

I dont understand what you mean. You were asleep during the operation but you remembered the pain after you woke up? Or you woke up in severe pain? Some people wake up in severe pain because people have very different pain thresholds. People with a low pain threshold require a lot of narcotics upon awakening. The problem with narcotics is they cause you to stop breathing. Most people have a decent sized window between the amount they need for pain relief, and the amount it takes to make them stop breathing. People with low pain thresholds have a very small window. It makes it very difficult to give just the right amount of narcotics to hit that sweet spot where the patient is not feeling pain and is still able to breath on their own. Most of the time you hit it, but sometimes you don't. At that point you just have to give more, little by little until they are not feeling pain any more. Not always so easy. These are the same patients that get zonked out in the recovery room, almost to the point of not breathing, then they wake up screaming, and before you can even give them any more medication, they are zonked out again, only to briefly wake up again complaining of pain, and the cycle repeats.

I dont understand this either. You were asleep and you woke up in a panic? Why didn't they use a spinal for your c section? It is safer for the baby. Occasionally, I have a patient that tells me the last 2 spinals they had didn't work. That worries me because the 3rd one likely won't work either. For those patients I always am ready with the general anesthesia on hand in case of a situation just like yours.

Kids can be tough. Especially after breaking a bone. They put out a lot of adrenaline after a trauma like that. It can last for a day or more, which requires a much higher dose of anesthesia than normal for their weight.

I hate hearing about when this occurs. It is every anesthesiologist's nightmare. Thankfully, it is the rarest form of recall during general anesthesia. When recall does happen, it is usually just auditory recall. They remember hearing conversations, but do not remember feeling anything. This type of recall is extremely rare with general anesthesia, but it does happen.

Well, yes, we are in life saving mode at that point. But it is not likely that he forgot to give the anesthesia. When something like this happens, MORE anesthesia is the opposite of what you want. When a patient becomes instantly unstable like this, the anesthesia can only make them more unstable. The first thing you do is turn off the anesthesia. There comes a point when you just have to make the decision that the benefits of anesthesia are outweighed by the risks of giving it.

What I wish more of the general public understood is that everybody reacts to anesthesia differently. There are so many factors that are in play that there is not a single formula that works for everybody. Pain tolerance, heart conditions, lung conditions, liver, and kidney conditions, age, and medications they take, all play a roll. We all like to think that everybody else is just like us, but that couldn't be further from the truth. The anesthesiologist has to take into account your whole history and then formulate a plan unique to you. I think most people think it is much more cookie cutter than it actually is.

I get that you are an anesthesiologist... that is quite obvious in that you feel the need to defend your profession. However, this thread isn't about denigrating your profession, it is simply sharing stories. We know that everyone has different reactions and that is the point of this thread.

In my case, (the bold above) you state that people with low pain thresholds have certain behavior when anesthetized... I birthed 4 kids without any drugs. I also had an appendicitis emergency where I suffered 4 days with the pain before realizing it might be serious yet after surgery I didn't even need pain meds. When I broke my hand it was the next morning before I went to the ER, the specialist showed me the signs that I was in severe pain but to me it was just pain. So as you can see, I have a very high threshold for pain.

However, this surgery when I woke up it was an immediate rush of pain so intense that I literally screamed at the anesthesiologist to put the IV back in. The IV was still in his hand at the time so he did put it back in (another sign he probably wasn't the best in his profession since he should have used a new one). To me... at that time, it was like my body was reliving the surgery through the pain. Being familiar with the procedure, it felt like in those few minutes a flashback of all the pain I would have felt. It's been nearly 10 years and I can still recall the intensity of the pain.

I have a lot of respect for those in your profession. However, since we all have different reactions... you don't need to feel like you have to defend anesthesiologists by saying "I don't understand..." because it really is doing just the opposite of what you intend.

[Pikantari]

This happened to me during an upper endoscopy, and I have never forgotten it. It has been many years ago and I found out what they used and have it in my chart to not be used again.

Since that time I have had 3 colonoscopies and probably 7 endoscopies and have never had the problem again, thank goodness.

[AnesthesiaMD]

Originally Posted by katjonjj

I get that you are an anesthesiologist... that is quite obvious in that you feel the need to defend your profession. However, this thread isn't about denigrating your profession, it is simply sharing stories. We know that everyone has different reactions and that is the point of this thread.

In my case, (the bold above) you state that people with low pain thresholds have certain behavior when anesthetized... I birthed 4 kids without any drugs. I also had an appendicitis emergency where I suffered 4 days with the pain before realizing it might be serious yet after surgery I didn't even need pain meds. When I broke my hand it was the next morning before I went to the ER, the specialist showed me the signs that I was in severe pain but to me it was just pain. So as you can see, I have a very high threshold for pain.

However, this surgery when I woke up it was an immediate rush of pain so intense that I literally screamed at the anesthesiologist to put the IV back in. The IV was still in his hand at the time so he did put it back in (another sign he probably wasn't the best in his profession since he should have used a new one). To me... at that time, it was like my body was reliving the surgery through the pain. Being familiar with the procedure, it felt like in those few minutes a flashback of all the pain I would have felt. It's been nearly 10 years and I can still recall the intensity of the pain.

I have a lot of respect for those in your profession. However, since we all have different reactions... you don't need to feel like you have to defend anesthesiologists by saying "I don't understand..." because it really is doing just the opposite of what you intend.

I don't think I was trying to defend anything. Just trying to explain one of the possibilities. It was difficult to understand the description you gave.