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

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

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

[georgehollingsworth]

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.

[shellyrae]

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 .

[spunkygmahappy]

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

[katherineheasley]

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.

[lovintexas]

I remember saying to my anesthesiologist "Nice beard". He smiled and said "Good night". That was it.
He also had nice teeth, btw.

[jeanmcwilliams]

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

[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.

[purrsandwhispers]

In 1988, I underwent gallbladder surgery the “old fashioned “ way. I woke up during surgery while I was cut open and being gutted like a fish. The first feeling I felt was pain so deep and so severe that I thought I had been shot. I could not move or make a sound but I heard the surgeon and his team talking to each other- it was muffled, like being under water but I DID hear them. I tried to open my eyes but they felt like they were glued closed. I was able to open them a little bit and though it was blurry, I saw my surgeon and two people beside him all in their scrubs. I got the sense that more people were there but I could not see them. It seemed to last for a very long time, and the next thing I remembered was hearing people moaning. I thought I was in Hell. It was the most invasive and terrifying experience I’ve ever had. When the surgeon came to my room the next morning, I told him but the egotistical young man said it was IMPOSSIBLE. A week later I was released and came home. A news documentary was on and the name of it was “Surgical Awareness.”
It validated everything I had experienced and there were people being interviewed who had also experienced it. My next major surgery was 2 years later and I spoke with my surgeon and anesthesiologist about my horrific gallbladder surgery. They did their job as I made no new memories and the surgery was successful.

[yvonnebarash]

This happened to me during the birth of my first child. I had a fourth degree laceration, so they put me under general anesthesia to repair it. I was under enough that I could not voluntarily move, but could still feel the resident suturing me. It was this horrible, absolutely unbearable jabbing pain, the only way that I can describe it is that it was worse than childbirth pain. I tried so hard to scream because the pain was so bad, but my mouth wouldn't move. My husband said that he saw my whole body jerk (like when they defibrillate you), then the obstetrician yelled at the anesthesiologist. Then he said a few moments later, my whole body jerked again and then the obstetrician cursed at the anesthesiologist. Today 36 years later I still have vivid memories of that awful experience. The anesthesiologist did get some kind of reprimand on his medical license though, thank goodness.

[goldengirl]

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.

[cutkill]

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.

[lawrenceofarabiaarabia]

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.

[abigailwester]

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.

[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.

[deborahfrye]

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!!

[danf]

Anesthesia doctors are my hero, equal to my surgeon in respect and admiration.

[zachariahgore]

Back in 2013 I stepped an IED in Afghanistan. Lost my left leg, left arm, and severely messed up my right leg (I wish it had been cut off). During one of the many, many surgeries I went through I have memory that I will never forget. I "woke up" during a surgery. I remember feeling everything, immense pain!! Being able move my eyes but not open them. Trying to move and scream but being unable to. Feeling the breathing tube in my throat and feeling like I can't breath and am choking. I knew I was in surgery and could feel everything without being able to do anything. It lasted maybe 5 to 8 seconds, but it felt like eternity! None of my doctors said anything to me about it and I never said anything about it to them. But I knew and remember that it happened. I was terrified and thought that no one would know I was "awake" and that I was going to die. Again. I know there are many variables at play with any surgery and sometimes shit happens. I was that 1/10 of 1%. It sucked and it will always stick with me, but I'm still here and able to share my experience with others so that's gotta count for something. So yeah...That's my story of "waking up" during surgery.

[Animenumfan]

I love the feeling of trying to stay awake as they put me out. There is this amazing almost high feeling to it.

[elizabethfoy]

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.)