What Anesthesiologists Do When Someone Wakes Up During Surgery

Over two decades as an anesthesiologist, I have honed expertise in addressing these unique and challenging situations. When a patient wakes up during surgery, the first step is to assess their comfort level and ensure their safety. If the patient feels discomfort, I provide additional support through warmth, sedation, entertainment, and soothing conversation.

The Reality of Anesthesia

Contrary to popular belief, anesthesia does not always mean complete unconsciousness. In my practice, approximately 2,000 out of 6,000 cases each year involve patients who remain awake due to regional anesthesia. This method blocks specific nerves in the body where the surgery is taking place, maintaining control without putting the patient to sleep, unless they experience anxiety which can be managed with sedation.

Motivation for Saintly Awareness

As a layperson, the general understanding of anesthesia is that it induces complete unconsciousness. However, in certain scenarios—like surgery with a local anesthetic for pain management—the patient may remain awake and aware. I have personally experienced surgeries where I chose to stay awake to gain real-time insights into the procedure.

Evolving Paradigms in Anesthesia

During my career, I've observed a shift in anesthesia principles. Historically, sedation and pain management were achieved through a single agent. Today, each aspect of anesthesia—unconsciousness, pain management, muscle relaxation, and reflex suppression—is individually managed using a combination of agents. This approach allows for shorter recovery times and better pain management. However, monitoring patient awareness remains complex.

The primary challenge lies in identifying the point of consciousness recovery. Traditional measures like heart rate and blood pressure have become less reliable due to the diverse effects of anesthesia on different physiological systems. Modern techniques such as cerebral function monitors and EEG analysis are still improving, but they are not yet definitive.

Surveillance and Countermeasures

When a patient begins to show signs of awareness, the anesthesiologist will increase the dose of the anesthetic agent that primarily induces unconsciousness. They may also use a potent short-acting opioid to alleviate pain and a benzodiazepine that prevents short-term memories from becoming long-term, reducing post-traumatic stress disorder (PTSD). In extreme cases, a longer-acting drug like ketamine may be used for those in critical condition, followed by a prolonged ICU stay.

High-Risk Groups

Certain groups are at a higher risk of awareness during surgery:

Patients in shock:

Due to their unstable cardiovascular condition, these patients require careful monitoring and a specific combination of drugs, often including ketamine and fentanyl, to ensure their safety and recovery.

Drug addicts:

These individuals often require significantly higher doses of anesthetics, which can be challenging to determine without careful titration.

Emergency C-sections:

In these high-pressure situations, local anesthetics are used first to numb the area, and then a fast-acting general anesthetic is administered, ensuring the mother's awareness and comfort.

While rare, awareness incidents are still reported, and proper follow-up and psychological support are crucial for patient well-being.

Understanding these strategies and paradigms can help both medical professionals and patients better prepare for and manage surgical procedures, ensuring a safer and more comfortable experience.