Awareness under anesthesia
Oct 28th, 2007 by Terry
In my previous life, before I became an anesthetist, I had worked for years in critical care and PACU. I became quite familiar with the care of post-operative patients and the issues that surround operative care.
When I decided to start my family, I carefully read every book I could lay my hands on about a natural, well-planned and thought-out labor and childbirth. I attended my prenatal classes, practiced my breathing, and, when I went into labor, already had my overnight case packed, with books to read, music to listen, phone numbers ready.
Life doesn’t always go like you plan it. It took me many painful hours (more than 24) just to dilate to 5 centimeters (in those days that was the magic number to receive an epidural). I actually hadn’t even planned on getting an epidural. Nope, didn’t want one. I quickly changed my tune after the first 24 hours of contractions. Epidural went in fine, pain relieved, but for the next 24 hours, I would not finish dilating. Got to 9 cm, but could not progress any further, despite everyone’s best efforts. My baby was starting to show non-reassuring signs on the fetal monitor, and it was decided that I would need a Caesarian section. So much for my plans.
But, to make matters worse, my epidural was deemed non-suitable for delivery - apparently it had dislodged. Suddenly, my baby’s heartrate dropped precipitously, and I was rushed off to the Operating Room. They had to put me to sleep with general anesthesia to get the baby out as quickly as possible. Now I realized I would miss my baby’s birth. But his safety was paramount to me, and I gazed into my husband’s eyes as I drifted off to sleep.
It is not as hard for me now to talk about what happened next as it was at earlier times in my life. I used to not be able to even think about it without getting a hard pit in my stomach and a well of tears.
In the middle of the operation, while I was still being cut and before the baby was out, I woke up. Yes, I felt the sharpness of the knife and the tearing of my tissues, the pushing on my belly, and indescribable, unspeakable pain. I tried screaming and screaming (in vain), and then realized that I had the breathing tube in my throat, plus I was still paralyzed from my anesthesia drugs and could not even move a finger or open my eyes. How many patients had I cared for, how many patients waking up from anesthesia, how many incisions and how many pain medications? Why was this happening to me?
This was beyond a nightmare; it was some kind of cruel joke. No one could hear me (I WAS SCREAMING), and I was totally awake and could not communicate to anyone what was happening to me! What seemed like hours but may have only been a few minutes, I was in some different parallel universe of torture and agony. And then, that’s all I remember. Everything went blank after that; next thing I knew, I woke up (again in a lot of pain) in the PACU, and it was over. The psychic pain, though, remained for a long time.
When a mother must undergo general anesthesia for a C-section, she is traditionally kept “light” - a term that means that “not too much but just enough” anesthesia is given. Mothers under general anesthesia are kept light until after the baby is delivered, because of the real concern about anesthesia drugs crossing the placenta into the fetus and possibly causing an unsafe situation for the newborn. This is exactly what happened to me; sadly, I was a little too light. When I “blanked out” during the C-section, I had probably just been “deepened” with anesthesia because my baby was being delivered.
This experience was life-changing on many levels, but I will speak here about how it has informed the way I practice. I fulfilled a career-long dream to become a nurse anesthetist about 10 years after the delivery of my son. I love everything about giving anesthesia - it is clinically stimulating, intellectually challenging; it’s about making a sound differential diagnosis, navigating the decision tree, and problem-solving. But what it’s really all about is the patients.
Patients’ fears and concerns are real, all of them. None of them are silly, neurotic, or whimsical. I take them all seriously, and I allow my patients to talk freely about what is worrying them about their upcoming surgery. Often their biggest trepidation is the anesthesia - dying, brain damage, loss of control, throwing up, feeling pain, waking up in the middle of the operation . . . .
My horrific experience under anesthesia has empowered me to become a strong listener, a better CRNA, a more genuine patient advocate, and a more caring person. I try to tune in to my patients’ preoperative anxieties, and I pay particular care and diligence to ensuring that their anesthetic experience is optimized to their comfort, well-being, and safety. To do anything less for my patients would be diminishing to the standards of my profession, to what I’ve lived through, and to who I am.
For more information about awareness under anesthesia, I would refer you to this outstanding book, Silenced Screams, and to this information released by the American Association of Nurse Anesthetists. As a postscript, I would like to assure my readers that the frequency of awareness under anesthesia is quite low and uncommon today, ranging between 0 .1- 0.2% of the adult population.
WOW, what an amazing story…thank you so much for sharing. I hope you use this experience therpeutically for your patients; I think if I was undergoing surgery and my anesthetist told me about personal experience like this and the good outcome, I would find it very reassuring.
Wow, what a tough memory. It speaks to your personal strength that you recovered emotionally and physically. I think it’s easy for us to forget that anesthesia, like any medicine isn’t perfect. I tend to remember more of the pre and post-op stuff than my doctor expects.
And I’ve also had ankle blocks done for surgery which didn’t prevent the RSD from flaring. The last surgery my doctor saw the sympathetic response in the middle of surgery. But that’s where good doctors come in and they find ways to pick up the pieces.
Oh my! I thought I was the only one who started to feel anything! That hurt just reading about it! I had a C-section myself (with a spinal) and I remember when they were pricking my abdomen before they started the incision.
I said, “Don’t start yet. I still feel that poking going on down there.” (I could not see them actually doing it because I was already behind the drape.) Thankfully, they waited and I felt nothing.
Your patients are so lucky to have you watching for that!
Terry, do you do anything different in your work to prevent such occurrences? I understand there are ways to monitor consciousness (EEG?) that could prevent this from happening. Thanks for sharing the story.
I’ve seen reports of this happening. I can’t imagine the fear and pain. I’ll bet that experience makes you so much more consciousness as a practitioner.
What a horrific experience. I applaud you for acknowledging the suffering you went through and for using your experience in the service of helping others. Thank you for sharing this.
How horrifying a thing to experience. I hope to never have that happen to me. One of my biggest fears is being intubated and awake. I have so much trouble at the dentist, not being able to swallow with a bite block in there. God bless you, Terry. You are very strong and brave.
Wow, Terry, what a horrible experience you had! I can’t even imagine the pain and fear you went through! But, the fact that you overcame that experience and now use it to empower your patients, shows how strong a person you are! Your patients are really lucky to have you.
Warmly,
Hueina
Were you given Versed? I thought that was given to block out any memory of the operation. What a traumatic experience. Thank you for sharing.
That is one of my biggest fears, especially with my upcoming dental surgery. i don’t know what I would do if I woke up or knew what was going on during surgery where I’m getting 12 teeth removed and 2 root canals at the same time. I’d probably have a panic attack right then and there, and if there was a paralytic and intubation I’d never recover mentally.
Awesome site, I’m adding a link to it on my own site, RagingServer.com
Also, keep up the good work, nurses are so under-appreciated these days it makes me sick, especially seeing as they’re smarter than most doctors I know.
For the thousands of women who have had c/s’s and were told… you didn’t really feel that… it couldn’t have been that bad… I never had anyone wake up…. you are over reacting.
Thank you.
so many thank you’s!
In regards to the Versed comment - wouldn’t it still be better yet to have the patient not experience any pain - instead of having the inability to remember the pain? It freaks me that someone could experience the pain and then not even recall it - they were still in horrific pain.
Very good point, Michelle. The Versed is like a “cya” action - cover your a$$. But what happened to the event, and what happened to the memory?
Thank you for writing this.
I had a caesarean with an epidrual/spinal combo and still felt most of the surgery, but due to the heavy premeds I was unable to vocalise or make anyone aware that I was in agony.
Approaching my second birth I met with the anaesthesia clinic and they took my concerns on, and advised to avoid anaesthesia at all costs!
Needless to say I have had 2 completely natural births since.
But the memory of the pain will never fade. The burning, tearing feeling as you are cut open, wide awake, and unable to move.
x B
Very scaring situation.
I see that the Medical University of South Carolina has some additional information on their website about this issue.
I also saw a USA today story quoting Dr Guidry from MUSC. Interesting how this problem is being addressed today.
You can also learm more about Dr. Orin Guidry at
I also see that they have a series of audio podcasts on the subject as well. You can listen to them at:
Without short-term memory, would some of the horror of it be prevented? Some of our awareness seems to come from being able to experience both the moment, and the time before it - what’s happened/the way things have been just before. I am not a health professional, I am just wondering.
According to a link to the American Association of Nurse Anesthetists on Navelgazing Midwife’s blog, people who’ve once experienced awareness under anaesthesia are at increased risk of experiencing it again. I really admire that you went on to have two more children, SungaiKecil.
Sam, the drug Versed, which is a benzodiazepam, like Valium, has amnestic qualities. It will cause anterograde amnesia, not retrograde amnesia. What that means is that from the time the drug is administered, everything that happens after that may very well be forgotten. But anything that the patient may have experienced before the Versed is adminstered will most probably be remembered.
The problem with giving Versed before the baby is delivered is that it crosses the placental barrier, and that means that some of this drug will be delivered to the fetus before delivery. In addition to being an amnestic, Versed is also a sedative, and the baby could very well be born sedated and “floppy,” as they say in the business. Nobody gives Versed before the delivery of the baby.
It is hard for me to comment on Sungaikecil’s experience during her C-section, as I am not privy to the medical record. Spinal or epidural is the preferred mode of anesthesia for a C-section, as the mother is awake and in control her own airway, and there is no medication that crosses the placental barrier to affect the newborn. I do not know what medications she was given before the delivery as pre-meds, so it is hard for me to comment.
During a spinal or epidural anesthetic for a C-section, it is NORMAL to feel pushing and pressure while the surgeons are operating, particularly as the baby is being delivered. The anesthesia cannot take those sensations away. What is NOT normal to feel is PAIN, CUTTING, BURNING. This should all be explained to the mother before the consent for the anesthesia is obtained, and all good practitioners do that.
When I had general anesthesia for my C-section, they had to put me to sleep, with a breathing tube down my throat. I was unable to tell anyone that I was awake and feeling everything before my baby was born, so Versed would not have been administered anyway, since no one knew that I was feeling anything.