What happens if you wake up during surgery?

There you are, wheeling off into surgery, expecting the best sleep of your life. After all, that’s surely one of the perks of anaesthesia, right? A thought creeps into your mind; what if you wake up during the operation? Rumours purport that this is possible, but is it true?

How they knock you out

First, let’s understand how anaesthesia works. Anaesthesia is medication that numbs the pain of surgery by relaxing your muscles and putting you to sleep. Think of it as a temporary hypnosis. Depending on the type of operation, you can get different levels of anaesthesia:

Local anaesthetic: If the operation is on the surface of your body, you don’t need to be asleep. A simple injection to numb the signals from your nerves to your brain, is enough.
Nerve block: In bigger surgeries, like hand and arm surgeries, you can still be awake, but the anaesthologist will need to block off a bigger part of your nerves. You still won’t feel a thing!
Conscious sedation, is a very light form of anaesthesia where you don’t lose consciousness, but you feel a bit ‘out of it’. It is very popular, because it’s less risky than general anaesthesia. It is used for different types of procedures, from dental procedures to plastic surgery.

For general anaesthesia (where you are completely asleep, your anaesthetist will inject an induction agent into the drip and you’ll drift off to sleep within 30 seconds. You wake up later with no memory of the job done.

What if you’re not really asleep?

There have been cases of people waking up during surgery or simply being aware of something happening. This awareness can manifest as a vague recollection; a feeling of pressure or slight pain. Others report feeling like they were in a dream that felt real, and having an idea of their surroundings. The most common outcome, according to the ASA is that of hearing noises and sounds. “If you look at the effects of anaesthetics on the brain, the auditory system is the last to shut down, so it makes sense,” they say. On the list of least likely things to happen is opening your eyes.

Anaesthesia awareness, as it’s called, happens in one in every 10 000 cases. In other words: few and far and between. In these cases, the anaesthetic fails to do its job. The disconcerting thing here is that an anaesthetic includes a pain-reliever and a paralytic – so in these uncommon cases of awaking during surgery, the patient is still technically “paralysed” and can’t indicate they’re awake!

Although very rare, it is still quite a worrying thought. Experts point out that anaesthesia awareness is most likely to happen during a high-risk surgery, with heart surgery or a caesarean section for instance.

“The anaesthesia puts you to sleep, so your eyelids shut naturally. Even if you regain consciousness, the xanaesthesia still restricts muscle movement so your eyes will stay shut,” explains Dr Daniel Cole of the ASA. “But there’s still 10-20% eye opening when you sleep. So during surgery, we will cover the patient’s eyes or tape them shut to prevent injury and keep the eyes clean.”

Should this put you off surgery?

There’s no need to panic. Modern medicine is a wonder and with a one in 10-40 000 chance of being awake during surgery; you’re safer on the table than in a car! It’s always worth chatting to your doctor or surgeon before surgery and letting them know if you’ve had problems with anaesthesia before. And if you do experience this phenomenon, you can and should get counselling thereafter to soothe feelings of confusion and trauma.

Good to know

Your anaesthetist is present throughout your surgery. So, rest assured should anything out of the ordinary happen, he’s there to make adjustments.
According to the Royal College of Anaesthetics in the UK, “Most reported episodes of awareness are short. Three-quarters of those who experience accidental awareness have an experience that lasts less than five minutes.”

Risky business

While anaesthesia awareness is rare, a few risk factors emerged in studies. These include:

Ages 25-40
Obesity
Women
Types of surgery (obstetrics, cardiac, thoracic)
Anaesthetics given in an emergency

How they knock you out

What if you’re not really asleep?

Should this put you off surgery?

Good to know

Risky business

References