I recently had multiple questions come in about waking up under anesthesia – what a terrifying thought! You may have heard horror stories about people being awake during their surgery, unable to move or say anything. Yikes! Is this actually possible? It’s a complicated answer, but the short answer is that NO ONE can “resist” falling asleep with our anesthetic drugs. Learn more below!
Sedation vs General Anesthesia
General anesthesia is the “deepest” type of anesthesia. You are fully unconscious during the surgery. This is different from local anesthesia or sedation because you’re fully asleep. You don’t respond to people saying your name. You also don’t respond to people touching (or cutting you).
Most people “waking up” are actually under sedation
Sedation is a “light” form of anesthesia. When you have sedation, your body is not fully unconscious. You are drowsy and are still breathing on your own. Conscious sedation and twilight sedation are usually used interchangeably by non-anesthesiologists. They’re often used for:
- Pain injections
- Upper endoscopies
- Dermatologic procedures
- Some minor plastic surgeries
- Some minor foot and hand procedures
So, you’re not supposed to be fully asleep in these cases! That means you likely will “wake up” during the procedure! That’s normal 🙂
Importantly, just because you’re not unconscious doesn’t mean you necessarily will remember anything or feel pain! My patients are very nervous about this! But there’s little reason to be afraid. In fact, patients like to have sedation, especially for colonoscopies!
Anesthesia is a balancing act – between anesthesia effects and lethal side effects
So, can you wake up under General Anesthesia?
So, if you’re fully under general anesthesia, you’re fully “knocked out.” You won’t be responding to the knife, and you won’t be waking up. It’s like 99.9999% certainty.
However, there can be problems with general anesthesia when we can’t give enough to ensure you’re fully under. The problem is that anesthesia is a balancing act, we need to balance anesthesia effects with side effects. The major side effects are decreased heart function that can lead to critical brain and kidney damage.
This is important in emergency situations where patients are in critical condition. Why? Because their bodies simply can’t handle a full load of general anesthesia. Otherwise, they could have a heart attack, stroke, or even die. That’s why we keep patients “lighter” in emergency situations, like:
- Trauma, like car accidents
- Severe infections requiring emergency surgery to cut out the infected tissue
- Emergency caesarian sections when the baby’s (or mother’s) life is at risk
In these cases, awareness under anesthesia is a little higher, because we simply can’t safely give enough anesthesia. Otherwise, the patient could die.
So what are the chances of possibly waking up under anesthesia?
“Waking up” in the middle of surgery is incredibly rare, but the more likely scenario is being “aware” under anesthesia. The chances of being aware depend on many, many factors. In particular, your heart health and what kind of surgery you’re having.
“Awareness” under anesthesia is usually hearing noises. It’s rarely ever painful because you have lots of medications on board to block the pain. That being said, it can certainly be traumatic. I take it very seriously.
So, for a healthy person having an elective surgery, the risk is probably less than 1 in 1,000. In my experience, it’s much, much less than that, but these appear to be conservative numbers.
What are other scenarios when patients might be aware under anesthesia?
Open heart surgery is the only other major surgery that has higher risk of patients being aware under anesthesia. Even thought these are usually elective, we still need to run these patients “light.” Why? Because patients with sick hearts also may not fully tolerate general anesthesia without a heart attack or stroke. Therefore, we need to keep them a little “lighter,” running the small risk that they might have some awareness.
Malfunctions can also cause patients to remember parts of their surgery
Lastly, it’s rare, but possible, to have technical problems. If general anesthesia isn’t reaching the patient, then the patient might wake up during their surgery. This could be from a malfunctioning ventilator or medication pump. This is awfully rare though, so I wouldn’t be too concerned about this.
Bottom line: don’t let people scare you about waking up under anesthesia! Especially if they’re trying to scam you!
I don’t want you to be worried about waking up under anesthesia. That anxiety and worry can hurt your recovery. Best to use that worry for something productive, like cooking a solid, healthy meal for yourself! Don’t let people scare you unnecessarily before surgery!
But worse, some patients are offered drugs or medications to “calm the nerves” before surgery. This can be dangerous! Marijuana and xanax are common options for patients. These are not safe before surgery! Please don’t let people exploit fears before surgery to sell you these drugs! Just like with the breast cancer exploitation, you have more control over your health than they want you to know!
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The information provided in this post in intended for general education. It is not medical advice. While I make every effort to provide the most up-to-date information, please note that new data is continuously becoming available and may change the conclusions I present here.
Bischoff, Petra, and Ingrid Rundshagen. “Awareness under general anesthesia.” Deutsches Ärzteblatt International 108.1-2 (2011): 1.