Why does one become aware during surgery despite anesthesia?

Question

Hello doctor,

I am a 55-year-old female. I have had many surgeries, and am a well-educated person. I am not a typical patient, given my knowledge, background, etc., including the fact that I get a copy of my complete chart for each surgery or medical procedure using any form of sedation or anesthesia. I am knowledgeable about most drugs used during anesthesia, and how they work. I have been told by a surgeon (included in his surgical report) and two dentists that I require a lot of anesthesia.

I have had multiple bad experiences with anesthesia, primarily conscious sedation. In my last surgery, I became alert, and aware and had full memory of the second, third, and fourth stitches. I have experienced pain and awareness, or memory during other oral surgeries and other procedures. I abhor the idea of conscious sedation, and the drug versed, specifically, except when used for induction. I have had my specific verbal and written expectations violated. This has all led to both fear of some simple procedures (like oral surgery and even regular dentistry) and a distrust that I will be cared for in a manner that I do not find acceptable. Two days ago, I had oral surgery and had some memory of pain and other things and, because of my experience, I am also a person who brings a high-quality recorder into the procedure room (when the opportunity presents itself). So, for the oral surgery two days ago, I recall experiencing pain and asking for more medication. I recall being told to calm down.

I have a procedure with the anesthesiologist. He also does some pain management procedures, and I will be getting the nerve block test for lumbar RFA tomorrow. I will have a CRNA who will be doing the anesthesia or sedation. But, I will not be able to discuss what happened to me during oral surgery with the anesthesiologist. I am a bit upset about that. I have a fear of dental and other painful procedures. I know that the local anesthetics do not work as well on me, as they do on others. It is an ongoing issue that just grows more intense with every procedure that my trust is violated, and I experience pain and, I need the RFA.

I have multiple herniated discs and arthritis, facet joint damage. I do not know how to articulate my needs in such a way that the anesthesiologist or CRNA takes my concerns seriously. I do not just need something to calm me, in fact, the very thing that an anesthesiologist would use to calm me is one of the most fearful things to me. I do not want to experience pain. I do not need anesthesia, and I do not need to be calm. I just need no pain and if that take a heavier dose of Propofol (in a hospital setting). So be it. If that takes more local anesthetic. So be it. I need to be unconscious, or I need enough pain management and deep sedation or no sedation. What do I need to say to get that without offending, or getting interpreted as just another person who is afraid of the OR? Is it possible that I would share that after being given versed?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your past experiences of conscious sedation, and I understand how difficult it would have been for you.

One thing I want to clear you first is that conscious sedation does not mean general anesthesia. Conscious sedation works on this principle only if you or the patient is conscious. It may decrease the pain, and increase the cooperation for the procedure, but it does not mean that you will not hear or feel anything. For small oral surgeries and small procedures, everywhere conscious sedation is used. It just means that it will decrease to some extent your feeling of pain, and you might be sedated for most of the procedure time, but not the whole time of the procedure. It means one can recall so many things from surgery in conscious sedation. If you want to be completely knocked down and not feel or listen to anything, then what you need is general anesthesia, which is usually not given for small procedures.

Now coming to your problem. First, you need to discuss with your anesthesiologist a day or a few days before the surgery, explaining to him everything that happened in past surgeries and what you expect from him. If you discuss this with your anesthetist a few days earlier or at least a day before, he will not think that you are just afraid of the OR (operating room). You have to make up your mind and explain to him whether you want conscious sedation or general anesthesia. If you do not want to feel anything and do not want to be awake in between the procedure, explain to him that you want general anesthesia, and not sedation. Explain to him clearly what your experiences are from the past, and what you expect from him this time in the procedure.

Do you never talk to your colleague whenever you are doing your thesis or research work? I guess everybody does. It is routine work for them, so it is not possible for everybody is keep silent during work. Have you never met a little difficult person to handle? Just answer one question, if you get a scary dream, is it good to have any horror dream repeated in your mind again and again, or is it better to forget one? The choice is yours.

Telling some patients to calm down during a procedure is a type of psychotherapy, and it has been proven effective. It is not that the person wants to give you less drug, the problem with conscious sedation is that you have to limit the dosage of the drug or else the patient will stop breathing, and that is not what you or the doctor want. So, better ask for general anesthesia. Last but not least, consult a psychotherapist or psychiatrist regarding your past awareness of anesthesia. The sessions will help you remove or at least decrease the mental trauma from past episodes.

I hope this helps.

Please let me know if you need any help.

Thank you.