Are you awake?
January 5, 2013 6:10 PM Subscribe
What does it mean to be conscious? The point of view of anesthesiology.
But because one of the first steps of surgery is to tape patients’ eyes shut (...)Why?
posted by Flunkie at 6:37 PM on January 5, 2013
Flunkie: "According to one of the commenters: "Your eyes are often taped because your reflexes are obtunded and you will have no blink reflex. We tape your eyes to prevent ocular injury."But because one of the first steps of surgery is to tape patients’ eyes shut (...)Why?"
posted by moody cow at 6:58 PM on January 5, 2013
To keep them from drying out. The paralytics prevent blinking.
At a previous lab, I did some research with combined TMS-EEG methods, like the final device to assess consciousness. It is a devilishly hard problem to solve from a technical standpoint. The "gun" that he's talking about? (The one I used looked like this.) It induces a huge magnetic field in everything under it. Ideally this is just brain tissue, but the biggest place you see it is in the EEG signal, because the electrodes sit between the TMS coil and the scalp. The spike from the TMS pulse is orders of magnitude larger than anything you're picking up from the brain, through the skull and the scalp. Worse still, it "rings"-- it induces an oscillation across the EEG net itself. This causes huge problems when what you're looking for is energy from the pulse propagating across the brain. There are a number of ways of filtering out the TMS artifact (PCA is a big one), but they're computationally expensive.
I also recognize the system he used to target the pulse. It's called a BrainSight; it's actually very very cool-- it shows a 3D model of the surface of the brain (obtained with structural MRI), and displays a dot at the point the coil is aimed towards. (It uses a 3D camera system and reference points, a lot like motion capture.) I wish I could find a video; it's really neat to see one's brain on a computer screen with a little dot showing where the next zap is going to hit one's gray matter.
posted by supercres at 7:02 PM on January 5, 2013 [5 favorites]
At a previous lab, I did some research with combined TMS-EEG methods, like the final device to assess consciousness. It is a devilishly hard problem to solve from a technical standpoint. The "gun" that he's talking about? (The one I used looked like this.) It induces a huge magnetic field in everything under it. Ideally this is just brain tissue, but the biggest place you see it is in the EEG signal, because the electrodes sit between the TMS coil and the scalp. The spike from the TMS pulse is orders of magnitude larger than anything you're picking up from the brain, through the skull and the scalp. Worse still, it "rings"-- it induces an oscillation across the EEG net itself. This causes huge problems when what you're looking for is energy from the pulse propagating across the brain. There are a number of ways of filtering out the TMS artifact (PCA is a big one), but they're computationally expensive.
I also recognize the system he used to target the pulse. It's called a BrainSight; it's actually very very cool-- it shows a 3D model of the surface of the brain (obtained with structural MRI), and displays a dot at the point the coil is aimed towards. (It uses a 3D camera system and reference points, a lot like motion capture.) I wish I could find a video; it's really neat to see one's brain on a computer screen with a little dot showing where the next zap is going to hit one's gray matter.
posted by supercres at 7:02 PM on January 5, 2013 [5 favorites]
If paralytics are used how can a patient signal from the operating table that the analgesics are not working?
posted by maggieb at 7:29 PM on January 5, 2013 [1 favorite]
posted by maggieb at 7:29 PM on January 5, 2013 [1 favorite]
"If paralytics are used how can a patient signal from the operating table that the analgesics are not working?"
One of the major points of the article is that they cannot. Anesthesiologists use their best judgment, but are not always correct, and some patients regain at least some consciousness during surgery, and can't do anything about it.
posted by Eyebrows McGee at 7:34 PM on January 5, 2013 [3 favorites]
One of the major points of the article is that they cannot. Anesthesiologists use their best judgment, but are not always correct, and some patients regain at least some consciousness during surgery, and can't do anything about it.
posted by Eyebrows McGee at 7:34 PM on January 5, 2013 [3 favorites]
Anesthesia awareness is one of those things I wish I didn't know existed.
posted by bondcliff at 7:38 PM on January 5, 2013 [10 favorites]
posted by bondcliff at 7:38 PM on January 5, 2013 [10 favorites]
Half way through I got the impression that alluding to the philosophical take on consciousness might prove mere journalistic garnishment and I had to search the text for "philo" to see that further down he would actually tackle the matter again convincing me to read on. Ignoring the mention of an "outdoor pizza oven" I admire this elegant transition:
How smooth is that. Thanks for posting!
posted by quoquo at 7:59 PM on January 5, 2013
Chalmers has praised Tononi for his bold attempt to quantify consciousness, but he doesn’t think Tononi has come any closer to solving the hard problem. And even Tononi admits that, in scientific-research time, his theory is still in its infancy. What Tononi has made progress on is neither the easy nor the hard problem: it’s the practical problem.
How smooth is that. Thanks for posting!
posted by quoquo at 7:59 PM on January 5, 2013
A family friend had a theory that people who believe aliens abducted/probed them had surgery in an operating theater and opened their eyes. Somewhere in their brain lurks that image, fogged by the anesthesia, which explains why all of the stories are so similar. The bright lights, the metal, the "aliens" leaning over them with their non-existent mouths (hidden by surgical masks, which also make their eyes look large), the smooth scalps and grey-green uniform-color skin (from head covers and scrubs), etc.
Patients might, perhaps many years later, have a flashback-like experience set off by some other unusual brain event (mini-stroke, fainting, small seizure, etc.) that they would interpret, or explain to themselves, as the experience of being abducted by aliens. If the surgery occurred during childhood the memory would be implanted, as it were, with less capacity to understand it within the context of (or link it to other knowledge of) an operating room tableau.
It would be interesting to test this hypothesis by researching how alien abduction experiences were described in diaries/letters/interviews pre-dating modern approaches to surgery and widespread use of anesthesia... if there are any (and maybe they are called something else, like being taken over by demons). If alien abductions are real, then it seems to me that those reported during, say, the 19th century should be recognizably similar to stories like the above, just as an account by a person who experienced an early 20th century car or plane would be recognizably similar to its counterpart today.
I'd also love to compare and contrast how people in different cultures describe their abductions and relate all such accounts to film history.
posted by carmicha at 8:05 PM on January 5, 2013 [14 favorites]
Patients might, perhaps many years later, have a flashback-like experience set off by some other unusual brain event (mini-stroke, fainting, small seizure, etc.) that they would interpret, or explain to themselves, as the experience of being abducted by aliens. If the surgery occurred during childhood the memory would be implanted, as it were, with less capacity to understand it within the context of (or link it to other knowledge of) an operating room tableau.
It would be interesting to test this hypothesis by researching how alien abduction experiences were described in diaries/letters/interviews pre-dating modern approaches to surgery and widespread use of anesthesia... if there are any (and maybe they are called something else, like being taken over by demons). If alien abductions are real, then it seems to me that those reported during, say, the 19th century should be recognizably similar to stories like the above, just as an account by a person who experienced an early 20th century car or plane would be recognizably similar to its counterpart today.
I'd also love to compare and contrast how people in different cultures describe their abductions and relate all such accounts to film history.
posted by carmicha at 8:05 PM on January 5, 2013 [14 favorites]
Re: maggieb's comment...
They can't.
I woke up on the table during an operation on my elbow and they had to give me so many drugs to knock me back out that it took significantly longer than usual to come out of it. Originally they'd wanted me to stay the night but they ended up calling my boyfriend to come take me home. I was, and I quote, "howling like a banshee and scaring the other patients."
The first thing I remember is the anesthesiologist being summoned as soon as I woke up. He told me not to talk, my throat would be painful (shoving a tube in or out during the episode? I don't know).
I don't actually remember the waking up itself, my understanding is they often give amnesia-causing drugs specifically to keep you from remembering...like they used to do for really bad childbirth.
Any time I've had to have work done since I've insisted on maximum drug use (wisdom teeth removal was NOT fun), I'm terrified of waking up again!
posted by bitter-girl.com at 8:07 PM on January 5, 2013 [1 favorite]
They can't.
I woke up on the table during an operation on my elbow and they had to give me so many drugs to knock me back out that it took significantly longer than usual to come out of it. Originally they'd wanted me to stay the night but they ended up calling my boyfriend to come take me home. I was, and I quote, "howling like a banshee and scaring the other patients."
The first thing I remember is the anesthesiologist being summoned as soon as I woke up. He told me not to talk, my throat would be painful (shoving a tube in or out during the episode? I don't know).
I don't actually remember the waking up itself, my understanding is they often give amnesia-causing drugs specifically to keep you from remembering...like they used to do for really bad childbirth.
Any time I've had to have work done since I've insisted on maximum drug use (wisdom teeth removal was NOT fun), I'm terrified of waking up again!
posted by bitter-girl.com at 8:07 PM on January 5, 2013 [1 favorite]
The Origin of Consciousness in the Breakdown of the Bicameral Mind blew mine.
posted by fairmettle at 8:09 PM on January 5, 2013 [4 favorites]
posted by fairmettle at 8:09 PM on January 5, 2013 [4 favorites]
The whole "waking up during surgery thing" happens often enough for standard anesthesia protocol to include dosing patients in surgery with amnesia inducing drugs. Some people are just immune to the anesthesia. But not to paralytics.
Sometimes you can tell by monitoring systems that the patient is awake. Then they change drugs. But the jury's out as to how damaging that kind of memory and suffering could be long-term, even with amnesia and preventing your brain from storing that memory in long term recall.
posted by hobo gitano de queretaro at 8:10 PM on January 5, 2013
Sometimes you can tell by monitoring systems that the patient is awake. Then they change drugs. But the jury's out as to how damaging that kind of memory and suffering could be long-term, even with amnesia and preventing your brain from storing that memory in long term recall.
posted by hobo gitano de queretaro at 8:10 PM on January 5, 2013
Both my brother and my late father have woken up on the operating table. Novocaine lasts about 1/3 as long as it should on me, and about 4X as long as it should on my sister.
Ughghghghghghghghggggg.
posted by oflinkey at 8:18 PM on January 5, 2013 [1 favorite]
Ughghghghghghghghggggg.
posted by oflinkey at 8:18 PM on January 5, 2013 [1 favorite]
"If paralytics are used how can a patient signal from the operating table that the analgesics are not working?"
One of the major points of the article is that they cannot. Anesthesiologists use their best judgment, but are not always correct, and some patients regain at least some consciousness during surgery, and can't do anything about it.
posted by Eyebrows McGee at 10:34 PM on January 5 [+] [!]
Neuromuscular blockade doesn't block the sympathetic nervous system. So if you are having breakthrough pain (eg, during manipulation of the viscera) despite the analgesics you've been given, your heart rate will go up and your blood pressure will go up. The anesthesiologist or nurse anesthetist (my wife is a CRNA, so they are definitely going to get a mention) can either see these changes on the monitor or they are aware of them by the tones emitted from the ECG monitor or, more likely, the pulse oximeter. What is interesting is that the patients baseline vital signs set a steady rhythm or tempo, and changes due to pain or some other event become pretty obvious without having to look at the monitors because you hear the change in tempo.
So, it's a lot more than "best judgment" .... There is a steady stream of physiologic data coming from the patient via monitors that the anesthetist relies on to assess pain regardless of the use of paralytics.
More recently, more anesthetists are using BIS monitors, which are essentially two-lead EEGs with an algorithm, that converts the EEG data into a numerical score from 100 (fully awake) to 0 (dead) reflecting level of consciousness. More can be read here.
posted by scblackman at 8:41 PM on January 5, 2013 [7 favorites]
One of the major points of the article is that they cannot. Anesthesiologists use their best judgment, but are not always correct, and some patients regain at least some consciousness during surgery, and can't do anything about it.
posted by Eyebrows McGee at 10:34 PM on January 5 [+] [!]
Neuromuscular blockade doesn't block the sympathetic nervous system. So if you are having breakthrough pain (eg, during manipulation of the viscera) despite the analgesics you've been given, your heart rate will go up and your blood pressure will go up. The anesthesiologist or nurse anesthetist (my wife is a CRNA, so they are definitely going to get a mention) can either see these changes on the monitor or they are aware of them by the tones emitted from the ECG monitor or, more likely, the pulse oximeter. What is interesting is that the patients baseline vital signs set a steady rhythm or tempo, and changes due to pain or some other event become pretty obvious without having to look at the monitors because you hear the change in tempo.
So, it's a lot more than "best judgment" .... There is a steady stream of physiologic data coming from the patient via monitors that the anesthetist relies on to assess pain regardless of the use of paralytics.
More recently, more anesthetists are using BIS monitors, which are essentially two-lead EEGs with an algorithm, that converts the EEG data into a numerical score from 100 (fully awake) to 0 (dead) reflecting level of consciousness. More can be read here.
posted by scblackman at 8:41 PM on January 5, 2013 [7 favorites]
Amnesia is more or less a basic property of general anesthesia, insofar as unconscious brains produce no memories. The real issue is that, as the article mentions, the effect of general anesthetic drugs are less like a light switch and more like a dimmer switch, and physicians have to guess how far to turn it. Too little and you risk some degree of awareness. Too much and you over-inhibit areas of the brainstem that keep your body alive (which is a Bad Thing).
Worse, there can be significant variation between patients in terms of the doses needed to reliably hit the sweet spot. And to complicate matters still further, most surgeries will involve a combination of different agents, because some are better suited to induction whereas others are better for maintenance.
posted by dephlogisticated at 8:50 PM on January 5, 2013 [1 favorite]
Worse, there can be significant variation between patients in terms of the doses needed to reliably hit the sweet spot. And to complicate matters still further, most surgeries will involve a combination of different agents, because some are better suited to induction whereas others are better for maintenance.
posted by dephlogisticated at 8:50 PM on January 5, 2013 [1 favorite]
More recently, more anesthetists are using BIS monitors
TFA has things to say about these, if you'd care to read it.
posted by flabdablet at 9:13 PM on January 5, 2013 [8 favorites]
TFA has things to say about these, if you'd care to read it.
posted by flabdablet at 9:13 PM on January 5, 2013 [8 favorites]
Is this something that really requires lawsuits? It seems like such an imprecise procedure that I'm amazed it works as well as it does.
posted by Brocktoon at 9:47 PM on January 5, 2013
posted by Brocktoon at 9:47 PM on January 5, 2013
Thanks for the post. The science of concsiousness is unfortunately one of my favorite topics. Unfortunate because I probably don't have the aptitude to really understand what I'm reading, but, whatever, I can't stop myself.
I've been reading a little bit about Tonini and Koch's integrated information theory of consciousness. It seems to me an informational or computational theory of consciousness could appear to be valid for a very long time and still be fundamentally wrong. Suppose we were able to determine the entirety of essential physical processes happening in the brain that 'cause' the experience of the color red, for example. Whatever that process turns out to be could be described as information because all mathematical scientific explanations for any process or system can be thought of as mathematical, informational, or computational and said to have some amount of 'integration.' That is the general nature of mathematical scientific explanation. To make the conclusion that information itself IS consciousness seems highly dubious and possibly fraught with philosophical errors and therefore should be subject to the highest levels of verification. It seems the opposite is often proposed - the Turing test is not convincing to me at all. The best (possibly only) way to verify a theory of consciousness, in my opinion, is to first predict novel forms of consciousness (a new primary color perhaps) and then find a way to create that experience and interface it to a human brain such that a person could actually experience it first hand.
the idea that consciousness is identical to (or emerged from) unconscious physical events is, I would argue, impossible to properly conceive—which is to say that we can think we are thinking it, but we are mistaken. We can say the right words, of course—“consciousness emerges from unconscious information processing.” We can also say “Some squares are as round as circles” and “2 plus 2 equals 7.” But are we really thinking these things all the way through? I don’t think so. --Sam Harris
Christof Koch, who works with Tonini, and worked on consciousness under Francis Crick, has a new book out: Consciousness: Confessions of a Romantic Reductionist.
With the advent of Shannon's mathematical theory of information, information being the difference that makes a difference, scholars averred a linkage between information and conscious experience, without working out what this could be and what it might imply. Tononi's theory of integrated information does so. Proceeding from two axioms that are rooted in everyday phenomenal experience, the theory defines a measure (the eponymous phi) associated with every system consisting of causally interacting parts. This measure is high if a system constitutes a single entity above and beyond its parts (integration) and if it is endowed with a large repertoire of discriminable states (information). The more integrated information any system has, the more irreducible it is, the more conscious it is. This framework, couched in a probabilistic language, also captures the unique quality of that experience, why blue is more similar to red than to pain or to smell. --Christof Koch
It was recently reviewed by John Searle in NYRB: Can Information Theory Explain Consciousness? Where he lays out the philosophical problems he sees with the theory.
posted by Golden Eternity at 9:51 PM on January 5, 2013 [6 favorites]
I've been reading a little bit about Tonini and Koch's integrated information theory of consciousness. It seems to me an informational or computational theory of consciousness could appear to be valid for a very long time and still be fundamentally wrong. Suppose we were able to determine the entirety of essential physical processes happening in the brain that 'cause' the experience of the color red, for example. Whatever that process turns out to be could be described as information because all mathematical scientific explanations for any process or system can be thought of as mathematical, informational, or computational and said to have some amount of 'integration.' That is the general nature of mathematical scientific explanation. To make the conclusion that information itself IS consciousness seems highly dubious and possibly fraught with philosophical errors and therefore should be subject to the highest levels of verification. It seems the opposite is often proposed - the Turing test is not convincing to me at all. The best (possibly only) way to verify a theory of consciousness, in my opinion, is to first predict novel forms of consciousness (a new primary color perhaps) and then find a way to create that experience and interface it to a human brain such that a person could actually experience it first hand.
the idea that consciousness is identical to (or emerged from) unconscious physical events is, I would argue, impossible to properly conceive—which is to say that we can think we are thinking it, but we are mistaken. We can say the right words, of course—“consciousness emerges from unconscious information processing.” We can also say “Some squares are as round as circles” and “2 plus 2 equals 7.” But are we really thinking these things all the way through? I don’t think so. --Sam Harris
Christof Koch, who works with Tonini, and worked on consciousness under Francis Crick, has a new book out: Consciousness: Confessions of a Romantic Reductionist.
With the advent of Shannon's mathematical theory of information, information being the difference that makes a difference, scholars averred a linkage between information and conscious experience, without working out what this could be and what it might imply. Tononi's theory of integrated information does so. Proceeding from two axioms that are rooted in everyday phenomenal experience, the theory defines a measure (the eponymous phi) associated with every system consisting of causally interacting parts. This measure is high if a system constitutes a single entity above and beyond its parts (integration) and if it is endowed with a large repertoire of discriminable states (information). The more integrated information any system has, the more irreducible it is, the more conscious it is. This framework, couched in a probabilistic language, also captures the unique quality of that experience, why blue is more similar to red than to pain or to smell. --Christof Koch
It was recently reviewed by John Searle in NYRB: Can Information Theory Explain Consciousness? Where he lays out the philosophical problems he sees with the theory.
(Koch) is saying that certain information just is consciousness, and because information is everywhere consciousness is everywhere. I think that if you analyze this carefully, you will see that the view is incoherent. Information is one of the most confused notions in contemporary intellectual life.So Searle sees a big philosophical problem with equating consciousness with information, but doesn't seem to see a philosophical problem with an 'emergent" theory of consciousness the way Chalmers and Harris do.
[...]
you can’t explain consciousness by saying it consists of information, because information only exists relative to consciousness.
[...]
The mathematical theory of information is not about content, but how content is encoded and transmitted. Information according to the mathematical theory of information is a matter of bits of data where data are construed as symbols. In more traditional terms, the commonsense conception of information is semantical (semantic content requires consciousness as I understand Searle), but the mathematical theory of information is syntactical. The syntax encodes the semantics.
[...]
Tononi and Koch want to use both types of information, they want consciousness to have content, but they want it to be measurable using the mathematics of information theory.
[...]
all observer-relative phenomena are created by consciousness. It is only money because we think it is money. But the attitudes we use to create the observer-relative phenomena are not themselves observer-relative. Our explanation of consciousness cannot appeal to anything that is observer-relative—otherwise the explanation would be circular. Observer-relative phenomena are created by consciousness, and so cannot be used to explain consciousness.
[...]
What about the mathematical theory of information? Will that come to the rescue? Once again, it seems to me that all such cases of “information” are observer-relative. The reason for the ubiquitousness of information in the world is not that information is a pervasive force like gravity, but that information is in the eye of the beholder, and beholders can attach information to anything they want, provided that it meets certain causal conditions.
posted by Golden Eternity at 9:51 PM on January 5, 2013 [6 favorites]
This subject is really triggering me. I wrote a long post, and then I noticed my PTSD reaction and deleted it. This isn't some abstract discussion of consciousness. This is about people suffering the tortures of the damned, and being powerless to do anything about it. A quote from the article, which I fully understand:
Of the agony it occasioned I will say nothing. Suffering so great as I underwent cannot be expressed in words, and fortunately cannot be recalled. The particular pangs are now forgotten, but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so.
posted by charlie don't surf at 10:28 PM on January 5, 2013 [2 favorites]
Of the agony it occasioned I will say nothing. Suffering so great as I underwent cannot be expressed in words, and fortunately cannot be recalled. The particular pangs are now forgotten, but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so.
posted by charlie don't surf at 10:28 PM on January 5, 2013 [2 favorites]
Oflinkey: Novocaine lasts about 1/3 as long as it should on me, and about 4X as long as it should on my sister.
Weird. I'm super sensitive to pain killers and Novocaine, and my sister and father have to be massively doped up for drugs to work. My sister had the worst time with dentists believing her when she was a kid that it still hurt. Assholes.
posted by [insert clever name here] at 11:33 PM on January 5, 2013
Weird. I'm super sensitive to pain killers and Novocaine, and my sister and father have to be massively doped up for drugs to work. My sister had the worst time with dentists believing her when she was a kid that it still hurt. Assholes.
posted by [insert clever name here] at 11:33 PM on January 5, 2013
The hard problem of consciousness is truly a philosophical problem in the sense that the resolution requires dissolving the philosophical perplexity that gives rise to it rather than making any kind of empirical discovery. Chalmers is to a large degree responsible for maintaining that perplexity. I think once you get used to idea that neural activity can carry information (in interaction with the world) it becomes easier to experience your own thinking as physical processing.
posted by leibniz at 1:03 AM on January 6, 2013
posted by leibniz at 1:03 AM on January 6, 2013
There's also the kind of brain tumour surgery a friend of mine had, where the patient is kept conscious and engaged while parts of their brain are deactivated by electric pulses, to work out what can be removed without seriously affecting their mental function, before being cut out. Here's an article about it.
posted by A Thousand Baited Hooks at 1:37 AM on January 6, 2013 [1 favorite]
posted by A Thousand Baited Hooks at 1:37 AM on January 6, 2013 [1 favorite]
I'm not sure what type of anesthesia is typically used for a colonoscopy, but when I had mine, I woke up at some point and felt something inside me turning a corner near the bottom of my rib cage. At least, that's what it felt like.
Thankfully, it wasn't surgery. I can't imagine waking up while being operated on and being powerless to do anything about it. And I don't really want to.
posted by Ducks or monkeys at 5:24 AM on January 6, 2013
Thankfully, it wasn't surgery. I can't imagine waking up while being operated on and being powerless to do anything about it. And I don't really want to.
posted by Ducks or monkeys at 5:24 AM on January 6, 2013
Oh, here's my chance to tell my anesthetic stories!
I broke my right leg in many places due to a bicycle accident, and had to be operated on. I got knocked out pretty quickly at the operating table but woke up three times during the op.
The first time, I felt some pressure on my left leg and heard the doctor say something about a scalpel. Panicked that he might be cutting the wrong leg, I raised my arm in a jiffy and said, "It's my right leg that's broken!" Long, long silence. Finally, the same doctor replied, "We know, I was just putting a pan on your left leg." Reassured, I knocked out again.
The second time, I woke up to singing. The singer turned out to be me. I was in a dream state, so I didn't think it strange to be singing softly while feeling some scrapping sensation on my right leg and surrounded by bright lights.
The third time, I woke up panicked and distressed, and sobbed for someone to please hold my hand. A young lady on my left side, her eyes wide as tea saucers, inched up to me and gingerly grabbed my outstretched hand. I think she was more frightened than I was.
When I had a endoscopy, the doctor said the anesthetic wouldn't make me unconscious, but I knocked straight out for over an hour. I have odd reactions to anesthetic. During a colonoscopy I woke up halfway and everything looked like a badly adjusted 3D movie. I woke up enroute out of the operating theatre after my four-tooth root canal trying to ask the nurses for their mailing addresses so I could send them all flowers.
posted by Alnedra at 5:43 AM on January 6, 2013 [1 favorite]
I broke my right leg in many places due to a bicycle accident, and had to be operated on. I got knocked out pretty quickly at the operating table but woke up three times during the op.
The first time, I felt some pressure on my left leg and heard the doctor say something about a scalpel. Panicked that he might be cutting the wrong leg, I raised my arm in a jiffy and said, "It's my right leg that's broken!" Long, long silence. Finally, the same doctor replied, "We know, I was just putting a pan on your left leg." Reassured, I knocked out again.
The second time, I woke up to singing. The singer turned out to be me. I was in a dream state, so I didn't think it strange to be singing softly while feeling some scrapping sensation on my right leg and surrounded by bright lights.
The third time, I woke up panicked and distressed, and sobbed for someone to please hold my hand. A young lady on my left side, her eyes wide as tea saucers, inched up to me and gingerly grabbed my outstretched hand. I think she was more frightened than I was.
When I had a endoscopy, the doctor said the anesthetic wouldn't make me unconscious, but I knocked straight out for over an hour. I have odd reactions to anesthetic. During a colonoscopy I woke up halfway and everything looked like a badly adjusted 3D movie. I woke up enroute out of the operating theatre after my four-tooth root canal trying to ask the nurses for their mailing addresses so I could send them all flowers.
posted by Alnedra at 5:43 AM on January 6, 2013 [1 favorite]
When I had major surgery on my hand (to repair the inept first major surgery), I needed general anaesthetic (as I did the first time). I'm in the ER, totally terrified of waking up in the middle of surgery and feeling the pain of them cutting out parts of my bone -- this article has not helped -- and it was cold and I was about to start grad school and so the anaesthesiologist could not find my vein. At this point she was looking for it with her eyes, not with a needle, which was very nice.
So we started chatting, and she tried to put me at ease. Which was sort of working.
"Are you worried about this surgery?"
"Yes, I am."
"What are you worried about?"
And as I am about to mention my fear of pain, she answers for me.
"Are you scared you're not going to wake up from the surgery?"
WELL. Not until this very second, no.
She looked horrified, and quickly found the vein and put me out. I didn't wake up during the surgery, I did wake up after, and I had this weird reaction to the drug where I essentially cried for a week straight.
posted by jeather at 6:51 AM on January 6, 2013 [1 favorite]
So we started chatting, and she tried to put me at ease. Which was sort of working.
"Are you worried about this surgery?"
"Yes, I am."
"What are you worried about?"
And as I am about to mention my fear of pain, she answers for me.
"Are you scared you're not going to wake up from the surgery?"
WELL. Not until this very second, no.
She looked horrified, and quickly found the vein and put me out. I didn't wake up during the surgery, I did wake up after, and I had this weird reaction to the drug where I essentially cried for a week straight.
posted by jeather at 6:51 AM on January 6, 2013 [1 favorite]
fairmettle: The Origin of Consciousness in the Breakdown of the Bicameral Mind blew mine."At the heart of this classic, seminal book is Julian Jaynes's still-controversial thesis that human consciousness did not begin far back in animal evolution but instead is a learned process that came about only three thousand years ago and is still developing."
Yeah, um... Chariots of the Gods was pretty eye-opening for me when I read it.
posted by IAmBroom at 8:12 AM on January 6, 2013 [1 favorite]
There's also the kind of brain tumour surgery a friend of mine had, where the patient is kept conscious and engaged while parts of their brain are deactivated by electric pulses, to work out what can be removed without seriously affecting their mental function, before being cut out. Here's an article about it.
They are not kept awake, they are woken up for the important parts of brain testing. They are asleep for the cutting.
Do people even read articles these days?
posted by two lights above the sea at 9:59 AM on January 6, 2013
They are not kept awake, they are woken up for the important parts of brain testing. They are asleep for the cutting.
Do people even read articles these days?
posted by two lights above the sea at 9:59 AM on January 6, 2013
My first memory is being put to sleep for eye surgery when I was two years old. I had several surgeries, but only remember one of them.
I never, ever had nightmares as a kid, but I get sleep paralysis, which is pretty frightening. After reading this article, I'm wondering if they're related. The sensation of being put under anesthesia (which I have also experienced as an adult) and sleep paralysis are fairly similar--I can't see or move, but I can hear, I start freaking out that I can't breathe, and concentrate on moving my toes or opening my mouth to wake myself up.
I wonder if it's just a coincidence or actually related to the experiences I had during surgery as a child. Huh.
posted by inertia at 10:17 AM on January 6, 2013
I never, ever had nightmares as a kid, but I get sleep paralysis, which is pretty frightening. After reading this article, I'm wondering if they're related. The sensation of being put under anesthesia (which I have also experienced as an adult) and sleep paralysis are fairly similar--I can't see or move, but I can hear, I start freaking out that I can't breathe, and concentrate on moving my toes or opening my mouth to wake myself up.
I wonder if it's just a coincidence or actually related to the experiences I had during surgery as a child. Huh.
posted by inertia at 10:17 AM on January 6, 2013
Stories like this make me wonder how anybody jazzes up the courage to go for an elective surgery like a facelift or a breast implant. To err is human &c.
posted by bukvich at 10:45 AM on January 6, 2013 [1 favorite]
posted by bukvich at 10:45 AM on January 6, 2013 [1 favorite]
Woke up during a colonoscopy, but I don't remember the pain. The monitor was a foot from my head, so you can imagine the odd experience of watching someone play a tunneling video game through you.
posted by hanoixan at 11:10 AM on January 6, 2013
posted by hanoixan at 11:10 AM on January 6, 2013
As a veteran of an angiogram and two angioplasties I can attest you are fully conscious during the procedure. They numb the entry portal and push a little ativan to take the "edge" off and while that may work for some it isn't enough for me. I know what works for me. The room is just this side of a walk in cooler the contrast dyes are not warmed up the reason for the angioplasty (a heart attack) has you in a vulnerable frame of mind, and then you have to argue with the doctor for enough meds to get you buzzed, relaxed. Add to this a difficult blockage to clear and it is no fun feeling the cath trying to re-position your heart. When I tell you I want 10 ml of diazepam on board trust me it will go a lot better for both of us.
Why don't they put you out anyway?
posted by pdxpogo at 11:46 AM on January 6, 2013
Why don't they put you out anyway?
posted by pdxpogo at 11:46 AM on January 6, 2013
Yeah, um... Chariots of the Gods was pretty eye-opening for me when I read it.
I appreciate the skepticism behind your snark, but the two theories are not particularly analogous. As the article in the OP makes clear, there is still much to discover about the true nature of consciousness. Although it's certainly not the final word on the subject, Jaynes work has if anything, become more respected as research continues.
posted by fairmettle at 12:32 PM on January 6, 2013
I appreciate the skepticism behind your snark, but the two theories are not particularly analogous. As the article in the OP makes clear, there is still much to discover about the true nature of consciousness. Although it's certainly not the final word on the subject, Jaynes work has if anything, become more respected as research continues.
posted by fairmettle at 12:32 PM on January 6, 2013
Waking up during surgery is a terrible fear of mine, I could barely make my way through that article. I saw it a few days ago and was both attracted and repelled by it... I knew it would make a good post for mefi, but I couldn't bring myself to read it all at once - I just completed it now. And I approached each comment in this thread with trepidation that something awful would be revealed.
Like others who awoke during a colonoscopy, I sort of woke up at some point too and heard myself yelling "hey cut that out" followed by a voice saying "OK, give her more juice" or something like that. I vaguely remember feeling something uncomfortably probing that caused me to yell, but I have no real memory of pain or fear.
A colonoscopy is one thing, until recently people had those with little to no anesthesia -- but my real anxiety came 6 weeks later when I was going to go through gall bladder removal. The idea of waking up while having flesh and organs cut --- eeek, my heart races and my palms sweat just thinking about it. I told the anesthesiologist my fear and he was very patient about trying to reassure me - he gave me stats and science and I said, yes, but I am worried about winning this terrible lottery despite the odds - he squeezed my hand and said that because I was worried he would be even more attentive. That hand squeeze did more than anything else to make me feel better. I had to stay two nights after surgery and the MD and anesthesiologist both came to check on me. They said I was one of the chattiest people they ever had when I was going under - I guess I said: "So many people for me? You are my medical posse and I love you all!" On my followup visit, the surgeon said they all call themselves the Gall Bladder Posse now.
carmicha, your theory about alien abductions is fascinating!
posted by madamjujujive at 1:26 PM on January 6, 2013 [2 favorites]
Like others who awoke during a colonoscopy, I sort of woke up at some point too and heard myself yelling "hey cut that out" followed by a voice saying "OK, give her more juice" or something like that. I vaguely remember feeling something uncomfortably probing that caused me to yell, but I have no real memory of pain or fear.
A colonoscopy is one thing, until recently people had those with little to no anesthesia -- but my real anxiety came 6 weeks later when I was going to go through gall bladder removal. The idea of waking up while having flesh and organs cut --- eeek, my heart races and my palms sweat just thinking about it. I told the anesthesiologist my fear and he was very patient about trying to reassure me - he gave me stats and science and I said, yes, but I am worried about winning this terrible lottery despite the odds - he squeezed my hand and said that because I was worried he would be even more attentive. That hand squeeze did more than anything else to make me feel better. I had to stay two nights after surgery and the MD and anesthesiologist both came to check on me. They said I was one of the chattiest people they ever had when I was going under - I guess I said: "So many people for me? You are my medical posse and I love you all!" On my followup visit, the surgeon said they all call themselves the Gall Bladder Posse now.
carmicha, your theory about alien abductions is fascinating!
posted by madamjujujive at 1:26 PM on January 6, 2013 [2 favorites]
pdxpogo: " Why don't they put you out anyway?"
Because procedural sedation has much less associated morbidity and mortality than general anaesthesia.
Actually some of the weirdest surgeries I have been at have been pediatric surgeries using ketamine. It's usually a good idea to dissuade parents from observing these, because the ketamine dissociation produces a kind of glazed pseudo-alert wakeful-appearing state in the kids. In developed countries, we are now culturally primed to associate "anaesthesia" with a certain presentation of the patient: eyes taped closed, slow breathing, bagged or intubated, paralysed. Ketamine sedation breaks all these rules, and so whereas we're more okay cutting into people who look "dead", cutting into these kind-of-alert kids just looks plain *wrong*. But it works.
Anaesthesia during labour is another fascinating conundrum, and has been handled a few times on MeFi.
posted by meehawl at 2:00 PM on January 6, 2013
Because procedural sedation has much less associated morbidity and mortality than general anaesthesia.
Actually some of the weirdest surgeries I have been at have been pediatric surgeries using ketamine. It's usually a good idea to dissuade parents from observing these, because the ketamine dissociation produces a kind of glazed pseudo-alert wakeful-appearing state in the kids. In developed countries, we are now culturally primed to associate "anaesthesia" with a certain presentation of the patient: eyes taped closed, slow breathing, bagged or intubated, paralysed. Ketamine sedation breaks all these rules, and so whereas we're more okay cutting into people who look "dead", cutting into these kind-of-alert kids just looks plain *wrong*. But it works.
Anaesthesia during labour is another fascinating conundrum, and has been handled a few times on MeFi.
posted by meehawl at 2:00 PM on January 6, 2013
I had a esophagogastroduodenoscopy unsedated. The gastroentologist wanted to sedate me and I told him I strongly preferred staying conscious and talked him into it. There was no pain. I guess they pump air into the stomach so that they can maneuver the scope around easier because I heaved up a godawful amount of air and a small amount of stomach juice. The nurse thought the stomach juice was going to gross me out. They wheeled me to recovery and the doctor came around about fifteen minutes later with most of the results. While I was laying there conscious I heard him explain to the person in the next recovery cubicle that he couldn't see anything on their colonoscopy and would have to schedule a do-over.
I wonder what the percentage is on colonoscopy fails? I chart what goes through my colon and it is not predictably regular: 21 hours absolute minimum (8 oz. of mushrooms goes straight through and wipes out all obstacles) and 72 hours max. If I really need to get one I am eating 16 oz. of mushrooms 30 hours ahead of time zero.
I also wonder what the percentage on esophagogastroduodenoscopy unsedated is. My doctor told me it's practically zero but I think that was bullshit.
posted by bukvich at 2:14 PM on January 6, 2013
I wonder what the percentage is on colonoscopy fails? I chart what goes through my colon and it is not predictably regular: 21 hours absolute minimum (8 oz. of mushrooms goes straight through and wipes out all obstacles) and 72 hours max. If I really need to get one I am eating 16 oz. of mushrooms 30 hours ahead of time zero.
I also wonder what the percentage on esophagogastroduodenoscopy unsedated is. My doctor told me it's practically zero but I think that was bullshit.
posted by bukvich at 2:14 PM on January 6, 2013
The reason why so many people are "waking up" during endo/colonoscopies is because you are not actually "asleep" in the majority of cases. Most endo/colonoscopies use painkiller drugs like fentanyl and/or other drugs to induce amnesia. Verrrrry different from general anaesthetic that you get in real operations. So, for a colonoscopy, you are *usually* not "asleep", just really, really high.
posted by smoke at 3:32 PM on January 6, 2013
posted by smoke at 3:32 PM on January 6, 2013
Actually some of the weirdest surgeries I have been at have been pediatric surgeries using ketamine.
Yeah, I once held a friend's hand as she woke from an (ultimately unnecessary) ER procedure. They anaesthetized her with ketamine and propofol. But she came off the propofol faster than the ketamine, and just freaked when she awoke in the K-Hole. She was never the same.
posted by charlie don't surf at 3:33 PM on January 6, 2013
Yeah, I once held a friend's hand as she woke from an (ultimately unnecessary) ER procedure. They anaesthetized her with ketamine and propofol. But she came off the propofol faster than the ketamine, and just freaked when she awoke in the K-Hole. She was never the same.
posted by charlie don't surf at 3:33 PM on January 6, 2013
Why don't they put you out anyway?
Already addressed, but I thought I'd clarify. Putting someone out is more dangerous than not. They only do it if they have to. Not to mention, the waking up afterwards can be a 24 hour vomit party for some people, and you don't want people with heart attacks and a mere cork plugging up the femoral artery dry heaving if they don't have to.
posted by gjc at 6:44 PM on January 6, 2013 [1 favorite]
Already addressed, but I thought I'd clarify. Putting someone out is more dangerous than not. They only do it if they have to. Not to mention, the waking up afterwards can be a 24 hour vomit party for some people, and you don't want people with heart attacks and a mere cork plugging up the femoral artery dry heaving if they don't have to.
posted by gjc at 6:44 PM on January 6, 2013 [1 favorite]
Cool! I work with Dr. Tononi. Well, for him. I do IT stuff for his lab. I don't know too much about what he does - he's very busy, and unfortunately, there is a language barrier, too.
And usually, when he does talk to me - its to talk four-wheeling. I've got a Tacoma that is a work in progress. He's got a nice Ford Raptor, and his wife has a pretty well built up Jeep Rubicon. When the lived in California, they would go off-roading in the desert, which she really enjoyed. There are fewer opportunities for that here, in Wisconsin, but some exist. We talk about those things. They are fun, funny people.
That said, he does some groundbreaking stuff, and he has some really exciting and very smart grad students and post-docs working for him. I've got a degree in engineering and 20 years IT experience, and usually, I am the idiot in the room. I love it.
posted by Pogo_Fuzzybutt at 7:31 PM on January 6, 2013
Having grown up in a country where there exist human cultural artefacts at least 40,000 years old, the idea that consciousness itself is a mere 3,000 years old strikes me as completely implausible.
What's Jaynes's extraordinary evidence for this extraordinary claim?
posted by flabdablet at 7:58 PM on January 6, 2013
What's Jaynes's extraordinary evidence for this extraordinary claim?
posted by flabdablet at 7:58 PM on January 6, 2013
Jaynes defines "consciousness" more narrowly than most philosophers. Jaynes' definition of consciousness is synonymous with what philosophers call "meta-consciousness" or "meta-awareness" i.e. awareness of awareness, thoughts about thinking, desires about desires, beliefs about beliefs. This form of reflection is also distinct from the kinds of "deliberations" seen in other higher animals such as crows insofar as Jaynesian consciousness is dependent on linguistic cognition.
Not applicable to this conversation, really. There always seems to be a lot of confusion about the definition of consciousness. I think it makes the most sense to simply define consciousness as awareness, experience, subjectivity. All synonymous basically. I'm not familiar with Jaynes, but his ideas sound interesting. Seems to me Jaynes may be talking about the development of thinking and language and the formation of personality in general as a sort of learned process? Wouldn't we possibly see examples of what he's talking about (a lack of "meta-consciousness" or pseudo-schizophrenic hallucinations) in more isolated/"Primitive" tribes? That doesn't seem to be the case as far as I'm aware.
This is a fascinating (to me) quote from Helen Keller:
"Before my teacher came to me, I did not know that I am. I lived in a world that was a no-world. I cannot hope to describe adequately that unconscious, yet conscious time of nothingness. I did not know that I knew aught, or that I lived or acted or desired. I had neither will nor intellect. I was carried along to objects and acts by a certain blind natural impetus. I had a mind which caused me to feel anger, satisfaction, desire. These two facts led those about me to suppose that I willed and thought. I can remember all this, not because I knew it was so, but because I have tactile memory. It enables me to remember that I never contracted my forehead in the act of thinking. … I also recall tactually the fact that never in a start of the body or a heartbeat did I feel that I loved or cared for anything. My inner life, then, was a blank without a past, present, or future." (Helen Keller, *The World I Live In*, 1910, p. 11)
posted by Golden Eternity at 9:10 PM on January 6, 2013 [5 favorites]
Not applicable to this conversation, really. There always seems to be a lot of confusion about the definition of consciousness. I think it makes the most sense to simply define consciousness as awareness, experience, subjectivity. All synonymous basically. I'm not familiar with Jaynes, but his ideas sound interesting. Seems to me Jaynes may be talking about the development of thinking and language and the formation of personality in general as a sort of learned process? Wouldn't we possibly see examples of what he's talking about (a lack of "meta-consciousness" or pseudo-schizophrenic hallucinations) in more isolated/"Primitive" tribes? That doesn't seem to be the case as far as I'm aware.
This is a fascinating (to me) quote from Helen Keller:
"Before my teacher came to me, I did not know that I am. I lived in a world that was a no-world. I cannot hope to describe adequately that unconscious, yet conscious time of nothingness. I did not know that I knew aught, or that I lived or acted or desired. I had neither will nor intellect. I was carried along to objects and acts by a certain blind natural impetus. I had a mind which caused me to feel anger, satisfaction, desire. These two facts led those about me to suppose that I willed and thought. I can remember all this, not because I knew it was so, but because I have tactile memory. It enables me to remember that I never contracted my forehead in the act of thinking. … I also recall tactually the fact that never in a start of the body or a heartbeat did I feel that I loved or cared for anything. My inner life, then, was a blank without a past, present, or future." (Helen Keller, *The World I Live In*, 1910, p. 11)
posted by Golden Eternity at 9:10 PM on January 6, 2013 [5 favorites]
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