Anaesthetic Doesn't Work

Kernel

I was watching a documentary on late night tv the other night, about when anaesthetics go wrong. They said they use 3 types of anaesthetic whenever you undergo an operation. 1 type to stop you feeling pain. 1 type to knock you out and 1 type to paralyse you.

Apparently 1 or maybe 2 in a thousand times (but they don't know for sure.. maybe much more frequently) the anaesthetic doesn't work properly and people end up paralysed, but completely aware of the operation they undergo (they feel all the sensations/pain etc).

Interesting eh? Anyone here ever had an operation and remembered anything?

Dinner

I think I saw that documentry before. But I've never experienced it. Although I've only ever been under anaesthetic once, when I broke my arm and there was lots of hand marks on my arm from where the surgeon reefed it back into place.

Kernel

Arabel wrote:

I think I saw that documentry before. But I've never experienced it. Although I've only ever been under anaesthetic once, when I broke my arm and there was lots of hand marks on my arm from where the surgeon reefed it back into place.

The most interesting part of it for me was this one woman who they asked, during the operation, to clench her fist if she was, at any time, becoming aware. She did it a couple of times, and the dosage was increased, sending her back to sleep. Afterwards they asked her if she had any recollection, and she had, pretty much, none.

The question that struck me then was; how many people came to during the operation, but then simply have no recollection after the anaesthetic is increased! :eek: :eek:

DrIndy

Remember that anaesthesia is a process, not an event. You are given painkillers, anaesthetic agents and muscle relaxants along the way. The anaesthetist is monitoring your heart rate and blood pressure and if they change, they adjust the dose you are given to counteract that. They are also given benzodiazepines which relax you but also have a great side effect of making you not actually remember the entire event.

Awareness Under Anaesthesia (AUA) is a very rare (around 0.1%) but recognised in medicine. It results from for some reason, the anaesthetic agent not making the person unconcious, but the other agents work, resulting in them not able to move.

It can be frightening but it is unpredictable on who it affects. The changing profile of anaesthesia where the agents are altered and the treatment is closely monitored has made a big difference.

http://www.asahq.org/news/SEAfinal.pdf

This is the official bulletin from the American Association of Anaesthesiologists

For further information, use medline
medlineplus.gov

DO NOT GOOGLE FOR MEDICAL INFORMATION as you get the returns from the biggest hits/cross links and not neccesarily the most factually correct.....

eth0_

DrIndy wrote:

Awareness Under Anaesthesia (AUA) is a very rare (around 0.1%) but recognised in medicine. It results from for some reason, the anaesthetic agent not making the person unconcious, but the other agents work, resulting in them not able to move.

Studies have shown it's most likely quite a bit higher than 0.1%
I think that figure was agreed upon by anaestheseologists, not by impartial researchers.

You should have a read of 'Complications: A surgeon's notes on an imperfect science' by Atul Gawande, and so should some of the people reading this, it might make you understand that doctors AREN'T infallible and mistakes do happen sometimes.

The fist clenching thing is very promising, basically the anaesthetist applies a tourniquet on one arm, so that if the anaesthetic wears off, the patient will have some movement in his/her fingers and will be able to alert them. But I don't think you could use this technique in a procedure that would take hours, it can't be healthy for the circulation in the arm!

Another thing i've found hard to believe about these cases of people being aware they're being operated on is the fact that your BP and heart rate will skyrocket if you 'wake up' and can feel pain, even if the muscle relaxant has not worn off.

There are only a few reasons that would happen, such as a major bleed, so why isn't it spotted more often?

Capt'n Midnight

Anyone see that documentary on the guy who could not sleep because of a brain problem ? IIRC it was that he could not get REM sleep and I seem to remember that normal sleeping pills etc. just didn't work. And if he was rendered unconcious he got no rest.

Really horrible, my uncle met a man who served on the Russian front and reckoned the worst of it was the lack of sleep. Yer man in the documentary looked bad - died eventually - not a nice way to go.

Kernel

DrIndy wrote:

Remember that anaesthesia is a process, not an event. You are given painkillers, anaesthetic agents and muscle relaxants along the way. The anaesthetist is monitoring your heart rate and blood pressure and if they change, they adjust the dose you are given to counteract that. They are also given benzodiazepines which relax you but also have a great side effect of making you not actually remember the entire event.

The whole lack of memory thing is what played on my mind the most. You may have actually been aware of the operation while it was going on, then when you wake from the operation you would have no recollection of it. Kinda opens a philosophical question as to whether or not you actually were aware of something if you have absolutely no recollection of it. Hmmm.

Capt'n Midnight wrote:

Anyone see that documentary on the guy who could not sleep because of a brain problem ? IIRC it was that he could not get REM sleep and I seem to remember that normal sleeping pills etc. just didn't work. And if he was rendered unconcious he got no rest.

Reminds me of an episode of the X-Files. In the episode they disabled the sleep function in the brain of vietnam vets and injected them with Serotonin to keep them feeling normal. People don't fully understand what happens when we sleep, and why we need it, but I think releasing Serotonin in the brain is one reason/effect.

DrIndy

You are not aware of it if you can't remember it in a nutshell. Anaesthesia is not fully understood. Doctors know that it works, but do not fully understand why anaesthetic agents actually have their effect.

Serotonin is interesting stuff - high levels are linked to aggression and low levels are linked to depression. Antidepressants work in the large part by boosting the levels of serotonin by various mechanisms in the brain which elevates mood.

John

DrIndy wrote:

Serotonin is interesting stuff - high levels are linked to aggression and low levels are linked to depression. Antidepressants work in the large part by boosting the levels of serotonin by various mechanisms in the brain which elevates mood.

Actually it's low levels for both depression and agression. They have done studies with fluoxetine (Prozac) on monkeys and human volunteers that have shown that by giving Prozac you get a decrease in aggressive behaviour as Prozac causes an increase in serotonin available for use.

As for serotonin in sleep, it is important in at least two stages (out of five) of sleep. Slow wave sleep involves a decrease in activity of noradrenaline, serotonin, histamine and acetylcholine. REM involves the same except for acetylcholine which is increased in REM.

Kernel

DrIndy wrote:

You are not aware of it if you can't remember it in a nutshell. Anaesthesia is not fully understood. Doctors know that it works, but do not fully understand why anaesthetic agents actually have their effect.

Serotonin is interesting stuff - high levels are linked to aggression and low levels are linked to depression. Antidepressants work in the large part by boosting the levels of serotonin by various mechanisms in the brain which elevates mood.

Yes, but even if you cant remember after the event, that does not mean that you were not aware during the event. :eek:

Serotonin is cool. I heard low levels caused depression alright, and that was a side effect of prolonged ecstacy use (either serotonin levels were reduced or receptors were damaged.. cant remember). Didn't know about the agression though.

John2: The X-files was right again so, eh? Theoretically, would it be possible for humans to go without sleep altogether if the chemicals released during sleep were introduced into the system artificially?

Pet

The X-files was right again so, eh?

It's the X Files. Of course they were right!!

Theoretically, would it be possible for humans to go without sleep altogether if the chemicals released during sleep were introduced into the system artificially?

Tricky question. There's more to sleep than just the brain; the body also undergoes a load of endocrine and homeostatic processes that don't happen in the waking hours. Not to mention the effect on the psyche that a lack of dreaming would have..

John

Kernel wrote:

Serotonin is cool. I heard low levels caused depression alright, and that was a side effect of prolonged ecstacy use (either serotonin levels were reduced or receptors were damaged.. cant remember). Didn't know about the agression though.

John2: The X-files was right again so, eh? Theoretically, would it be possible for humans to go without sleep altogether if the chemicals released during sleep were introduced into the system artificially?

I don't know about that, I'm sure there's loads of stuff going on that we haven't even scratched the surface on when it comes to sleep.

And as for ecstasy, it can cause serotonin syndrome which is when there is a massive increase in serotonin in the synapse. It is a bad thing. Here's a pretty good pdf about serotonin syndrome.

Kernel

Pet wrote:

It's the X Files. Of course they were right!!

Hell yeah, they made me the scientist I am today (although I'm not a scientist).

Pet wrote:

Tricky question. There's more to sleep than just the brain; the body also undergoes a load of endocrine and homeostatic processes that don't happen in the waking hours. Not to mention the effect on the psyche that a lack of dreaming would have..

I think we should start the experiments!

John2 wrote:

And as for ecstasy, it can cause serotonin syndrome which is when there is a massive increase in serotonin in the synapse. It is a bad thing. Here's a pretty good pdf about serotonin syndrome.

An increase in the serotonin but a problem with the receptors? Can't view PDF in work, for some reason, but I shall read over the weekend.

John

It's not a problem with the receptors, it's a massive overload to the system, like a power surge. I'm not that certain with the ins and outs of it myself, I'll check it out as soon as I'm done on these exams.