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Moose
2010-Feb-27, 09:57 PM
How about waking up in the middle of an operation, paralyzed from the muscle relaxing drug but no longer unconscious or analgesial.

That's why you're administered an amnesiac...


Most commonly a 2'-halogenated benzodiazepine (http://en.wikipedia.org/wiki/Benzodiazepine) such as midazolam (http://en.wikipedia.org/wiki/Midazolam) or flunitrazepam (http://en.wikipedia.org/wiki/Flunitrazepam) is the drug of choice, although other strongly amnestic drugs such as propofol (http://en.wikipedia.org/wiki/Propofol) or scopolamine (http://en.wikipedia.org/wiki/Scopolamine) may also be used for this application.

... immediately before the procedure.

Drunk Vegan
2010-Feb-27, 10:00 PM
^ Just had an idea for an interesting bank-robbery story, involving use of amnesiac drugs in aerosol form.

Essentially the robbers don't worry about being seen by anyone - they just disable the cameras, make their robbery, and spray the room with an amnesia mist before running away.

Implausible, but funny.

HenrikOlsen
2010-Feb-27, 10:00 PM
So you'll be in pain for the rest of the operation but you won't remember it afterwards?
That sounds like a really bad thing to wake up to.

Moose
2010-Feb-27, 10:14 PM
Not really, Henrik. I'd thought the same way when I'd first thought about it, but in the recovery room from one of mine, the morphine pump had been set a bit too low. I was hurting really bad, but I never brought it up until the amnesiac had worn off and I was remembering stuff again. (I know for a fact - the anesthesiologist said so - that I had been awake and responding to simple-judgment questions at the end of the procedure, while the amnesiac was in play.)

I honestly don't know how much pain I was experiencing beforehand. I could make a rational argument that while my memory was off, I experienced nothing at all.

grant hutchison
2010-Feb-27, 10:33 PM
That's why you're administered an amnesiac...


Originally Posted by Wiki
Most commonly a 2'-halogenated benzodiazepine (http://en.wikipedia.org/wiki/Benzodiazepine) such as midazolam (http://en.wikipedia.org/wiki/Midazolam) or flunitrazepam (http://en.wikipedia.org/wiki/Flunitrazepam) is the drug of choice, although other strongly amnestic drugs such as propofol (http://en.wikipedia.org/wiki/Propofol) or scopolamine (http://en.wikipedia.org/wiki/Scopolamine) may also be used for this application.... immediately before the procedure.Of these, midazolam and propofol wear off too quickly to provide amnesia for anything but the shortest operations. The longer acting agents are often avoided because they delay recovery from anaesthesia. So relatively few patients nowadays undergo general anaesthesia with a long-acting amnestic drug on board. Those that do have usually received the drug for some other indication, rather than insurance against conscious recall.

The safeguards against waking up during surgery are:
1) Good physiological monitoring: heart rate and blood pressure changes occur in most people long before consciousness is recovered.
2) Good monitoring of anaesthetic machine function: disconnection alarms, low vapour alarms and the analysis of expired anaesthetic agents.
3) Monitoring of the central nervous system itself: analysed EEG and evoked responses can provide real-time indications of unconsciousness.

Grant Hutchison

kleindoofy
2010-Feb-27, 10:40 PM
... The safeguards against waking up during surgery are: ...
and

4.) A heavy wooden mallet.

Just in case. ;)

Moose
2010-Feb-27, 11:14 PM
Of these, midazolam and propofol wear off too quickly to provide amnesia for anything but the shortest operations.

Interesting. I do know I was on one (although I don't know which), and that the operation lasted a bit over eight hours.

Tobin Dax
2010-Feb-27, 11:56 PM
How about waking up in the middle of an operation, paralyzed from the muscle relaxing drug but no longer unconscious or analgesial.
That's about the last thing I ever need to hear or think of. It's been five minutes, and I'm still trying to shake it off.

At the beginning of one operation I had, I was under the anesthetic, but I could still see out of one eye. (My left eyelid doesn't always close completely.) Everything was gray and fuzzy, like television static, except for one little area where I could see a doctor prepping or whatever he was doing and a nurse or two moving around in the background. That lasted until I saw the doctor reach toward me and, presumably, cover my eyelid or something similar.

I did want to share that, but now, all I can think about is being in an OR just before surgery. I think it's time to find something else to focus on for a while.

GalaxyGal
2010-Feb-28, 12:56 AM
That's about the last thing I ever need to hear or think of. It's been five minutes, and I'm still trying to shake it off.

At the beginning of one operation I had, I was under the anesthetic, but I could still see out of one eye. (My left eyelid doesn't always close completely.) Everything was gray and fuzzy, like television static, except for one little area where I could see a doctor prepping or whatever he was doing and a nurse or two moving around in the background. That lasted until I saw the doctor reach toward me and, presumably, cover my eyelid or something similar.

I did want to share that, but now, all I can think about is being in an OR just before surgery. I think it's time to find something else to focus on for a while.

What you experienced is known as "Anesthesia Awareness" and is rare but can be extremely disturbing to patients and their families. It's a patient safety concern that the medical community takes very seriously.

The American Society of Anesthesiologists (ASA) sponsors an Anesthesia Awareness registry - available here (http://depts.washington.edu/awaredb/awareness.shtml) The FAQ's (http://depts.washington.edu/awaredb/FAQ_Awareness.html) explain some of causes and findings.

Here's a patient story (http://www.youtube.com/watch?v=9XBnehUjA7o&feature=fvw) and a news report (http://www.youtube.com/watch?v=bR5a78ANEHI&feature=related) about a panel convened on the topic.

What the site DOESN'T mention is drug diversion. Unfortunately, amongst medical professionals, Anesthesiologists are 'over-represented' in drug treatment programs. ASA Source (http://www.asahq.org/clinical/curriculum.pdf)

Again, Anesthesia Awareness to any degree is extremely rare, about 1 in 1,000 cases.

Tobin Dax
2010-Feb-28, 04:33 AM
What you experienced is known as "Anesthesia Awareness" and is rare but can be extremely disturbing to patients and their families. It's a patient safety concern that the medical community takes very seriously.

The American Society of Anesthesiologists (ASA) sponsors an Anesthesia Awareness registry - available here (http://depts.washington.edu/awaredb/awareness.shtml) The FAQ's (http://depts.washington.edu/awaredb/FAQ_Awareness.html) explain some of causes and findings.

Here's a patient story (http://www.youtube.com/watch?v=9XBnehUjA7o&feature=fvw) and a news report (http://www.youtube.com/watch?v=bR5a78ANEHI&feature=related) about a panel convened on the topic.

What the site DOESN'T mention is drug diversion. Unfortunately, amongst medical professionals, Anesthesiologists are 'over-represented' in drug treatment programs. ASA Source (http://www.asahq.org/clinical/curriculum.pdf)

Again, Anesthesia Awareness to any degree is extremely rare, about 1 in 1,000 cases.
Thanks for the info, GG. I forgot to say that this was only for a few minutes at most, and everything went black after that. It was also about 20 years ago and hasn't happened again (or before).

Strange
2010-Feb-28, 01:28 PM
Again, Anesthesia Awareness to any degree is extremely rare, about 1 in 1,000 cases.

That doesn't really sound rare enough to me.

grant hutchison
2010-Feb-28, 01:58 PM
Again, Anesthesia Awareness to any degree is extremely rare, about 1 in 1,000 cases.More recently (2007) there has been a large survey finding an incidence of 1:14,000 for all patients, going down to 1:42,000 for fit patients. Particular anaesthetic techniques have a higher risk, but the use of processed EEG monitoring should drive those figures lower.

Grant Hutchison

HenrikOlsen
2010-Feb-28, 02:44 PM
Is that because for unfit patients there's a tendency towards lower dosages because their bodies react unfavorably to larger dosages compared with fit patients?

grant hutchison
2010-Feb-28, 04:20 PM
Is that because for unfit patients there's a tendency towards lower dosages because their bodies react unfavorably to larger dosages compared with fit patients?A complicated mixture of factors. Certainly it's difficult, sometimes, to find the right level of anaesthesia for people who have some acute or chronic cardiovascular problem: a little more than adequate will result in a profound drop in blood pressure; a little less and the blood pressure shoots up. On the other hand, some people with cardiac disease are on potent drugs that obtund some of the simple physiological indicators of light anaesthesia: fast heart rate, rising blood pressure. Or they may be physically incapable of generating a rise in blood pressure, even when paralysed, awake, on a ventilator and having surgery. Or they may already have a rapid heart rate because of the illness that has led to surgery. Against that, set the fact that sick people often need lower doses of anaesthetic agents to keep them unconscious. So the anaesthetist is seeking an adequate level of anaesthesia in a complicated and fluid situation, using unreliable feedback, while attempting to avoid a life-threatening overshoot. At the rare extreme, this can come down to a choice between risking awareness and risking death.

Grant Hutchison

GalaxyGal
2010-Feb-28, 05:55 PM
More recently (2007) there has been a large survey finding an incidence of 1:14,000 for all patients, going down to 1:42,000 for fit patients. Particular anaesthetic techniques have a higher risk, but the use of processed EEG monitoring should drive those figures lower.

Grant Hutchison


In the American Society of Anesthesia's Statement on Anesthesia Awareness (http://www.facs.org/ahp/activity/asa-awake.pdf), they use the findings from both studies. The Joint Commission* study of U.S. cases of awareness which found 1-2 per 1,000 cases and the 2007 study. The 2007 study attributed dramatic reductions in awareness to employing "vigilant patient monitoring"


• Incidences of awareness occur once or twice per thousand surgeries performed with general anesthesia. These statistics include reported mild events that lasted only a few seconds. When awareness occurs, it is often just prior to the general anesthetic taking effect or as the patient is emerging from the anesthesia.

• The risk for experiencing anesthesia awareness is higher for unstable patients or for patients undergoing high-risk surgeries such as trauma, cardiac surgery or emergency caesarean sections. In these high-risk cases, using a deep anesthetic may not be in the best interest for patient safety.

• Recent studies indicate that with vigilant patient monitoring, cases of awareness are as low as 1 in 14,000 surgeries and 1 in 42,000 surgeries that are not high risk.

*The Joint Commission, which certifies hospitals, classifies Anesthesia Awareness as a sentinel event. Any time a sentinel event occurs, the health care organization is expected to complete a root cause analysis, make improvements to reduce risk, and monitor the effectiveness of those improvements. The root cause analysis is expected to drill down to underlying organization systems and processes that can be altered to reduce the likelihood of a failure in the future and to protect patients from harm when a failure does occur. The policy also encourages organizations to report to The Joint Commission sentinel events so “lessons learned” can be shared with other health care organizations.

GalaxyGal
2010-Feb-28, 06:09 PM
That doesn't really sound rare enough to me.

Agreed - we take it quite seriously. One case, is one case too many.

Strange
2010-Feb-28, 06:18 PM
Agreed - we take it quite seriously. One case, is one case too many.

Which is clear from the earlier comments. I am worried about absolute numbers. Even with the 1 in 42,000 number, how many actual cases does that come to?

grant hutchison
2010-Feb-28, 06:30 PM
The 2007 study attributed dramatic reductions in awareness to employing "vigilant patient monitoring" ...Actually, Pollard et al. made no claims with regard to vigilant patient monitoring. Their paper is available here (http://www.uic.edu/com/mcas/Intraoperative-Awareness.pdf) (200KB pdf). They invoked their Continuous Quality Improvement programme by way of explanation. But there are aspects of their anaesthetic protocols (such as the emphasis on inhaled agents) which are also very likely contributory.

Grant Hutchison

GalaxyGal
2010-Feb-28, 06:38 PM
Which is clear from the earlier comments. I am worried about absolute numbers. Even with the 1 in 42,000 number, how many actual cases does that come to?

For the U.S., that would drop awareness to 500 (out of the 21 million surgical cases requiring general anesthesia) per year

BigDon
2010-Feb-28, 08:23 PM
Of these, midazolam and propofol wear off too quickly to provide amnesia for anything but the shortest operations. The longer acting agents are often avoided because they delay recovery from anaesthesia. So relatively few patients nowadays undergo general anaesthesia with a long-acting amnestic drug on board. Those that do have usually received the drug for some other indication, rather than insurance against conscious recall.

The safeguards against waking up during surgery are:
1) Good physiological monitoring: heart rate and blood pressure changes occur in most people long before consciousness is recovered.
2) Good monitoring of anaesthetic machine function: disconnection alarms, low vapour alarms and the analysis of expired anaesthetic agents.
3) Monitoring of the central nervous system itself: analysed EEG and evoked responses can provide real-time indications of unconsciousness.

Grant Hutchison


Also depends on where and when you have your procedure Grant.

Back in 1980 I was in the ship's infirmary due to cutting my big toe on a coral reef in Subic Bay. Itty-bitty cut not a half inch long and barely deeper than the skin.

But it was the guy in the bed next to me I felt sorry for. Apendectomy with a spinal block as anaesthesia.

Placed too low.

Wasn't hard to comfirm. Big red dot where he placed it. The chief surgeon of the ship, who did the operation, was absolutely furious with the anaesthesiologist and it looked like a large part of his anger was at himself for not picking up on it.

korjik
2010-Feb-28, 08:49 PM
Also depends on where and when you have your procedure Grant.

Back in 1980 I was in the ship's infirmary due to cutting my big toe on a coral reef in Subic Bay. Itty-bitty cut not a half inch long and barely deeper than the skin.

But it was the guy in the bed next to me I felt sorry for. Apendectomy with a spinal block as anaesthesia.

Placed too low.

Wasn't hard to comfirm. Big red dot where he placed it. The chief surgeon of the ship, who did the operation, was absolutely furious with the anaesthesiologist and it looked like a large part of his anger was at himself for not picking up on it.

Judging from when my appendix went bad, getting it cut out with no anesthesia probably wouldnt hurt any more than it hurts before the surgery, but that is still a break your finger to make your leg stop hurting sort of thing.

I have had two surgeries, appendix and gall bladder. If I had some anesthesia awareness, they hit me with the forget juice and it worked real well, cause my memory says I was out before I even got the OR for the appendix, and was out about three seconds after getting into the OR for the gall bladder.

grant hutchison
2010-Feb-28, 08:50 PM
Also depends on where and when you have your procedure Grant.Sure does. We have fewer cases of awareness (and fewer deaths) now than we've ever had. And if you work in a place today where modern resources aren't available, then you can expect to have similar problems to those western anaesthetists were encountering thirty or more years ago (while avoiding some other problems we've invented in the meantime).


But it was the guy in the bed next to me I felt sorry for. Apendectomy with a spinal block as anaesthesia.

Placed too low.

Wasn't hard to comfirm. Big red dot where he placed it. The chief surgeon of the ship, who did the operation, was absolutely furious with the anaesthesiologist and it looked like a large part of his anger was at himself for not picking up on it.That's a very strange anaesthetic technique, if the patient was unable to protest during the surgery.

Grant Hutchison

BigDon
2010-Feb-28, 08:53 PM
Sure does. We have fewer cases of awareness (and fewer deaths) now than we've ever had. And if you work in a place today where modern resources aren't available, then you can expect to have similar problems to those western anaesthetists were encountering thirty or more years ago (while avoiding some other problems we've invented in the meantime).

That's a very strange anaesthetic technique, if the patient was unable to protest during the surgery.

Grant Hutchison

He was still paralyzed, sir.

Strange
2010-Feb-28, 09:14 PM
If you couldn't feel pain but still had sensation, that would be pretty weird - possibly unpleasant depending how squeamish you are.

hhEb09'1
2010-Feb-28, 09:14 PM
Of these, midazolam and propofol wear off too quickly to provide amnesia for anything but the shortest operations. The longer acting agents are often avoided because they delay recovery from anaesthesia. So relatively few patients nowadays undergo general anaesthesia with a long-acting amnestic drug on board. Those that do have usually received the drug for some other indication, rather than insurance against conscious recall.

The safeguards against waking up during surgery are:
1) Good physiological monitoring: heart rate and blood pressure changes occur in most people long before consciousness is recovered.
2) Good monitoring of anaesthetic machine function: disconnection alarms, low vapour alarms and the analysis of expired anaesthetic agents.
3) Monitoring of the central nervous system itself: analysed EEG and evoked responses can provide real-time indications of unconsciousness.
When you say "long-acting" you mean, the length of the surgery right? I had to read that carefully, because I've undergone quite a few surgeries over the past twenty years or so, and almost all of them with midazolam (Versed). Of course, most surgeries are short! It was also administered for endoscopy (or, I was administered)--a lot of outpatient surgery is "conscious sedation" but they still use Versed **shudder**

grant hutchison
2010-Feb-28, 10:08 PM
He was still paralyzed, sir.Yes, that's what I meant, though I was pretty telegraphic. :)
The only reason to do that would be if the anaesthetist wanted to give general anaesthesia on top of the spinal/epidural block, and the only reason to do that would be if the anaesthetist wasn't sure if the spinal/epidural would adequately cover the surgery. And if you do that then you make pretty sure the general anaesthesia is enough to do the job on its own, and you're alert for clinical signs of light anaesthesia so that you can deepen the general anaesthetic to compensate for any inadequacies in the spinal/epidural.
So this fella seems to have received an inadequate central neural block, an inadequate general anaesthetic, and inadequate monitoring. It's a worry.

Grant Hutchison

grant hutchison
2010-Feb-28, 10:13 PM
When you say "long-acting" you mean, the length of the surgery right?Pretty much, yes. If you're receiving a general anaesthetic then you're unconscious, so an amnestic doesn't add anything useful during that time.

Grant Hutchison

Swift
2010-Mar-01, 02:17 AM
If anything, I have (sort of) the opposite problem. I've had several procedures (several colonoscopies and ankle surgery) where I was supposedly conscious during the procedure, but given stuff for both pain and .... let's say anxiety (make me happy!). However, as near as I can tell, I was essentially unconscious, or at least I have absolutely no memories of any of them. The last couple of colonoscopies, when they are setting up the TV so I can watch too, I tell them not to bother, cause I won't remember any of it.

There have been a couple of times I don't even remember post-op, and supposedly you are not released from that until you are aware.

I guess I'm just a cheap date. ;)

Ara Pacis
2010-Mar-01, 06:06 AM
I remember things from my colonoscopy, like waking up and seeing things on the monitor. More importantly, I remember feeling things too, way inside, and it hurt and I said "ouch!" and a nurse did something and I faded away again.

My surgery was better, without any issues that I remember. I wasn't given anything until I was on the table in the OR. Then they started the knock-out juice and I could feel it move up my arm, across my chest, up my neck and I was giving them the play-by-play as I felt it. I knew from past experience with iodine contrast agents where the sensation would hit me full, so right before it got to the point that I expected to pass out, I said goodnight and closed my eyes and I didn't remember anything after that.

However, they tell me it took me a longer time than normal in recovery. I don't know if it was the anasthetic or the pain or what. I remember feeling the need to throw up and then not needing to after all, then fading in and out for a long time as they kept asking me how much pain I had and they ended up maxing out the shots they could give me.

mugaliens
2010-Mar-01, 09:32 AM
This brings back interesting thoughts of waking up halfway through my wisdom teeth being taken out...


So you'll be in pain for the rest of the operation but you won't remember it afterwards?

With me it was the reverse. I didn't feel the pain (he'd administered localizer, as well), but I recall every detail of the third and fourth tooth removed.

I don't know what it is with me and these meds, but I do wish they'd find something that worked better. Heaven help me if I ever have to go in for more than tooth surgery.

chrissy
2010-Mar-02, 08:56 PM
Well I don't know what they gave me to make me forget anything about my ops, I have had nine in the last five years, but the last one they wanted to give me an epidural and I was pretty scared about that, I refused it at first. It is just the thought of a needle going into the spinal chord scared the living daylights out of me.

I am glad they persisted in asking me and told me of the benefits of less post op pain I agreed. [something I don't want again in a hurry] A full abdominal hysterectomy for those who are curious to know what op I had.
It did work and I never really had any need for the morphine or pain relief either while I was in hospital (3 days) but when I was home I needed it. :(

Mugs, over here when getting a tooth out they just give you novocaine. (a local anesthetic)

Van Rijn
2010-Mar-02, 11:19 PM
Mugs, over here when getting a tooth out they just give you novocaine. (a local anesthetic)

Usually, here, it's novocaine as well. Conscious sedation is usually reserved for the more difficult stuff. I've had two dental surgeries with conscious sedation: Once when I had all wisdom teeth removed at the same time (and one or two were impacted). Another is when they drilled into my jaw to install a couple of titanium screws that would later hold a couple of artificial teeth.

Click Ticker
2010-Mar-03, 06:34 PM
I've had two open heart surgeries. I remember being wheeled into the OR, and I remember waking up in Cardiac ICU both times. Don't recall a thing in between. I'm pretty sure they administered the drug in pre-op and started wheeling be to OR right after that. For those I was on a heart lung machine for quite a while. I'm not sure if that reduces the risk of waking up during.

The most recent one I was out from about 8:30 AM until 2:00 AM. The operation itself was about eight hours with a couple hours on the heart lung machine.

mugaliens
2010-Mar-04, 11:20 AM
Mugs, over here when getting a tooth out they just give you novocaine. (a local anesthetic)

Same here, except for wisdom teeth, particularly when you're having all four pulled at the same time! They really prop your jaw open...

BigDon
2010-Mar-04, 10:50 PM
So this fella seems to have received an inadequate central neural block, an inadequate general anaesthetic, and inadequate monitoring. It's a worry.

Grant Hutchison

I'm trying to remember the ship's surgeon's name. Brilliant surgeon. Don't let this one episode paint a bad picture of him. Because of him I'm still pretty. I had significant lacerations on my face around my left eye including my lower eyelid through to the eyeball.

He came by to check on the doctors working on my face and took over the operation when the doctor doing the procedure started to remove bits around my eye in the wound clean up process he didn't think were going to be viable. The chief surgeon disagreed. And he sewed all the macerated bits back together.

The scars are only visible if I tan my face. Then I look like a cheap villian in a bad spy movie.

On shore he was the chief of surgery at Balbao Naval Hospital. Then when Carrier Air Wing Nine deployed he was the head doctor of the ship.

BUUUUTTT

It wasn't entirely unknown for this man to give a subordinate doctor a black eye. (Haven't you ever wanted to do that?) And you can see why. Not in this case though. Frank Burns' do exist. Belied the myth of surgeons being all paranoid of injuring their hands.

grant hutchison
2010-Mar-04, 11:03 PM
I'm trying to remember the ship's surgeon's name. Brilliant surgeon. Don't let this one episode paint a bad picture of him.It paints a bad picture of the anaesthetist.

Grant Hutchison

Paracelsus
2010-Mar-04, 11:24 PM
Have had numerous surgeries in my life, and I'm happy to report that I've woken up blissfully unaware of what transpired while I was 'asleep' except for one instance: the removal of my wisdom teeth. I was given novacaine in my gums plus nitrous oxide anesthesia. Woke up in the middle of the procedure while the surgeon/dentist was 'extracting', so to speak. My head was being yanked back and forth, and I was hearing cracking noises. Meanwhile, the surgeon was yakking about his golf game and the latest gossip on his colleagues. I might as well have been a piece of meat for all the care he was taking with my head. I wasn't feeling pain and fear as much as puzzlement. I think I went back to sleep after that brief episode and woke up with my mouth stuffed full of cotton. Uncomfortable.

grant hutchison
2010-Mar-04, 11:39 PM
Nitrous oxide isn't really an anaesthetic agent, unless you use it in a hyperbaric chamber. If you were receiving nothing but nitrous oxide and a local anaesthetic, then you were getting "relative analgesia", which is a form of conscious sedation. The idea is that the patient is relaxed but conscious and cooperative throughout, although perhaps amnesic afterwards. Unconsciousness is actively avoided, because it means you stop protecting your own airway. So the idea is that the sedationist maintains constant verbal contact with the patient, and adjusts the level of nitrous oxide accordingly.
It sounds like your dentist might have been putting a little too much trust in the amnesia, and not enough effort into the verbal contact.

Grant Hutchison

HenrikOlsen
2010-Mar-05, 12:11 AM
I've gotten nitrous oxide a couple of times and was fully conscious throughout the procedure.
Didn't totally remove the pain but took enough off it that I didn't care.

BigDon
2010-Mar-05, 04:59 PM
I never had it. I don't trust it.

grant hutchison
2010-Mar-05, 05:27 PM
I never had it. I don't trust it.You don't trust nitrous oxide to do the advertised job? Or you don't trust conscious sedation to meet your needs?

Grant Hutchison

flynjack1
2010-Mar-05, 05:48 PM
The odd thing for me is that during a recent colonscopy I don't recall being unconscious. I know I must have been for some part, but mostly I remember watching the screen and even witnessed them remove a polyp. I fully recall going to the recovery room and being ready to leave very quickly. The doctor laughed when I said that I thought I was supposed to be unconscious during the procedure. I remember laying there feeling no pain and wondering why I was conscious, but unable to verbalize the fact that I was awake to the nurses or Dr.

I too had a wisdom tooth removed surgically under anesthesia. I don't recall that procedure at all. It was done under anesthesia due to it being in a very bad location and they had to dig it out.

BigDon
2010-Mar-05, 06:18 PM
You don't trust nitrous oxide to do the advertised job? Or you don't trust conscious sedation to meet your needs?

Grant Hutchison

I've been to large raucous parties back in the late 1970's where people died misusing it. I never tried it because at another party I was watching people huff it, giggle, then fall straight forward and break their noses on the floor. (Then giggle again.) At the time I went, "Hmmm, stupid drug." Then people started dying from it. Placed it right up there with huffing glue.

Sort of stuck with me.

grant hutchison
2010-Mar-05, 07:18 PM
Then people started dying from it.Actually (apart from the inevitable "falling over due to drug-induced stupidity" deaths) people don't die from nitrous oxide inhalation; they die because they ignore Hutchison's First Fundamental Principle (http://www.bautforum.com/1690073-post14.html): "Never breathe anything with no oxygen in it."

Modern anaesthesia and relative analgesia machines always deliver nitrous oxide along with oxygen, and are set up with a mechanical linkage which prevents the delivery of a hypoxic mixture. Your recreational user, on the other hand, is unfettered by such namby-pamby safety standards. If you fill a large bag with any gas mixture containing no oxygen and take several deep breaths from it, then you will stress-test your physiology in all sorts of interesting and potentially lethal ways.

Grant Hutchison

BigDon
2010-Mar-05, 08:25 PM
Oh I'm a believer!

I was on a working party that had to clean up a huge mess. A high temperature steam line gave up the ghost in a hold used to store pallets of soda. You entered the room from above, down a vertical ladder. In three interconnecting rooms that held eight pallets each.

The heat had burst so many of the soda cans that the room was awash to about four inchs below the knee. Definately cleared the knee knockers.

When we first approached I saw all the ventilating gear (large blowers) were sitting by the hatch with all with their cords coiled up and stowed. And no supervisors.

Since protocol dictated venting for several hours before you can send unequipped men into a iffy space, we assumed it had already been done.

Bummer.

Two guys from my squadron and I put on some waders and went down the ladder. By the time I reached the bottom of the ladder, I turned around and had immediate tunnel vision. For about three seconds. Long enough to see the two guys ahead of me slump forward. Then it was night night time. I lucked out and fell across a partialy unloaded pallet that kept my face out of the crap. The other two weren't as lucky.

Inhaling large quantities of soda pop is horrifically bad for your lungs by the way. Worse than fresh water drowning by far. Just saying.

The docs say it's a toss up between this incident and a later head trauma that could be responsible for my seisure disorder.

Of course there was also the time myself and five others were in a confined space and a big eight gallon container of carbon tetra chloride was accidently ruptured via a long story and drenched us. We were all red faced and drooling heavily before we could get out. (Medical was quite duely alarmed.)


Hey! The only way to never get hurt is to never do anything!


(Stupid)

GalaxyGal
2010-Mar-13, 08:22 PM
This clip (http://www.youtube.com/watch?v=WOrjcLJ2IE0&feature=related) was shown at reception for our OR staff this week. At 1:19 there's a reference to awareness.

JohnD
2010-Mar-13, 09:46 PM
"Entonox" is a mixture of nitrous oxide and oxygen, 50:50, in a cylinder. Very useful as though N2O isn't very effective as an anaesthetic it is a pain killer. With a demand valve and a mouthpiece, it is still the quickest way to get some pain relief, and easily reversible too, just breath fresh air. Used widely in the UK on ambulances for trauma and in obstetric units.
My point is that it may be given by paramedics or midwives as properly used Entonox is very safe indeed. Used in the US too, I think.

N2O used less and less for actual anaesthesia these days.

John

BigDon
2010-Mar-14, 07:03 PM
John, the things I'm talking about happened thirty years ago. I'd hope there would be improvements. Thanks.

SeanF
2010-Mar-15, 09:43 PM
I don't know for sure what the drugs are they gave me when I had my dental work done - it's some form of conscious sedation - but I don't remember any of it.

Even when, during my wisdom teeth removal, the dentist had to drive me across town to an oral surgeon because she couldn't get the teeth out. "Your bones are like rock," she said.

I always knew I was hard-headed, now I've got medical proof. :)