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Thread: Why don't I dream during general anesthesia?

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    Why don't I dream during general anesthesia?

    I just got home after my 4th operarion in 9 months. All pretty smal operations lasted between 15 and 40 min.
    But they all have to be done under GA (propofol).

    My question is: i allmost allways dream heavy, at night, when i take a short nap... but not during GA, why?
    Is it just me? do other people dream during GA? Is it the drug(s) they used? Or the short duration of the operations?


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    I don't recall dreaming the last few times I had general anesthesia, but give me some opiate-based pain killers and I understand a bit how Coleridge, et al, may have been inspired.

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    No, people don't dream under general anaesthesia - because it's not sleep.
    Your brain is shut down in a completely different way from normal sleep, and the EEG appearances are very different. People do report dreams, but they happen during the recovery period - you can get a sort of drug delirium during emergence, and then normal sleep and dreaming thereafter. Because we often don't lay down memories in the immediate post-recovery period, people forget waking up, having a conversation, and then falling into a normal sleep; so they associate those later dreams as being part of the period of general anaesthesia.

    Grant Hutchison

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    I am on some right now, i got home just a couple of hours ago so i might regret posting the op in a bit...
    But i'm genuinely interested in how it works for me.

    The second the anaesthesiologist pushes on that seringe, i feel tingly, warm, and everyting gets fuzzy.
    En than, snap. I wake up, all is done everyting ok. But no dreams.

    -- Dennis

    #edit. In replonce to Schlaugh
    Your theory is crazy, but it's not crazy enough to be true. - Niels Bohr

    Ad eundum quo nemo ante iit

    Hint: this is at heart a scientific forum, and underneath the fooling around there are some diamond-hard minds hanging about, ready to tear you to shreads. -- Mike Alexander

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    Thank you. Grant.

    After surgery, when going from OR to recovery am i still under full GA?
    Because when i wake up, there are mostly just recovey folks, and no dr. In sight.

    -- Dennis
    Your theory is crazy, but it's not crazy enough to be true. - Niels Bohr

    Ad eundum quo nemo ante iit

    Hint: this is at heart a scientific forum, and underneath the fooling around there are some diamond-hard minds hanging about, ready to tear you to shreads. -- Mike Alexander

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    Quote Originally Posted by BetaDust View Post
    I am on some right now, i got home just a couple of hours ago so i might regret posting the op in a bit...
    But i'm genuinely interested in how it works for me.

    The second the anaesthesiologist pushes on that seringe, i feel tingly, warm, and everyting gets fuzzy.
    En than, snap. I wake up, all is done everyting ok. But no dreams.

    -- Dennis

    #edit. In replonce to Schlaugh
    Yeah, one of the many interesting things about general anaesthesia is that it shuts down the brain-stem clock. After normal sleep, we generally have some sense that time has passed while we've been unconscious, but after a GA it's common to have the feeling that no time has passed. I often used to have conversations with patients who woke up after a three-hour procedure, reproachfully insisting that they were still waiting for the anaesthetic to kick in.
    In the bad old days when we were less good at maintaining a patient's body temperature during surgery, people used to wake up from prolong anaesthesia with the most incredible shivers, despite the fact their body temperature had dropped only fractionally. It turns out your body doesn't just respond to how cold you are, but how quickly your body temperature is changing. With the brain's clock switching off temporarily, the thermoregulatory mechanisms experienced a step change in temperature between pre- and post-anaesthesia - an effectively infinite rate of change, which drove the physiology to a madly over-the-top reflex response.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Yeah, one of the many interesting things about general anaesthesia is that it shuts down the brain-stem clock. After normal sleep, we generally have some sense that time has passed while we've been unconscious, but after a GA it's common to have the feeling that no time has passed. I often used to have conversations with patients who woke up after a three-hour procedure, reproachfully insisting that they were still waiting for the anaesthetic to kick in.
    In the bad old days when we were less good at maintaining a patient's body temperature during surgery, people used to wake up from prolong anaesthesia with the most incredible shivers, despite the fact their body temperature had dropped only fractionally. It turns out your body doesn't just respond to how cold you are, but how quickly your body temperature is changing. With the brain's clock switching off temporarily, the thermoregulatory mechanisms experienced a step change in temperature between pre- and post-anaesthesia - an effectively infinite rate of change, which drove the physiology to a madly over-the-top reflex response.

    Grant Hutchison
    And its quick. Got in at 12u, got released at 17u. 39min. Op.

    --Dennis

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    I remeber having to stay at least a night.

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    Quote Originally Posted by grant hutchison View Post
    Yeah, one of the many interesting things about general anaesthesia is that it shuts down the brain-stem clock. After normal sleep, we generally have some sense that time has passed while we've been unconscious, but after a GA it's common to have the feeling that no time has passed. I often used to have conversations with patients who woke up after a three-hour procedure, reproachfully insisting that they were still waiting for the anaesthetic to kick in.
    Yep. I've experienced the clock-stopping. You drift off, and then you're waking up, and everything's done.


    Quote Originally Posted by grant hutchison View Post
    In the bad old days when we were less good at maintaining a patient's body temperature during surgery, people used to wake up from prolong anaesthesia with the most incredible shivers, despite the fact their body temperature had dropped only fractionally. It turns out your body doesn't just respond to how cold you are, but how quickly your body temperature is changing. With the brain's clock switching off temporarily, the thermoregulatory mechanisms experienced a step change in temperature between pre- and post-anaesthesia - an effectively infinite rate of change, which drove the physiology to a madly over-the-top reflex response.
    Fascinating! Did not know that!

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    Quote Originally Posted by BetaDust View Post
    Thank you. Grant.

    After surgery, when going from OR to recovery am i still under full GA?
    Because when i wake up, there are mostly just recovey folks, and no dr. In sight.
    It depends on a lot of things - the type of anaesthesia, the training of the recovery staff, the distance between the OR and the recovery room. I used to transfer some patients while they were effective still anaesthetized (turn off the anaesthesia and make the transfer immediately), but others I wouldn't let out of my sight until they had woken up enough to hold a conversation. But many in the latter category would believe that they had woken up for the first time in the recovery area, because of the fact that memory is rather volatile for the first few minutes after anaesthesia, and they had then fallen into a natural sleep.

    I've had that experience myself. I had airway surgery a few years ago, and I know for a fact that my colleague would not have let me out of his sight until I had opened my eyes and was talking (demonstrating that my airway was clear and I was in full control of it). But my only recollection is of waking up sitting on a trolley in the recovery area with a recovery nurse cycling the BP cuff on my arm.

    Grant Hutchison

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    Quote Originally Posted by DaveC426913 View Post
    Fascinating! Did not know that!
    It's physiology operating on a proportional-derivative control loop. Interestingly there doesn't seem to be an integral term in the thermoregulatory control system, otherwise the shivering would ramp up slowly - instead it fires up immediately at maximum rate and force.

    Grant Hutchison

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    When I was a kid I had nitrous oxide in a dentist office. I thought I was an astronaut on an alien planet, with a spiral galaxy over my head, and a giant caterpillar like alien was attacking my mouth.
    SHARKS (crossed out) MONGEESE (sic) WITH FRICKIN' LASER BEAMS ATTACHED TO THEIR HEADS

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    Quote Originally Posted by Tom Mazanec View Post
    When I was a kid I had nitrous oxide in a dentist office. I thought I was an astronaut on an alien planet, with a spiral galaxy over my head, and a giant caterpillar like alien was attacking my mouth.
    Nitrous oxide isn't really a general anaesthetic, except in a hypoxic mixture - it's sort of a sedative analgesic amnesic agent. So dental office anaesthesia, back in the day, was a combination of sedation and suffocation. No wonder you had dreams.

    Here in the UK, back in the Dark Ages when I were a lad, dentists used to be solo operator/anaesthetists in their own offices, usually with an assistant who was qualified to hand them stuff and provide suction, but who had no other training, and with absolutely no monitoring equipment. Bad Stuff would sometimes happen (surprisingly rarely in retrospect) to small children. The law changed, and dentists had qualified anaesthetists and monitoring standards imposed upon them. So sometimes we'd get posted out to a couple of dental offices which had invested in the right equipment, and we'd anaesthetize a few kids. I vividly remember providing the first GA delivered under the new system, for a dentist who'd been doing his own thing for decades prior to that point. He put his forceps on the first tooth, and then looked up at me anxiously, "She's didn't move, doctor. Are you sure she's all right?"
    His safety measure had been that he never gave enough anaesthesia to prevent the child whimpering and withdrawing when the forceps went on. If the child ever stopped moving, that was a bad sign.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Yeah, one of the many interesting things about general anaesthesia is that it shuts down the brain-stem clock. After normal sleep, we generally have some sense that time has passed while we've been unconscious, but after a GA it's common to have the feeling that no time has passed. I often used to have conversations with patients who woke up after a three-hour procedure, reproachfully insisting that they were still waiting for the anaesthetic to kick in.
    In the bad old days when we were less good at maintaining a patient's body temperature during surgery, people used to wake up from prolong anaesthesia with the most incredible shivers, despite the fact their body temperature had dropped only fractionally. It turns out your body doesn't just respond to how cold you are, but how quickly your body temperature is changing. With the brain's clock switching off temporarily, the thermoregulatory mechanisms experienced a step change in temperature between pre- and post-anaesthesia - an effectively infinite rate of change, which drove the physiology to a madly over-the-top reflex response.

    Grant Hutchison
    Would you have any reference info on the underlined bit above? I'd much appreciate a deeper dive/excursion into that concept/model. Its fascinating.

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    Quote Originally Posted by Selfsim View Post
    Would you have any reference info on the underlined bit above? I'd much appreciate a deeper dive/excursion into that concept/model. Its fascinating.
    I'm usually pretty good at providing references for stuff I say here - but unfortunately not when it comes to my old job. It's a combination of having forty years' worth of information floating around in my head, and the fact that I junked my entire anaesthesia library on 13th November 2015.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    I'm usually pretty good at providing references for stuff I say here - but unfortunately not when it comes to my old job. It's a combination of having forty years' worth of information floating around in my head, and the fact that I junked my entire anaesthesia library on 13th November 2015.

    Grant Hutchison
    No problem .. In the interim, found this:
    Signals from the brainstem sleep/wake centers regulate behavioral timing via the circadian clock:
    Sleep-wake cycling is controlled by the complex interplay between two brain systems, one which controls vigilance state, regulating the transition between sleep and wake, and the other circadian, which communicates time-of-day. Together, they align sleep appropriately with energetic need and the day-night cycle. Neural circuits connect brain stem sites that regulate vigilance state with the suprachiasmatic nucleus (SCN), the master circadian clock, but the function of these connections has been unknown. Coupling discrete stimulation of pontine nuclei controlling vigilance state with analytical chemical measurements of intra-SCN microdialysates in mouse, we found significant neurotransmitter release at the SCN and, concomitantly, resetting of behavioral circadian rhythms. Depending upon stimulus conditions and time-of-day, SCN acetylcholine and/or glutamate levels were augmented and generated shifts of behavioral rhythms. These results establish modes of neurochemical communication from brain regions controlling vigilance state to the central circadian clock, with behavioral consequences. They suggest a basis for dynamic integration across brain systems that regulate vigilance states, and a potential vulnerability to altered communication in sleep disorders.
    and this:
    Suprachiasmatic Nucleus
    The suprachiasmatic nucleus (SCN) of the hypothalamus is the principal circadian pacemaker in the mammalian brain and, as such, it generates circadian rhythms in rest and activity, core body temperature, neuroendocrine function, autonomic function, memory and psychomotor performance, and a host of other behavioral and physiological processes. The SCN is the central player in an important neural system, the circadian timing system (CTS). This article reviews the principal properties of circadian rhythms, the characteristics of circadian rhythmicity in the SCN, and the major output of the latter. The nature of the SCN in nonmammalian vertebrates is also briefly considered.
    Cheers

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    What about the anesthesia that killed Michael Jackson? He claimed it helped him “sleep” and wake refreshed.

    That certainly doesn’t describe the clock-stop experience I had during minor surgery.
    After that, I commented to my wife that I now know what it is like to be dead.



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    Quote Originally Posted by Extravoice View Post
    What about the anesthesia that killed Michael Jackson? He claimed it helped him “sleep” and wake refreshed.
    Anaesthesia didn't kill Michael Jackson. A massive overdose of an anaesthetic agent (propofol), administered on top of a large dose of a benzodiazepine sedative, in utterly uncontrolled circumstances, killed Michael Jackson.
    Propofol does not have the properties Jackson claimed for it.

    (One of the disadvantages of being rich and famous is that you'll eventually find a doctor willing to prescribe or do whatever thing you think you need, no matter how foolish and unsupported by evidence that thing is. If you're lucky, the thing will be a pointless waste of money; if you're unlucky, the thing will be damaging or lethal.)

    Grant Hutchison

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    The interesting thing here is that there is evidence that our sense of time is dependent on the 'normal' functioning of this SCN center in the mamalian brain (and perhaps in non-mamalian brains too). Apart from the evidence of loss of physical bodily function co-ordination, the higher level sense of 'what time really is', also gets wiped out by a good dose of anaesthetic.

    What this means is that time itself is dependent on our normal functioning of the SCN center in the brain.

    The notion that time is 'an external something', (ie: a physical property of the universe around us), comes from within us .. and is not just 'a something outside' of us'. We should own that .. by paying due attention to this evidence.

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    Quote Originally Posted by Selfsim View Post

    The notion that time is 'an external something', (ie: a physical property of the universe around us), comes from within us .. and is not just 'a something outside' of us'. We should own that .. by paying due attention to this evidence.
    Not just, no. But also that.
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    Quote Originally Posted by Selfsim View Post
    What this means is that time itself is dependent on our normal functioning of the SCN center in the brain.
    I'm not sure that follows. I think that all that can be supported is that our perception of time is dependent on normal functioning of the SCN center in our brain. But maybe that's what you meant?

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    Quote Originally Posted by Darrell View Post
    I'm not sure that follows. I think that all that can be supported is that our perception of time is dependent on normal functioning of the SCN center in our brain. But maybe that's what you meant?
    Time has been and is regularly measured using plenty of objective things outside of our heads. Causality proceeds in a positive direction, one event follows another, therefore there is time. Please, let's not turn this into another Solipsism thread, we have a place for that already.
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    Quote Originally Posted by Selfsim View Post
    The interesting thing here is that there is evidence that our sense of time is dependent on the 'normal' functioning of this SCN center in the mamalian brain (and perhaps in non-mamalian brains too). Apart from the evidence of loss of physical bodily function co-ordination, the higher level sense of 'what time really is', also gets wiped out by a good dose of anaesthetic.

    What this means is that time itself is dependent on our normal functioning of the SCN center in the brain.

    The notion that time is 'an external something', (ie: a physical property of the universe around us), comes from within us .. and is not just 'a something outside' of us'. We should own that .. by paying due attention to this evidence.
    My bold. If that is the case, why doesn't timekeeping go crazy everytime someone has general anesthesia?

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    Quote Originally Posted by Noclevername View Post
    Time has been and is regularly measured using plenty of objective things outside of our heads. Causality proceeds in a positive direction, one event follows another, therefore there is time. Please, let's not turn this into another Solipsism thread, we have a place for that already.
    I don't understand this response. Did you understand what Selfism wrote and what I wrote? Selfism wrote that time is dependent on a function in the human brain. I said no, it is not. I'm not talking about Solipsism any more than you are.

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    Quote Originally Posted by Noclevername View Post
    Time has been and is regularly measured using plenty of objective things outside of our heads. Causality proceeds in a positive direction, one event follows another, therefore there is time. Please, let's not turn this into another Solipsism thread, we have a place for that already.
    All that can be scientifically supported is as has been explained in post #6 from Grant. No matter what you may think others may infer from that account, there can be no scientific correlation to what time may or may not be outside of empirical reality - that will never be scientifically known, it can only ever be a philosophical assumption as per standard realism. So without wishing to post on behalf of Selfsim in any way, it is inconceivable to me that he would make any kind of scientific correlation to a realm outside of empirical reality because such a realm is mind independent and can only be supported philosophically.

    The thread you refer to is not a solipsism thread - again, solipsism is a philosophical position just as realism is, the thread in question is not a dumping ground for philosophical positions of solipsism, realism or idealism - they only come up in the context of what is considered to be a scientific approach to modelling our reality. Philosophical notions of realism cannot actually be dumped anywhere out of sight, they are part and parcel of every scientific model that assumes there is an absolute linkage from empirical reality to a mind independent reality. When you imagine dumping them into the thread you mention, all you are really doing is choosing to ignore the fact that such a linkage is an assumption and by definition, unscientific. But more to the point, the thread in question has no use for such "isms", it cannot do anything with them and does not do anything with them.

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    OK, that's it, no more discussion about "The last and final argument about reality" thread or the physics/nature of time or anything remotely related to it. This thread is strictly about medical science and anesthesia in particular.
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    You DO dream.
    You are STILL ASLEEP.

    How can you be sure you ever wake up from a dream?
    How can you be sure you are exactly the same person who went to sleep?
    We trust our consciousness is 'dissolved' every night in non-REM sleep and then amazingly/ 'miraculously' reconstituted each time we wake exactly as it was before.
    I think ignores a really interesting scientific question. Usually people think about 'what is consciousness', not 'what is unconsciousness' - except if you are investigating 'brain death' in ICU, or you are an anaesthetist.

    There are also some philosophical issues about 'pain' Management using drugs like midazolam (e.g. for bone marrow biopsy/ endoscopies) which are NOT analgesia, simply (?) memory-wipe agents. They make you forget you were in pain. This is totally unethical. Death is the ultimate anaesthetic- does that mean it is OK to inflict pain in life- if will not be remembered after death? Pts should at least be consented to :
    'I understand I will not be given any pain relief and will experience pain during the procedure, but will not remember it later"
    Last edited by plant; 2020-Jan-23 at 02:26 AM.
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    Quote Originally Posted by plant View Post
    There are also some philosophical issues about 'pain' Management using drugs like midazolam (e.g. for bone marrow biopsy/ endoscopies) which are NOT analgesia, simply (?) memory-wipe agents. They make you forget you were in pain. This is totally unethical.
    And ... that'd be why we specifically don't do that thing.
    Even setting aside the ethical aspect, the practicalities would be nightmarish - attempting an invasive painful procedure on someone who is disorientated and disinhibited? Not going to go well.

    Grant Hutchison

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    Hi Grant - i think you mean "we don't do those things anymore" ... they were certainly done in the 80's-90's in my hospital.
    scopes/ BMA/T and shoulder re-locations in the ER.


    ...But this is a great sci-fi trope-

    administer memory wipe quickly after a traumatic event to erase the memory and prevent PTSD
    criminal gangs wiping memories of meetings/ crimes...
    "It's only a model....?" :-)
    https://www.youtube.com/watch?v=m3dZl3yfGpc

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    I’ve had what was called conscious or twilight sedation several times, including for a heart procedure (alcohol ablation). I assume that is more complex - I believe there are usually drugs to minimize pain, while others affect memory and sedation. In some cases, supplemental oxygen was used, other times not (depended on doctor and procedure). I also have had varying experiences, sometimes not remembering anything 30 seconds after the drug went in IV till recovery room. Other times remembering snatches or in two cases a fair amount about a procedure.

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