Many people have heard stories of people who awoke during an operation performed under general anesthesia. Some of these are horrific tales of people who awaken during surgery to find themselves unable to move or speak, yet fully conscious, and fully able to feel the dreadful pain of the operation they are undergoing. The video below tells of just such a terrible experience, and makes this fear of consciousness during anesthesia very real.
The video above tells of spectacularly horrible experiences. But not all experiences of consciousness during general anesthesia are nightmares such as this. Some people undergo experiences where they can hear the surgeon and other, built feel no pain. Some people even tell of undergoing out-of-body experiences during general anesthesia. How can these very different types of experiences during general anesthesia be explained?
To understand the phenomenon of consciousness, or awareness during general anesthesia, it is first necessary to understand the types of drugs used during general anesthesia. Modern general anesthesia uses three separate categories of drugs to provide the triad of general anesthesia.
Yet, even though unconscious due to general anesthesia with this standard combination of these three categories of drugs, people are still able to feel touch, to feel movements, to see light, to hear, and to smell (Banoub 2003, Thornton 1998). Yet they remember none of these things upon awakening, because of the effects of anesthetic drugs upon memory. Anesthesiologists always monitor many different body functions during anesthesia to determine whether the patients under their care are in good condition, are asleep, adequately paralyzed, or receive adequate amounts of painkilling drugs. Extra doses of these drugs are administered when required to provide extra muscle relaxation, painkilling, or to deepen the level of unconsciousness. Unfortunately, about 1-2 people per 1000 people undergoing general anesthesia experience various degrees of awareness or actual full consciousness under general anesthesia (see articles in Wikipedia on Awareness, Sebel 2004, RCOA 2008).
Not all experiences of awareness during anesthesia are distressing, painful or horrific. In fact there are several different experiences of awareness during anesthesia that are determined by the effects of the drug combinations used in modern general anesthesia. These different drug combinations explain all the horrific experiences, the partially conscious experiences, the fully conscious experiences, as well as the sometimes even wondrous conscious experiences of people under general anesthesia.
The brain function of a person who awakens while supposedly under general anesthesia is abnormal, and this, combined with the effects of the other anesthetic drugs can also cause many strange effects such as:
All these attitudes, and all these things must be taken into account when considering stories of weird and wonderful experiences occurring under general anesthesia.
People undergoing operations under general anesthesia cannot speak. So they can only report experiences they undergo during general anesthesia after they awaken. And they can only report these experiences if they can remember these experiences. A young woman once told me of an out-of-body experience she underwent during a nose operation for which I administered general anesthesia. Her experience demonstrates all these aspects of out-of-body experiences occurring during general anesthesia.
She told me that she awoke during her nose operation. She saw her body as it lay upon the operating table, as if she was standing outside her body in a position at the right-hand side of the foot of the operating table. She realized it was she who lay upon the operating table, but felt no alarm or consternation upon realizing that she was apparently standing outside her body. She saw the surgeon operating upon her nose, but felt neither the operation, nor any pain from the operation. She saw the assistant of the surgeon. She saw the anesthetic assistant sitting next to the anesthetic machine located at the left-hand side of her body. And she remarked that she could not see the faces of any of these people. (The image below is a photographic montage of the situation as she described it in the operating theatre where her out of body experience occurred. The operation being performed was the same as hers, as were the positions of anesthetic assistant, surgeon, and theater nurse. Operating table, anesthetic machine, and draping were also the same, as well as in the same positions, as during her out of body experience.)
I was fascinated by this report, because I finally had an account of an out-of-body experience where I knew all the circumstances surrounding the reported observations. So what happened to this woman before, during, and after her operation? She was fully conscious when brought into the operating theatre. General anesthesia was induced. Her blood pressure, blood oxygen content, heartbeat, as well as the concentrations of inhaled and exhaled oxygen, carbon dioxide, nitrous oxide, and other anesthetic gases were continually measured. She was aroused from the general anesthetic upon completion of the operation. We brought her to the recovery room only after she was fully conscious. And there she reported undergoing a short out-of-body experience during her operation.
Her blood pressure, blood oxygen concentration, and blood carbon dioxide concentration remained normal throughout the operation. No-one in the operating theatre observed anything unusual during the operation. No-one saw her soul standing next to the operating table. Her body remained upon the operating table during the operation. She could not move, breathe, or speak during the operation, because she had received a drug that almost totally paralyzed all the muscles of her body, and was being mechanically ventilated through a tube placed between her vocal cords. But shortly before the end of the operation, when the effects of all the drugs she received were partly worn off, she made slight movements of her arms and legs. So, just in case she was awake, the anesthetic assistant promptly administered an extra dose of a powerful sleep inducing drug (see the actual anesthetic chart on the right). Otherwise there was no reason to think she was conscious at any time during the operation. She was only capable of speaking after she awoke from the general anesthetic.
The observations she made during her out-of-body experience were correct, but her normal sensory functions explained all her observations. She was fully conscious when brought into, and out of the operating theatre, so she saw the people in the operating theatre, their clothing, the instruments, and the anesthetic machine at the left-hand side of the operating table. She saw all these things before, and after her operation. She was apparently conscious for a short time at the moment when she moved slightly. But at that moment, her brain and the rest of her body were still affected by the anesthetic drugs she had received. So she felt no pain from the operation she was undergoing, nor was she able to speak and tell people what was happening at that moment. In fact she did not even think of speaking during the experience. The effects of low concentrations of general anesthetic and muscle paralyzing drugs caused her muscle spindles to function abnormally. Her slight movements caused her abnormally functioning muscle spindles to generate a flood of sensory nerve signals about her body movements, weight, and position. Her brain malfunctioned due to general anesthetic drugs, so she interpreted this flood of abnormal sensory nerve signals in such a way that she perceived herself as being outside her body, as well as generating an autoscopic hallucination. Finally, she was able to remember her experience after awakening. Her out-of-body experience was a product of abnormal muscle spindle and mental function occurring during reflex movements while under the influence of anesthetic drugs.
This woman was simply conscious and aware while supposedly unconscious under general anesthesia. So how do anesthesiologists assess the level of consciousness of a person under general anesthesia?
The mainstays of monitoring and detecting awareness during general anesthesia still remain suspicion, the bodily reactions of the person, and supplementation of these things with diverse monitors. What do I mean by suspicion and the reaction of the person's body?
Nowadays in modern countries, suspicion, experience, and reactions of the person's body to surgery are often supplemented with electronic monitors purporting to accurately measure the level of consciousness, or depth of anesthesia. Unfortunately, none of these highly advanced electronic devices are 100% accurate, which is why some people are conscious during general anesthesia, even though the brain function monitor or EEG (electroencephalogram) indicates they were unconscious's at the time (see articles on reliability of monitoring depth of anesthesia by Avidan 2008, Bruhn 2006). This is why professional associations of anesthesiologists in nearly all countries, (including the USA), while acknowledging the utility of these measures of consciousness, always recommend they not be relied upon 100%, and that anesthesiologists must also use experience and common sense to gauge the level of consciousness (see extensive review and recommendations in ASA 2006).
The wondrous story of Pam Reynolds in chapter 11 of the book The Unholy Legacy of Abraham is the best known account of a person who was conscious during general anesthesia, even though the brain monitoring indicated she was unconscious.
A person who says they were conscious during an operation performed under general anesthesia is not hysterical or insane. They may very well have been conscious. Careful study of each story, together with an analysis of the anesthetic chart and the surgical procedure, often reveals the time period during which the period of consciousness occurred. The same considerations also apply to people reporting undergoing an apparently paranormal experience while seemingly unconscious during general anesthesia. All such experiences provide wonderful illustrations of the ways the functioning of the bodies of different individuals interact with the effects of surgery and anesthetic drugs. These are sometimes humbling events for the anesthesiologist, but are always to be taken seriously as learning moments for the true professional.