16 May 2017

Awake during surgery. On purpose.

From a report in the Wisconsin State Journal:
More doctors are letting patients remain alert during certain surgeries, for logistical, financial and medical reasons. It's a national trend playing out in Madison...

Many patients getting hand or arm surgeries, knee or hip procedures and even some breast and urological operations have started receiving regional or local numbing shots instead of general anesthesia. That can mean a quicker recovery, less cost and fewer side effects...

A small, but growing, fraction of patients is choosing to stay completely awake, with no sedation. They're joining two groups that have long remained conscious during surgery: many women delivering babies through Cesarean sections; and certain brain patients, such as those receiving deep brain stimulation, who must be able to communicate with doctors during their procedures...

Another obstacle the study identified: Surgeons said it's more difficult to teach residents — doctors in training after medical school — if patients are awake. Plus, some patients don't like knowing that residents are participating in their procedures.


  1. Many of my orthopedic patients are awake for their surgeries, although often with enough sedation so they doze. Regional anesthesia, nerve blocks specifically, allow for easier wake up, less nausea. No risk of airway trauma. Some people with cardiac issues cannot tolerate general anesthesia.

    When surgeons are used to teaching residents with awake patients, they get used to it. We often set up monitors so that patients can watch if they want to, many do.

    Some patients are just not up to dealing with being still long enough. An hour is about the limit using a tourniquet. Some surgeries are too long for anyone. Some surgeries can't be properly handled with regional blocks or spinals. But for the many that can, it works very well, and patients benefit.

  2. I have woken up during a tooth extraction - not pleasant for me to be in the middle of what is going on (I was a bit startled and started talking / mumbling), and, a bit of surprise to the oral surgeon. He quickly put me under.

    I have also woken up during a colonoscopy - just enough to see the monitor and some feeling of something moving inside. It is pink in there. :-)

  3. I had a gum grafting surgery done to me last summer without general anesthesia last summer. My periodontist took tissue from my upper palate and grafted it onto my gums, as well as some cadaver tissue. I did it all with only a local, and the surgery lasted about 1 hour and a half, since I was having all four quadrants of my mouth being done. I opted against anesthesia for the cost savings.

    The sound of tissue being ripped from your palate sounds a lot like denim being torn.

    1. That 'sound' is probably worse than pain, as you remember it.

      I can imagine hearing a hip joint replacement being done on yourself, with all the sawing and other power tools that are used.

    2. It was a shocking sound, I'm not sure if was worse than the pain. I didn't actually feel much pain at all during the procedure. Afterwards... well that's a different story.

  4. I had a wisdom tooth extraction done under local. The cracking sound of the tooth being broken up so it could get pulled out, and the pulling and wiggling, was enough by itself. The crowning touch was the dentist trying to get out that last piece, him almost grunting and getting frustrated and using an adjacent tooth as a fulcrum for his pliers. It reminded me of my pulling a rusty nail out of an old board with a pair or pliers. Put me under!

  5. I've had far more dental surgery than I like to think about with only local. I had a colonoscopy today actually, my third, they tell me that I won't remember anything but I clearly remember each one. Admittedly, I ask for light sedation, but I watched the whole thing. More interesting than usual as there was a polyp. Otherwise it's a boring movie �� But that is not major surgery. I don't see why you need anything at all for a colonoscopy. I would gladly take something for anxiety at least during dental surgery though I had a bone graft that took forever and would have loved to zone out for awhile.
    My mother had her hip replacements with just a local, she said the noise was bothersome, but felt it was safer.


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