And, sure enough, my memory was pretty much wiped for the hour or so after the event. Later that evening I had a conversation with my wife that went like this:
"Um, did you help me with putting my clothes back on?"
"Um, no. You did that."
"Did I talk to you and the doctor?"
"Sure. Normal conversation."
I have no recollection of these events at all. It gave me an uneasy feeling for a day or so. Nothing traumatic but every time I tried to reach back and think about that post-op period I drew and continue to draw a complete blank.
"Hey, I'm awake! That was easy."
"You've been awake for two hours."
"...Oh. Huh."
As I was being prepped for my third knee surgery, my doctor asked if I had any problems with anesthesia. I told him about the memory loss after my first surgery. My friends who were accompanying me, and had been at my second knee surgery, started mumbling "um, huh, well, oh, actually". It turns out that after my second knee surgery, when the surgeon was giving me a summary of how the surgery went, he told me he botched up my knee, and I proceeded to make very coherent and precisely detailed threats against his life. (The threats were bad enough that the surgeon considered bringing security into the recovery area and restraining me. In the end, my friends, including a combat vet, convinced the doctor that I'm not actually a violent person and agreed to restrain me if I actually became violent.) Again, I have absolutely no memory of this!
It seems to me like the internal, autobiographic self being disabled, and then upon awakening this self immediately says "wait, discontinuity in the recording ... where was I?" and this feeds back into the rest of the brain creating the confusion.
He wasn't confused the moment before, because his autobiographical self wasn't recording.
Maybe we're just the tape recorder?
Clearly though, this guy is still "conscious" - it seems like a situation we don't have quite the correct terminology to describe.
The trick, seemingly is manipulating the focus of awareness to convince the subconscious decision-making apparatus to make different decisions, even though all we really have control of is our awareness.
This is important because the psychological trauma of a surgical procedure will often cause people to avoid future procedures even when procedures are medically advisable. These drugs temporarily prevent strongly negative experiences from becoming a part of who you are mentally, subconscious or otherwise.
But that's actually something different than what I'm asking. I have no trouble understanding why I wouldn't want to remember a pain "similar to that of surgical incision". Similarly: I wouldn't want to remember an unanesthetized incision!
But before learning that surgical patients were routinely given midazolam to zap their memory, my impression was that surgical patients were completely zonked out by general anesthesia, and so there'd be no need to zap their memory, because they weren't going to consciously experience the incision in the first place.
Now I'm like, is all of general anesthesia a scam, and we're all enduring horrible pain, and we just don't remember it? J/K ONLY SERIOUS.
I'm medicine, not anesthesia, so I don't use these agents all day and therefore referred to cardioversion which is more in my domain. Cheers!
It seems unlikely that would be the case if the time inbetween was spent thinking 'oh my god this hurts so much' rather than just blacked out.
(Let me clear, I'm being deliberately silly about all this. I do not think there is a huge anesthesia conspiracy. I am, at the same time, seriously skeeved out by having my memory deliberately tampered with.)
I don't remember! :P
The answer to your question in is no, you aren't suffering enduring horrible pain while under general anesthesia. That doesn't mean you won't experience things you would rather not remember. Some examples: 1) patient may experience burning sensation from propofol (induction agent) entering the body 2) patient may see something disturbing before general has kicked in (e.g. a big saw before an orthopedic procedure) 3) in certain cases (e.g. emergencies) or due to human error, patient may not be fully under pre-surgery, e.g. patient may remember breathing tube being inserted.
The high level answer for why you are given midazolam (at least in the US) is because anesthesia is a "patient satisfaction" service and giving it increases patient satisfaction.
It varies by person but - Yes, it certainly can be.
My grandma had to undergo hip surgery awake with only local anesthetic. She was too frail and had all these health conditions so she couldn't be put under or given much medication. At the same time they couldn't just leave her hip broken. It was an extremely traumatic event for her.
Of course others would think it wasn't such a big deal.
For the procedure on midazolam, I have virtually no recollection of the procedure except for about a minute in the middle where it apparently wore off. It was a completely neutral experience.
For the other procedure, it was extremely unpleasant for two reasons but I got through it like a stoic. First, they had trouble keeping up with the local anesthetic, too many nerves involved, so there was quite a bit of transient pain and it got sloppier over the length of the procedure as the doc got tired. Second, even when you can't feel pain, you can still feel them tearing up your tissues and rearranging your parts, which is disconcerting if nothing else. Overall, I strongly recollect just how unpleasant and painful (even under anesthetic) that procedure was. I probably would not be able to tell you any of this if I was on amnesiacs because I would not remember.
It is really about where your thresholds are. Like you, I find the loss of memory on the amnesiacs disturbing and the alternative, anecdotally, was far more unpleasant than I think some people imagine. The experience that I remember doesn't bother me that much because that is my nature but I can't deny that I have vivid memories of it. I can easily imagine that many people would prefer to not have those memories. That said, I would likely elect to forego an amnesiac again if I thought it would inconvenience me (i.e. by making you useless for several hours). I can deal with the experience.
The only time I experienced it was for an endoscopy. Because I was a heavy drinker at the time (probably the reason for the symptoms that lead the the endoscopy, ironically) the intravenous sedation had little effect, so I was awake through the whole thing. I didn't find it traumatic, merely unpleasant, but I think other people might have. The local anesthetic at the back of my throat wore off after some time, so I was dry retching every few minutes. At one point they pumped air into my stomach so they could take a sample with a needle (which was in itself painless), and that sensation was also unpleasant.
So while I doubt people undergoing intravenous sedation during routine surgery are in extreme pain, they may be in very uncomfortable situations that most people would rather forget. Also if it had been effective, it would alter your state of mind as well, so that the immediate experience was less bad.
OTOH I regularly have a colonoscopy under heavy sedation, and never remember a thing.I know there are risks with any kind of sedation or anaesthetic, however anecdotally they've saved me a lot of trauma.
[1] (let's just say this was moving a camera in a....direction...against traffic)
As I understand it there's an increased risk of PTSD if people are chemically restrained, which is why some ITUs (but not in England) use physical restraints when needed.
This is a different use case from surgery, where these meds are useful.
To me, that (and experiments of Gazanigga etc) indicate that Jaynes was onto something with the "bicameral mind" theory, as crazy as it sounds.
It's a very odd feeling for sure. Nothing serious and I doubt it caused any damage, but it was the first time I'd ever just had a blank set of time that I just couldn't answer for. I did have family nearby though.
After a while I decided that I dont have month long seizures rather I have brief seizures in which I lose a month of memory.
For this and other reasons I am concerned I have a brain tumour. That would totally suck.
- You should definitely have imaging done to see if you can identify a cause.
- If you have seizures, you should definitely NOT be driving a car, for your safety and the safety of everyone around you
Please get this checked out immediately...
Instead, he should tell a family member or close friend right away. Then they can help him make the proper medical appointments, etc.
She had put it with my stuff then never mentioned it.
Mom is actually quite an intelligent woman but sometimes she can be a little daft.
Meanwhile, driving a car seam to be potentially dangerous.
Also sounds like he could have had a fugue state episode https://en.wikipedia.org/wiki/Fugue_state
Agreed, and psychogenic causation seems more likely (see my comment at the previous discussion https://news.ycombinator.com/item?id=9810025).
This seems to be yet another case of HN users upvoting dubious link-bait scientific press-releases. This particular one has been posted 3 times this week.
1. http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-n...
1. https://en.wikipedia.org/wiki/Preventable_causes_of_death#Ac...
2. http://journals.lww.com/journalpatientsafety/Fulltext/2013/0...
"With these latest revelations, medical errors now claim the spot as the third leading cause of death in the United States, dwarfing auto accidents, diabetes and everything else besides Cancer and heart disease."
Based on the findings of http://journals.lww.com/journalpatientsafety/Fulltext/2013/0...
It counts every death that could have been prevented by perfect care, not only harm caused by treatment in otherwise safe individuals.
For example, if someone with heart disease visits hospital and the hospital does not administer best known treatment protocol and the patient dies, that's a "medical error". But at root it is a heart-disease death. Same for cancer.
Some of the highlighted examples from the abstracts are extreme:
>>>
One example of a lethal error of communication between provider and patient occurred when cardiologists failed to warn their 19-year-old patient not to run. The patient had experienced syncope [fainting] while running, and 5 days of inpatient, diagnostic testing were inconclusive; however, his cardiologists knew he was not ready to return to running but failed to warn him against this risk. Having not been warned against running, he resumed running and died 3 weeks later while running.
<<<
The proper analysis is "what are your odds of survival when you choose to seek vs not seek care?"
For instance a family friend was told she had uterine cancer and was all set to start her doctor's protocol. But at the last minute wanted a second opinion from MD Anderson, the best cancer hospital in the world. After their team looked at her doctor's tests, they ordered their own test, and told her she had bladder cancer instead. They were dumbfounded how her doctor could have missed it, and that protocol would have certainly of led to her death, as bladder cancer treatment must be aggressive and fast.
Yet the only consequence her doctor faced was being told by her that two of MD Anderson's teams thought he was a dumbshit. Other than that, he'll keep on doing what he was doing.
Scouring the medical literature, he found five similar cases of mysterious memory loss without brain damage. Although none occurred during a trip to the dentist, they do seem to follow other periods of physiological stress during a medical emergency.
That doesn't prove that the anaesthetic isn't the root cause. The article title sounds link-baity.