Waking up from anesthesia can be a strange and potentially scary experience. As the drugs wear off, you may feel disoriented, confused, nauseous, or emotionally volatile. Your memories of this time are often hazy or nonexistent. Here we’ll explore what typically happens when you regain consciousness, why memories are elusive, and how you can make this transition a little easier.
What is it like to wake up?
Emerging from general anesthesia is a gradual process marked by several distinct stages:
- During anesthesia, you are in a controlled, reversible coma. Your brain is dampened down and you are completely unconscious.
- As the anesthetic drugs wear off, you enter an excited, delirious phase. You may talk nonsense, thrash around, or even scream.
- Next is a period of confusion. You are awake but disoriented, with impaired thinking and judgement.
- Finally you transition to full consciousness. Your memory kicks back in and you are aware of your surroundings.
The entire process usually takes anywhere from 10 minutes to a couple hours depending on factors like your age, health, type of surgery, and medications used. The delirious excited phase is shortest, lasting just a few minutes. The confused period is longer, potentially a few hours until the anesthesia is completely eliminated from your system.
Why don’t people remember this stage?
There are several reasons coming out of anesthesia is such an elusive memory:
- General anesthesia drugs impair memory formation. They prevent memories from being encoded or stored in the brain.
- The excited/delirious behavior occurs when you are not fully conscious. You lack awareness and cannot form memories.
- Confusional arousals are generally not incorporated into long-term memory. Your brain is awake but not recording.
- Memories are state dependent. Recalling events is easiest when you are in the same mental state as when they occurred.
- Delirium causes amnesia. The muddled mental state interferes with memory processing.
In essence, either your brain is too impaired to record memories during this transitional time, or your state of consciousness is too altered to easily access the memories later.
Risk factors for awareness under anesthesia
In very rare cases, people report some awareness with recall while under anesthesia. Their memories range from vague impressions to very lucid recollections of conversations or procedures. The incidence of awareness is about 1-2 per 1,000 patients, with risk factors including:
| Risk factor | Explanation |
|---|---|
| Light anesthesia | Inadequate anesthetic depth prevents complete unconsciousness. |
| Younger age | The developing brain may be more resistant to anesthetics. |
| Substance abuse | Chronic drug or alcohol use increases anesthetic tolerance. |
| Surgical stimulus | Painful or stimulating procedures can rouse the brain. |
| Intravenous anesthetics | Faster clearance can lead to premature awakening. |
| Medical conditions | Some disorders make arousal more likely during surgery. |
Awareness is more likely with certain types of surgery, such as cardiac and emergency procedures where lower anesthetic doses are used. Risk is greatly reduced by monitoring brain activity and using multiple drugs that work via different mechanisms.
Preventing awareness under anesthesia
Anesthesiologists take many precautions to avoid intraoperative awareness including:
- Adjusting drug doses based on individual factors like weight, age, and health.
- Mixing medications that work in different ways for a stronger effect.
- Monitoring vital signs closely for signs of light anesthesia.
- Using brain activity monitors to gauge anesthetic depth.
- Avoiding muscle relaxants unless necessary so the patient can move if feeling pain.
- Communicating reassurance to the patient during surgery in case any awareness occurs.
With current monitoring standards, anesthesia awareness is exceedingly rare during elective surgery. But anesthesiologists remain vigilant to prevent this traumatic experience.
Physical sensations while waking up
As anesthesia wears off, you may experience a variety of common physical sensations:
- Dry mouth – From oxygen therapy and breathing tubes
- Sore throat – From intubation equipment
- Dizziness – From anesthetic effects and lying still
- Shivering – From medication side effects and low body temperature
- Nausea – From anesthesia, motion sickness, and opioid pain meds
- Muscle aches – From lying still and endotracheal tubes
- Fatigue – From the stress of surgery and drugs
- Headache – From anesthesia, dehydration, or caffeine withdrawal
All these feelings are normal and expected after anesthesia. Staying warm, hydrating, and resting will help you recover. Let your care team know if any symptoms seem excessive or prolonged.
Tips for an easier recovery
While individual reactions vary, you can take steps before and after surgery to smooth the wake-up process:
- Talk to your anesthesiologist about any previous difficulties, awareness, or severe nausea and vomiting.
- Disclose any prescription, over-the-counter, herbal, or recreational drug use. These can interact with anesthesia.
- Stop smoking, as nicotine hampers anesthesia and healing.
- Adjust medications as instructed to avoid interactions.
- Rest and hydrate well before surgery day.
- Have a family member or friend with you for comfort when you wake up.
- Use relaxation techniques – deep breathing, meditation – while going under and waking up.
- Focus on pleasant images or music as you are regaining consciousness.
- Use anti-nausea medications as prescribed if you have a history of post-op nausea.
Let your care team know your preferences, such as having warm blankets available, wanting to wake up slowly without stimulation, or needing extra anti-nausea care. They can tailor your treatment to your needs.
Coping with upsetting memories
For the small number of people who do recall their time under anesthesia, these memories can be troubling. Strategies for managing trauma include:
- Seeking counseling to process the fear and anxiety.
- Trying relaxation, mindfulness, or grounding techniques when memories intrude.
- Avoiding obsessive thoughts by staying focused on the present.
- Talking through what happened to help integrate the memory.
- Using medication if anxiety or PTSD symptoms are severe.
- Writing down thoughts and feelings about the experience.
- Knowing the event was temporary and cannot physically hurt you now.
Support groups can also provide connection with others who understand. With time and coping skills, distress over anesthesia awareness usually fades.
When to be concerned
As you wake up from anesthesia, focus on your care team’s instructions. Let them know right away if you experience:
- Difficulty breathing or severe shortness of breath
- Chest pain, tightness, or pressure
- Severe nausea, vomiting, or headache
- Excessive pain, swelling, or bleeding at incision sites
- Confusion or agitation that persists more than a few hours
- Inability to wake up or be aroused
- Seizures or muscle jerking motions
- Weakness, numbness, or paralysis
Report any reactions that seem extreme or abnormal from what you were told to expect. Well-managed anesthesia side effects should steadily improve over the first 24 hours.
Conclusion
Waking up pleasantly from anesthesia involves the collaborative efforts of your whole medical team. With proper procedures, monitoring, and post-op care, the transition to full consciousness can progress smoothly. While confusing memories are common, true awareness under anesthesia is very rare. Focus on following recovery instructions and communicating any distressing symptoms or experiences. With preparation and vigilance, the wake-up process is usually uneventful and simply forgotten.