Anaesthetic awareness: what happens if you wake up during surgery?

One of the most disturbing cases of anaesthetic awareness I’ve handled involved a man who became conscious during surgery but was completely unable to communicate with the people operating on him.

He couldn’t move or speak. Eventually, in desperation, he deliberately passed urine, as it was the only way he could alert the surgical team to the fact that he was awake. He later spoke about his experience on ITV’s This Morning.

I’ve dealt with a number of anaesthetic awareness cases over the years. Understandably, people come to me wanting to be believed and to understand how it could have happened.

Sometimes they remember feeling pain. Sometimes they don’t. But being conscious and unable to let anyone know is terrifying in itself.

Anaesthetic awareness happens when someone becomes conscious during a general anaesthetic and later remembers something of the experience.

Fortunately, it’s rare. The Royal College of Anaesthetists estimates that around five patients in every 100,000 experience accidental awareness during general anaesthesia.

It doesn’t necessarily mean someone is fully awake throughout an operation. Awareness may last only a short time, and it’s more likely to occur as the anaesthetic is being started or towards the end of the procedure.

Some patients remember hearing conversations in the operating theatre. Others recall being touched or feeling pressure. Some experience pain.

What many find particularly distressing is the sensation of being paralysed, unable to move or call for help.

I remember a man who told me he’d woken up “in the middle” of an orthopaedic operation. He described his legs being moved around, from which our medical expert concluded that he might have become aware nearer the start of the procedure when he was being positioned prior to surgery.

People often assume that a general anaesthetic is simply a drug that sends you to sleep. In fact, there are several different things that an anaesthetist usually needs to achieve.

First, the patient must be kept unconscious. This is achieved using anaesthetic drugs given intravenously or through gases that are breathed in.

Second, pain needs to be controlled. Analgesics, often strong painkillers, are used for this purpose.

Third, most operations require muscle-relaxing drugs. These temporarily paralyse the muscles, making it possible for the surgeon to operate safely.

Not every general anaesthetic requires all three types of medication, and some drugs have more than one effect.

The important thing to understand is that a paralysing agent doesn’t make someone unconscious, and it doesn’t prevent them from feeling pain.

If the medication keeping the patient unconscious is insufficient, they may become aware of their surroundings whilst remaining paralysed.

This can happen because too little anaesthetic has been given, because its delivery has been interrupted or because the dose has had to be reduced for medical reasons.

In emergency surgery, for example, an anaesthetist may have to balance the need to maintain unconsciousness against the risk of dangerously low blood pressure.

Awareness doesn’t automatically mean that somebody has been negligent. However, there are cases where it happens because something has gone wrong with the administration or monitoring of the anaesthetic.

When I investigate a suspected case of anaesthetic awareness, one of the first documents I want to see is the anaesthetic chart.

It records the drugs administered and important observations made throughout the procedure, including the patient’s heart rate and blood pressure.

These records can sometimes help us piece together what happened.

Our bodies respond to surgical stimulation in ways we cannot consciously control. For example, heart rate and blood pressure may rise, even where the patient is unconscious.

If there is a sudden increase in both readings, particularly at a point that corresponds with the patient’s recollection, it’s something I would want an independent anaesthetic expert to examine.

But it isn’t proof that the patient was awake or felt pain. These changes can occur for other reasons, and someone can experience awareness without any obvious change in their observations.

The chart is only part of the evidence. We also need to consider the patient’s recollections, the drugs and doses administered, and any information about how the anaesthetic was monitored.

Sometimes the records help explain what happened. Occasionally, they raise more questions than they answer.

One thing I’ve learnt from dealing with these cases is that the absence of pain doesn’t necessarily make the experience any less traumatic.

For someone who has been conscious but unable to move, the feeling of helplessness can be deeply traumatic.

Patients may experience nightmares, flashbacks, anxiety or panic attacks. Some develop post-traumatic stress disorder (PTSD). Their confidence in medical professionals can also be badly shaken. The thought of needing another operation, even years later, may be extremely distressing.

And these difficulties aren’t always obvious to other people.

Someone may have recovered physically from their operation and appear perfectly well, whilst still struggling with memories of what happened. In the two examples I mentioned earlier, my clients went on to develop PTSD.

The psychological harm deserves to be taken every bit as seriously as a physical injury.

If you remember being conscious during an operation, tell your hospital team and ask to speak to an anaesthetist. Try to explain what you remember, even if the details seem strange or difficult to describe. It may help to write everything down whilst the memories are fresh. It’s important to let staff know this has happened as soon as possible after the procedure, so that they can take steps to help.

You should be given an opportunity to discuss what happened and, where appropriate, receive support for any psychological difficulties.

If you have already left hospital, speak to your GP or contact the hospital to request a review.

You can also make a formal complaint about your treatment. Our article about the duty of candour explains the circumstances in which healthcare providers must be open with patients when something goes wrong.

Yes, where it can be established that negligent care caused the awareness and resulting injury.

These claims involve careful examination of the anaesthetic records and independent expert evidence. Where someone has suffered psychological harm, we may also need an independent psychiatric assessment.

Compensation can reflect the distress and lasting psychological effects, as well as financial losses arising from the injury.

Our hospital negligence claims page explains how we investigate these cases and the support available.

The medical records and expert evidence matter, but so does the patient’s own account of what happened. Having been unable to make themselves heard during surgery, the last thing they need is to feel that nobody is listening afterwards.