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Being Conscious Under Anesthesia Is More Common Than We Thought, Shows Research

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Jun 1, 2022

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Image credit: Denise D'souza for The Swaddle

Anesthesia is notoriously complicated — not least due to the fact that there’s still much we don’t know about how it works. Complicated surgeries are nearly seamless procedures now thanks to general anesthesia that knocks patients out for the duration of the operation. A new study, however, shows how staying conscious even while being “put under” is much more common than we previously thought. To be awake during medical procedures is a terrifying prospect, which the research goes on to show is more common among younger and female-bodied patients.

Published last week in the British Journal of Anaesthesia, the study was among the largest of its kind. Conducted across 10 countries, it determined the prevalence of “connected consciousness” — a phenomenon related to people being aware of surroundings — in patients undergoing anesthesia. The research included 338 participants aged 18 to 40.

The thing about connected consciousness is that people don’t remember what happened after the surgery, when the anesthesia wears off. In the experiment too, nobody — save for one participant — was able to remember the commands after the procedure. Almost half of the participants, however, confirmed during the procedure that they had pain. Around one in 10 responded to instructions such as pinching the researcher’s arm if they could understand them, and squeezing twice if they were in pain while under anesthesia, Science Alert reported. Previous estimates suggested that the phenomenon occurred in 5% of the general population, but researchers confirmed a worrying suspicion that the actual proportion may be higher than that.


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“Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18–40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes,” the researchers wrote in their paper. In other words, people could feel pain at a time they were supposed to be numb.

Worryingly, connected consciousness was more prevalent in younger patients and in female patients: the latter, particularly, was three times more likely than others to experience it. But the researchers highlight the need to understand anesthesia better, and not to shy away from it. “The goal is not to discourage people from surgeries under general anaesthetic – it is very important to note that patients did not remember responding to the commands,” said senior author Robert Sanders.

As far back as 1999, researchers did have an inkling that female-bodied patients responded to general anesthesia differently — regaining consciousness three times as fast as male-bodied patients. “It shows that women have a higher chance of being aware during surgery than men, and indicates women may need significantly more anesthesia than men to keep them asleep,” said the study’s co-author at the time, highlighting the need to account for sex differences in administering anesthesia.

The study also found a potential way around this: administering the anesthetic continuously until intubation was found to reduce the chances of connected consciousness.

“There is an urgent need for further research on the biological differences, particularly sex, that may influence sensitivity to anesthetic medication,” Sanders added.

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Written By Rohitha Naraharisetty

Rohitha Naraharisetty is an Associate Editor at The Swaddle. Previously, she was a freelance writer and independent researcher working in the intersection of gender, social movements, and international relations. She can be found on Instagram at @rohitha_97 or on Twitter at @romimacaronii.

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