One of the first things David Biber remembers is feeling things moving around in his knee. He felt the plastic mask on his face. He looked at his arm. A needle, attached to an IV bag, punctured his skin. He glanced at his knee, the one on which the surgeons were operating. “I saw what appeared to be surgical forceps and other things sticking out of my leg,” says David, 61, of Dana Point, California. “It was very unsettling.”
His fight-or-flight instincts took hold. He pulled off the mask and reached toward the needle in his arm to pull it out. “When I sat up and looked around, I think the doctor hit me real hard with that anesthesia,” says David. “I remember him looking like a deer in the headlights, and I said something to the effect of ‘I told you.’ ”
What David had told the doctors before this procedure in 2005 was that he tends to wake up during surgery. “Make no mistake: You’re going to have a mess on your hands if I get up and start moving around,” he’d warned.
David first realized that anesthesia had little effect on him in 1972, when he required a dozen surgeries after a near-fatal car accident. During one operation, he recalls hearing the muffled sounds of a conversation. He also says he’s been aware during a colonoscopy and cataract surgery when he was supposed to be fully sedated.
Episodes like David’s are, thankfully, rare. An estimated one of every 1,000 patients who undergoes general anesthesia experiences “intraoperative awareness.” For most, it results in only a vague memory of the procedure. But in one study of 19 patients who had some awareness during surgery, seven felt pain at the incision site or from the breathing tube.
Certain people are at higher risk, says Daniel Cole, MD, a member of the American Society of Anesthesiologists. They include those with a genetic resistance to anesthetics (redheads, for instance, thanks to an otherwise harmless genetic mutation) and those who have “acquired resistance” from regular use of alcohol, pain medication, or exposure to sedation medication from previous surgeries. While David will never know for sure why he wakes up under anesthesia, he does fit the profile: He was born with red hair (which has since turned white) and has undergone numerous surgeries.
He’s now understandably reluctant to get deep sedation. A few years ago, when he needed surgery to remove lingering scar tissue (caused by injuries sustained in the car accident) from his eyebrow, he opted for local instead of general anesthetic.
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