Friday, February 11, 2011

The Face Behind The Mask: Part 5/5

This is our final Friday post with certified nurse anesthetist Kimberly Zweygardt. It's been a pleasure have her blog. I know I've learned several ways to increase the conflict in my OR scenes. What are some ways you'll add conflict? Comment contest is still in force. Leave the most comments this month and win a prize!

Finally, the complication that movie nightmares are made of: recall under anesthesia.
Recall under anesthesia is defined as remembering something while surgically anesthetized. The most common scenario involves the patient receiving muscle relaxants without enough amnesia and/or pain control provided. Some patients recall being in pain but unable to move while others have no pain but can remember things being said during the operation.
How can this happen?

Thirty years ago we had patients being told their heart wasn’t strong enough for anesthesia. With the advent of Open Heart surgery, anesthesia techniques changed that were safer for the heart, so we now operate on people who are on drugs that mask the normal response to pain. It becomes harder to asses if the patient is truly asleep if the heart rate and blood pressure don’t change related to pain.
And we also have what I call the “drive through” surgery phenomena. Surgery used to mean recovering in the hospital for several days. Now, you are dismissed within hours of the operation. Anesthetics must be shorter acting or patients not as deeply anesthetised during the operation so they will be safe to go home. I believe that is why recall is on the rise.
But we also must account for how we are fearfully and wonderfully made.
I read an interesting study that monitored depth of anesthesia and recall. Volunteers were anesthetized using an EEG to measure depth of anesthesia. They were not having surgery, but when they reached surgical depth of anesthesia, the anesthetist stood up and said, “There’s something wrong! They are blue! There’s something wrong.”
There was nothing at all wrong. They waited a period of time then woke the volunteer up. A small percentage spontaneously remembered that event and their fear. The rest were hypnotized to see if they recalled the event. A percentage became agitated, bringing themselves out of the trance at that point. The rest were able to recall under hypnosis what had been said during their anesthetic. What the study showed was that we are not just a physical body and though our physical body is anesthetised, our spirit may be aware of what is happening much like the near death experiences where the spirit hovers over the body.
I personally know of several incidences where a patient could not recall events in surgery but acted upon something said while they were asleep. Some were positive changes and others were tragic.
The BIS monitor was designed to prevent recall but it isn’t standard of care and only offers that most patients at a certain number are truly “asleep.” Even so, I am careful what is said in the patient’s presence.
But when it comes to fiction, I can think of several scenario’s to rachet up the drama and suspense related to anesthesia. How about you? 


Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information:


  1. Sometimes I forget that people who are reading this are not only writer's thinking of a plot point, but also patients themselves. Or the loved ones of a patient undergoing surgery.

    What I didn't say due to space/time concerns is that recall makes the news. No one wants to write about the hundreds of thousands of operations that go smoothly each and every day around the world. No one is interested in the patient who drifts off to sleep and wakes up pain free and comfortable...unless that patient is you or your loved one. So do not fear! Remember that the CRNA who is caring for you is doing just that....caring! We are your advocate in the OR so that your operation is so boring no one is interested in writing about it!

    But for the writer, looking for plot points, recall is an interesting scenario.



  2. Kim,

    Point well made. Thanks so much for the great work.

  3. This post was very interesting to read - especially about people remembering things under anesthesia. I had to undergo back surgery a few years ago and though I don't remember much, I do remember a few things directly before and after surgery, even while I was heavily sedated. Thanks Kimberly!

    ~ Katy

  4. Wow, back surgery. I hope you're fully recovered and doing well.

  5. Thanks Jordyn, yes I am. I think it's been close to 4 years now, and I am as healthy as ever. :-)