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No Sedation
Staying Awake During Surgery

Some paitents are now choosing to stay awake during surgery. The hip joint is anaesthetised but no sedation is given. Here Zoë Sprake gives us her first hand account of staying awake during surgery.

The Anesthesic

Zoe Sprake

Knowing that I was going to have a spinal anaesthetic, I asked for a minimum of sedation and preferably none at all. Neither the surgeon nor the anaesthetist had any objection as long as all was going well. I wrote down all I could remember of the operation as soon as I went home, and here it is -

When I was taken downstairs, I had a cannula put in my hand and a small amount of antibiotic put in. As there was no reaction, the rest went in a few minutes later. I sat on my bed with the operating table in front of me and leaned forward. I was warned that the antiseptic spray would be very cold, but I still squeaked.

A few moments later I mentioned that it continued to feel colder - it had an alcohol base, apparently. I was given another spray which wasn't quite as cold. Then I felt a sharp prickle in my back and I was told that the anaesthetic was being injected, and then I moved on to the operating table - I was able to do it myself with some support because it was awkward - and lay down again (I'm doing my best to remember this exactly, but may not get it 100%) and the anaesthetist pinched me below my waist and asked if I could feel it, I said I could. Then he asked if I could feel his fingers on my thigh. I said I could feel a touch. He told me he'd given quite a sharp pinch. My legs were becoming very heavy. When asked, I said that it felt that I'd cycled too far and fast, and that my muscles were tired and wobbly. They continued to feel heavy.

Two nurses came to fit a catheter and I wondered how they were doing it without moving my legs. When they moved aside, I saw that my legs were bent at the knee and apart, but they still felt as if they were in contact with the operating table. It was then 11.45.

Surgery with No Sedation

The surgeon came and chatted to me, looking very cheerful, and we confirmed what was happening regarding the spinal anaesthetic and my wish for no sedation. I was given an oxygen mask, can't remember what if anything else and I was wheeled in soon after noon. I'd been laid on my side. I was greeted by a cheery operating team. A blue sheet was put up to separate me and the anaesthetist from the others.

We chatted. "You'll hear hammering, and you'll feel it, but it won't hurt." There were quiet voices from the other side of the sheet but I didn't make much out of what was said. Then I heard the buzz of a saw. It was so peculiar to know that my femur was being sawn through, although the thought didn't bother me at all. It was not as loud as I'd expected, nor did it last as long. My blood pressure, heartbeat and breathing were being monitored, of course. I'd watched the machine for a while in the other room and would quite like to have kept an eye on it now, but I couldn't see it.

monitoring

We talked about the operation some more and he said I was doing well. I was calm and relaxed. He said that I might not get it because of the mask, but if I could smell burning, it was because some cauterising was being done to minimise bleeding. "I can smell it now," I said a few moments later. It smelled of bone rather than flesh.

I felt hammering. It was just like when you hold a fence post and someone bangs it into the ground - hard thumps that go right through you but are not painful at all. More hammering. Then he started reattaching everything, so there were just quiet voices again. The anaesthetist spoke to them every few minutes and relayed any useful information to me, without describing the actual scene. "Now you're being closed up. He's using glue, so you won't have to have stitches removed".

I heard someone say that I'd lost 350ml of blood, which they seemed pleased about - that it wasn't more, of course, I mean.

Then the surgeon appeared by my side as the screen was taken down, saying it had all gone very well and he'd see me in a few minutes. As I'd been moved from my side to my back, I noticed that the top of my thigh was pale flesh but then it suddenly turned very pink, unnaturally so (of course, that was some sort of sanitising liquid, not my flesh colour at all). Now, I only had a stocking on my unoperated leg and my paper pants were gone. It was a bit late, but I felt self-conscious. I still wore a gown of course and soon had a blanket put over me. I felt that my legs were cold, but I touched them and they were warm.

Back on My Feet

I was wheeled into the recovery room and noticed it was 1.15. My legs still felt as heavy as ever. I was asked if I could wiggle my toes yet. I tried and couldn't. I tried harder and moved my feet, but the surgeon, who had followed us, pointed out that I was doing it with my whole leg from the waist, not wiggling toes at all.

He left, and so did the anaesthetist, once he was happy that I was all right. He told me I was unique to him in having no sedation for a total hip replacement, and that he could see I was as relaxed as I said I was, from my vital signs.

I was there about an hour and finally could twitch my toes and was taken back to my room. My legs still felt cold and heavy and continued to do so for some time, although sensation gradually returned. Later, I was asked if I'd like to try to get up. I was helped to sit and moved to a sitting position on the side of the bed. I admitted that I felt woozy, but said I'd like to stand. I slid my feet down to the floor and put my hands on a frame, that had been adjusted to my height that morning, and stood. As I felt dizzy, it was agreed that I'd better not try walking, but if I wanted to try walking on the spot I could. I did so and it all seemed to work, although it felt odd in a way I can't now remember. I said I'd better get back on the bed before I fainted and I was helped back into bed where I felt warm at last and quite comfortable. I felt faint and had low blood pressure several times in the next few days, although I felt perfectly well in every other respect.

Zoë Sprake is a hip replacement patient who blogs regularly about her life and family at http://razorbladeoflife.blogspot.com/




Related Links: 

Preparing for Surgery 
Anesthetics 
Preparing for Recovery

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