HOW LONG WILL IT TAKE ME TO WAKE UP FROM GENERAL ANESTHESIA?

One of the most frequent questions I hear from patients before surgery is, “How long will it take me to wake up from general anesthesia?”

The answer is, “It depends.”

Your wake up from general anesthesia depends on:

1. What drugs the anesthesia provider uses
2. How long your surgery lasts
3. How healthy, how old, and how slender you are
4. What type of surgery you are having
5. The skill level of your anesthesia provider

In best circumstances you’ll be awake and talking within 5 to 10 minutes from the time your anesthesia provider turns off the anesthetic. Let’s look at each of the five factors above regarding your wake up from general anesthesia depends on:.

1. YOUR WAKE UP FROM ANESTHESIA DEPENDS ON WHAT DRUGS THE ANESTHETIST USES. The effects of modern anesthetic drugs wear off fast.

• The most common intravenous anesthetic hypnotic drug is propofol. Propofol levels in your blood drop quickly after administration of the drug is terminated, resulting in rapid awakening.
• The most common inhaled anesthetic drugs are sevoflurane, and nitrous oxide. Each of these gases are exhaled from the body quickly after their administration is terminated, resulting in rapid awakening.
• The most commonly used intravenous narcotic is fentanyl. Fentanyl levels in your blood drop quickly after administration of the drug is terminated, resulting in rapid awakening.
• The most commonly used intravenous anti-anxiety drug is midazolam (Versed). Midazolam levels in your blood drop quickly after administration of the drug is terminated, resulting in rapid awakening.

2. YOUR WAKE UP FROM ANESTHESIA DEPENDS ON HOW LONG YOUR SURGERY LASTS

• The shorter your surgery lasts, the less injectable and inhaled drugs you will receive.
• Lower doses and shorter exposure times to anesthetic drugs lead to a faster wake up time.

3. YOUR WAKE UP FROM ANESTHESIA DEPENDS ON HOW HEALTHY, HOW OLD, AND HOW SLENDER YOU ARE

• Healthy patients with fit hearts, lungs, and brains wake up sooner
• Young patients wake up quicker than geriatric patients
• Slender patients wake up quicker than very obese patients

4. YOUR WAKE UP FROM ANESTHESIA DEPENDS ON WHAT TYPE OF SURGERY YOU ARE HAVING

• A minor surgery with minimal post-operative pain, such a hammertoe repair or a tendon repair on your thumb, will lead to a faster wake up.
• A complex surgery such as an open-heart procedure or a liver transplant will lead to a slower wake up.

5. YOUR WAKE UP FROM ANESTHESIA DEPENDS ON THE SKILL LEVEL OF YOUR ANESTHETIST

• Like any profession, the longer the duration of time a practitioner has rehearsed his or her art, the better they will perform. An experienced pilot is likely to perform smoother landings of his aircraft than a novice. An experienced anesthesiologist is likely to wake up his or her patients more quickly than a novice.
• There are multiple possible recipes or techniques for an anesthetic plan for any given surgery. An advantageous recipe may include local anesthesia into the surgical site or a regional anesthetic block to minimize post-operative pain, rather than administering higher doses of intravenous narcotics or sedatives which can prolong wake up times. Experienced anesthesia providers develop reliable time-tested recipes for rapid wake ups.
• Although I can’t site any data, I believe the additional training and experience of a board-certified anesthesiologist physician is an advantage over the training and experience of a certified nurse anesthetist.

YOUR WAKE UP FROM ANESTHESIA: EXAMPLE TIMELINE FOR A MORNING SURGERY

Let’s say you’re scheduled to have your gall bladder removed at 7:30 a.m. tomorrow morning. This would be a typical timeline for your day:

6:00            You arrive at the operating room suite. You check in with front desk and nursing staff.

7:00             You meet your anesthesiologist or nurse anesthetist. Your anesthesia provider reviews your chart, examines your airway, heart, and lungs, and explains the anesthetic plan and options to you. After you consent, he or she starts an intravenous line in your arm.

7:15             Your anesthesia provider administers intravenous midazolam (Versed) into your IV, and you become more relaxed and sedated within one minute. Your anesthesia provider wheels your gurney into the operating room, and you move yourself from the gurney to the operating room table. Because of the amnestic effect of the midazolam, you probably will not remember any of this.

7:30             Your anesthesia provider induces general anesthesia by injecting intravenous propofol and fentanyl, places a breathing tube into your windpipe, and administers inhaled sevoflurane and intravenous propofol to keep you asleep.

7:40            Your anesthesia provider, your surgeon, and the nurse move your body into optimal position on the operating room table. The nurse preps your skin with antiseptic, and the scrub tech frames your abdomen with sterile paper drapes. The surgeons wash their hands and don sterile gowns and gloves. The nurses prepare the video equipment so the surgeon can see inside your abdomen with a laparoscope during surgery.

8:00            The surgery begins.

8:45             The surgery ends. Your anesthesia provider turns off the anesthetics sevoflurane and propofol.

8:55             You open your eyes, and your anesthesia provider removes the breathing tube from your windpipe.

9:05             Your anesthesia provider transports you to the Post Anesthesia Care Unit (PACU) on the original gurney you started on.

9:10            Your anesthesia provider explains your history to the PACU nurse, who will care for you for the next hour or two. The anesthesia provider then returns to the pre-operative area to meet their next patient. Your anesthesia provider is still responsible for your orders and your medical care until you leave the PACU. He or she is available on cell phone or beeper at all times. No family members are allowed in the PACU.

10:40            You are discharged from the PACU to your inpatient room, or to home if you are fit enough to leave the hospital or surgery center.

YOUR WAKE UP FROM ANESTHESIA . . . TO REVIEW:

1. Even though the surgery only lasted 45 minutes, you were in the operating room for one hour and 35 minutes.
2. It took you 10 minutes to awaken, from 8:45 to 8:55.
3. Even though you were awake and talking at 8:55, you were unlikely to remember anything from that time.
4. You probably had no memory of the time from the midazolam administration at 7:15 until after you’d reached in the PACU, when your consciousness level returned toward normal.

The Anesthesia Patient Safety Foundation (APSF) published an article titled, “How Long Does It Take to Wake Up From Anesthesia?”  In this reference, the APSF writes, “It is not uncommon for some patients to experience a delay in waking up from anesthesia. This is called delayed emergence. This typically occurs when it takes longer than 30 to 60 minutes for a patient to regain consciousness, depending on the procedure. In some instances, medications may be administered to promote wakefulness. These counteract the residual effects of the anesthetics used during surgery.” I would agree that delayed emergence can exist, although the etiology is almost always related to the points I’ve made above. An experienced anesthesiologist will be able to wake a patient promptly.

A website named AnesthesiaExperts.com has copied and reposted the article I’ve written above. The link is here. While I’m flattered that they value my writing, they neither asked for my permission nor corresponded with me prior to doing so.

Anesthesiologist Max Feinstein posted a video titled, “What are the odds of not waking up from anesthesia.” 

This is not an uncommon fear that patients have. Let me reassure you that patients who do not wake up from anesthesia–that is patients who die on the operating room table–are very rare, and most every instance this will be due to either: a) a patient who has a serious acute problem regarding their heart, lungs, brain, kidneys, liver, or coagulation system; b) a patient who is undergoing a high risk surgery such as a cardiac, neurosurgical, thoracic, trauma, or major vascular procedure; or c) the anesthesia professional makes a profound, negligent mistake.

Be reassured, anesthesia in the 21st century is quite safe. If you choose a reputable hospital or surgery center with a well-qualified anesthesia staff, you can expect to walk out of the facility alive. I refer you to my column, “How Safe is Anesthesia in the 21st Century?” for further information.

I also refer you to a related column AN ANESTHESIA PATIENT QUESTION: WHY DID IT TAKE ME SO LONG TO WAKE UP AFTER ANESTHESIA?”

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