I wondered about this at one point. I'd been under full propofol sleep a couple of times due to knee operations, and the experience was quite interesting.
You fall out of consciousness insanely fast. One moment you're talking to the anaesthetist about your name, what you're there for. You feel a cool sensation where the needle is. Before it's grown to your whole arm, you've vanished. I mean you're not dreaming, you're gone.
The only way you know you were gone is that there's no sensation of time. When you sleep, you feel like there's time. Under propofol I felt like my arm was cold, then I was groggy and waking up. In one action.
Maybe it's like dying, I don't know. But there's definitely this "system was rebooted" sensation as you come back to consciousness.
I've only been under once, and it was the strangest thing: I had an out-of-body experience. When I woke up, it was like I had two sets of "memories" (for lack of a better word): one was nothing (like you describe), and the other was the OBE. I presume that I wouldn't have been able to notice the span "nothing" (because it didn't contain any time or space references as I can tell) at all if there wasn't a sort of parallel overlay of the OBE.
By the way, this hasn't led to me drawing any particular conclusions about the nature of reality or consciousness. I didn't find it useful to hold a particular set of beliefs about these things before the event, and that didn't change afterwards. If anything, it just presents more questions.
Early in residency, had a guy once that seemed “out” as normal during an operation. No abnormalities. In the recovery room claims he heard everything we were saying in the OR. We of course initially thought he was full of shit, but he quoted verbatim much of the chit chat the team was having (not that any of it was bad thankfully). This is very much not typical.
Reminds me when we had basic military medicine training and our officer told us to be extremely careful what we would say even while moving around people who seemed dead.
Hearing is the last sense that goes he said. The idea was to keep calm and not talk about how something was hopeless.
I'm not qualified to say if this is true but I keep getting reminded about it in different other settings.
I'm no neurologist, but I can picture a brain retconning the OBE as a reaction to the knowledge that time had passed when you didn't perceive that it did.
Yep, very plausible. Also, some parts of the brain would still be active, I wasn't brain-dead after all.
The OBE itself had some dream-like qualities, though one thing I did notice was that the "resolution" was superb, unlike my normal dreams. We're talking next-gen graphics. The closest thing I can compare it to is as if the entire field of vision was center of focus.
Sometimes I dream like that. It's the oddest bthing to dream something with the fidelity of, or even above, ones default conscious experience.
Clear enough to afterwards, even years later, be able to recall the exact color and texture of the floor tile glazing, just how a doorway arched, and precisely how a distinctly non human entity looked and acted.
Curiously, at least to me, it's primarily a profoundly visual experience. Sound, touch, and smell is rarely, if ever, prominent in those dreams. Maybe the clarity of vision somehow drowns them out, or maybe I simply don't dream much in sound, but it only becomes apparent when the visual experience is almost jarringly clear.
If you study lucid dreaming, more of your dreams will become like that. Extra real. You'll have to use "reality checks" to know whether it's a dream. That's usually how you wake up inside a dream to begin with, though. You'll be able to control some, too.
Lucid dreaming resources will teach you about all that. You'll probably enjoy it.
Incidentally, the brain retconning to fill in gaps is actually so mundane and common, you do it hundreds of thousands of times per day. See: https://en.wikipedia.org/wiki/Chronostasis
I read a book that talked about the electrical activity around the posterior parietal lobe in people who have religous experiences. That lobe seems to orient your body in space. Shut off it's inputs and maybe it thinks your body is one with everything, or floating in the air.
(Am not a neurologist)
How is this different from anesthesia? This pretty much sums up exactly my experience being under anesthesia, except it takes 3 seconds. They say count down from 10, and both times I thought, oh I'm gonna make it to zero for sure, and by 7, I'm gone. It feels like no time has passed and I'm waking up immediately.
Interestingly, you're probably awake for more than 3 seconds but experience propofol-amnesia. At least, I did: I spoke with my surgeon in post-op (and said embarrassing things) and he shared with me some other embarrassing things I'd said after I "blacked out" (count back from 10).
The amnesia was considered a benefit because it's not the case that you want to remember everything that happens immediately before surgery...
Both times I had surgery, I only remember counting down to maybe 7 while laying down, then waking up somewhere else entirely in a wheelchair, with no idea of how much time had passed in between. I wasn't told about things I might have said, embarrassing or not, either at the beginning or at the end. I hope I'll never get to ask for staff to make a mental note next time.
My ex, waking up from anesthesia, heard the surgeon chat to others about $chain (local supermarket), to which she yelled out of the blue, to their surprise and amusement, just "$chain sucks!". She had no recollection of that and only knows about it because they told her later. [The place is ridiculously expensive, worse than Whole Foods was before the Amazon acquisition.]
Correct. Going fully under would be general anesthesia, as opposed to deep sedation, which the paper describes. Propofol can be used for both purposes.
The only way I have a sense of time from sleeping is if I can recall a dream when I wake up. Otherwise the experience is identical: I remember going to sleep, and I remember waking up, but the space in between is empty -- no sense of time or anything.
It's identical to being put under general anesthesia via propofol or other amnesia-inducing substances.
Darkness/light are not the only clues you might have to how much time has passed.
Other clues may be sounds you hear around you -- like other people going about their business (making breakfast, talking, etc), or cars driving past. These clues might be registered by your subconscious, even when you're not consciously aware of them.
Another clue is how rested you feel. If you wake up feeling incredibly tired, you probably haven't gotten much sleep.
Yet another clue is temperature, as it tends to get colder at night and warmer during the day.
The smell of breakfast or coffee could give you a clue. How hungry or full you feel could be a clue, as could needing to go to the bathroom.
There are probably plenty of other clues as well. In the absence of such clues, I'm not sure how well one would be able to guesstimate time after being asleep.
Not propofol specific, as I'm not sure what I was administered, but "rebooted" is the best way I've found to explain it. I've only been put under once, and similarly for knee surgery.
After everything was prepped, my surgeon and I were chatting about something and the last thing I recall was the anesthesiologist putting the mask on me and saying "nemasu" (Japanese for "sleep").
There was no countdown, no drowsiness, no sleepiness -- I was just gone and then waking up post surgery. It felt as though no time had passed, but it had been hours. Completely and utterly trippy.
I've fainted a few times and that reboot experience was the same. It felt like the RoboCop boot sequence, you get sound and then vision that slowly returns.
> Before it's grown to your whole arm, you've vanished
I wonder about this bit though - I wasn't sure if I really had gone out that quickly, or if I talked for more time but just don't remember it.
After my operation I apparently woke in the recovery room and said some things (I heard the nurses talking about it afterwards) - but I have no recollection of it at all.
Also, you're spot on about the passage of time - when I finally woke and was actually lucid (well, fairly!), it really felt like no time had passed.
> I wonder about this bit though - I wasn't sure if I really had gone out that quickly, or if I talked for more time but just don't remember it.
Something about the sensation of returning felt like it was on the waking side of the experience, rather than the falling asleep side.
And because I did it twice I did see that the doctor had practiced it, it wasn't just smalltalk. He got me to do a biographical spiel because you tend to have one (grew up there, moved for uni, blah blah) ready. So when it came time to give it, I sort of vanished while talking about myself. No slurred speech like I was drunk, just sort of "oh shit I'm falling asleep" after maybe a couple of sentences, and then gone.
I can see why Michael Jackson might have liked it. It really does KO you super fast.
probably lots of reasons, but I can certainly see someone who's used to having anything they want at any time also wanting to be put to sleep (pardon the term) whenever they want as well. if all of your life is 'on demand', why wouldn't sleep be as well?
You can get addicted to propofol, and some people who self harm frequently and severely report the propofol as one factor for their continued self harm. (although it's often only one of many factors).
Arguably the most talented and most troubled child prodigy/musical genius of all time. Obvious trauma right off the top would be a childhood of physical/sexual abuse combined with an unprecedented level of early fame and success.
Were you under with propofol the whole time though? Usually the propofol is just to put you down (it is very short acting) you’re intubated, and then anesthesia is maintained with a volatile fluorane such as sevo.
Propofol-only deep sedation is commonly used for minor outpatient procedures. If you’re going to have a patient down for less than an hour for a colonoscopy or endoscopy, it’s a very popular alternative to combination sedation as patient recovery is faster and a lot more pleasant.
I REALLY dislike that feeling of not existing or blinking out that people describe, it causes me some substantial existential dread afterward.
So I resolved to have a colonoscopy without any anesthesia or painkillers. It wasn’t a big deal for me, it felt like having bad gas when the tube would go around a corner in the intestines, but the nurses acted like I was insane. The doctor had to come out and tell them it was fine. He said doctors have to experience a colonoscopy awake at least once so they know what it feels like, which I found interesting. Seeing what was in there was pretty interesting too. The American medical system acts like the smallest bit of discomfort warrants being knocked out. The anesthesiologist seemed a little put out about it too, as I refused to even let them give me an IV. Maybe he didn’t get paid if I wasn’t out.
It was funny afterward because someone had the job of escorting me to my ride, so we walked together to my car. Made the whole thing far less unpleasant in my estimation.
> The American medical system acts like the smallest bit of discomfort warrants being knocked out.
There is a tremendous variation in both pain tolerance and anxiety. You sound like you’re in the minority.
The anesthetist still gets paid. His concern is if you freak out (this happens more often then you may think), he may at minimum have paperwork to do and worse you may sue him for malpractice (“well he didn’t clearly explain it would be that bad during the consent process).. again this problem happens more than you may think. Ie the negative ev for them if you do not do the typical protocol is considerable.
I got the idea from reading about colonoscopy practices in Europe, for example only 6% of people in Finland underwent sedation during a colonoscopy [0].
I have to go for a colonoscopy in another two and a half years, and I’ll insist on no sedation that time as well. You seem familiar with the process, is there a way to avoid feeling like I’m having a fight with the staff next time?
No sedation is perfectly ok. No IV is a VERY bad idea. I would personally refuse to take care of you in that case, and many of my peers would do the same, I believe.
Finnish person here. It is difficult to understand why any normal person would need sedation for colonoscopy. Perhaps there are super sensitive persons, but for most it should not be much more painful than getting vaccination, at least if the doctor is skilled and doesn't just force the colonoscope in. However, drinking large amounts of liquid that does not taste that great, in order to empty the colon, was the hard part. Colonoscopy was nothing compared to drinking that liquid.
The anesthesiologist was scared because without an IV, if something happens he's instantly in deep shit. And you too, for that matter. Anesthesiologists don't care if you want your thing this or that way. Their only priority is maximal security.
He/she must have been really, really pissed by your IV refusal.
This is the experience I have on something called seroquel, in my case taken for sleep issues. It comes on more gently than propofol, but once I'm out then I'm out, and waking up in the morning is, about 90% of the time, like a time warp. Sadly, remembered dreams are exceptionally rare now.
Propofol is an anesthetic, seroquel is not... it’s an antipsychotic. The thing with antipsychotics is they’re shit or “dirty” drugs... seroquel is not even indicated for insomnia (and depending on who you ask is a terrible choice.. a lot of family med/internists use it, psychiatrists often cringe). It works because it has a strong antihistamine side effect, so it’s basically a very potent Benadryl.
The point being, you’re still arousable. A vigorous rub of the sternum will likely wake you up. Not so much on propofol.
I'm not sure what your point here is. I made no claim of 1-to-1 parity with propofol, the various uses of seroquel, it's efficacy for a given purpose, etc. Seroquel is however in the class of drugs "major tranquilizers" and my claim was simply that it can have a similar "time warp" effect. It's a claim based on my experience with it, and it is not an uncommon one. (And I do have experience with propofol through a single surgery to compare)
I will address some of the other details of your comment though. First, the statement that someone on seroquel is "arousable": Compared to propofol, sure. But a vigorous rub of the sternum will absolutely not do it for many people, myself included. My wife can attest to the difficulty. And if aroused before time, the state can be likened to severe drunkenness in terms of ability to function.
Also, your are right, there are arguably better sleep aid options. But it's arguable because individuals react so differently to different medications. Seroquel was not a first choice for the task, or the third. A doctor likely would be negligent in prescribing it for that sole purpose on a first consultation without exploration of other options.
As for it being a shit or "dirty" drug, there aren't particularly good options within this class of drugs. We can argue about whether these are over-prescribed, but for people who truly do need them, it is something of a devil's bargain where the benefits can be suspect relative to the costs. For the fortunate that response to them, newer medicines like latuda offer a much lower side-effect profile for similar benefits. Absent very good insurance though, that is financial hit of roughly $15,000 per year that few can afford out of pocket. This leaves the "dirty" drugs.
I won't put words into your mouth with this next part, but there are some that would then argue that these sorts of drugs are universally unsuited for any use, and that people suffering from their targeted disorders might better control their symptoms with diet, exercise, and supplements. Having seen many people attempt such and fail, I regard this point of view as a sort of survivors bias. The people that argue this point of view tend to be the very rare people for whom it works, but just as with any particular medication, the efficacy of any treatment regime varies greatly with the individual.
I tried to keep my statements factual and my own opinion out of it.
While “shit” was a bit tongue in cheeky the term “dirty” is used among practitioners because of the wide range of metabolic side effects that the atypical psychotics have. Seroquel is a metabolically “dirty” drug. Taken in therapeutic doses long term a high percentage of people will end up with metabolic syndrome derangements.
Likewise, in the US and Canada, is not indicated for sleep disorder/insomnia use either. In Lexicomp it’s not even listed for off-label use. That’s just a fact, I don’t know what you’re trying to convince me of. In the US there is also a storied history with Astra-Zeneca and a lawsuit due to their practices of pushing off-label use resulting in a $.5 billion settlement.
Another fact is that Seroquel was one of the most heavily marketed drugs ever to primary care providers. As my 100s of dollars of Seroquel branded swag my office accumulated 15 or so years ago will attest to (I am not a psychiatrist).
My own personal experience has been that most psychiatrists I’ve spoken to at a large academic center, are appalled at the idea of using seroquel for insomnia long term due to serious side effects and the consensus is that it’s MOA is mostly due to its antihistamine property. That’s really all I was saying.
Also most atypicals are not highly sedating, lurasidone especially so. I have not heard of it seriously being mentioned likely for primary insomnia.
You seem to have an axe to grind against Seroquel. I don't fault you for it. I hate it. I wouldn't take it if I hadn't explored other options to their exclusion. In my case I take it both for sleep issues and because it's on-label and effective as an adjunctive treatment for other health issues.
Otherwise I wasn't referencing lurasidone for it's sedative properties (it can have the opposite effect) but in comparison with Seroquel for it's use on-label as an antpsychotic. Sorry if there was confusion there. It's a much better option than Seroquel, if it happens to work for you. It doesn't always.
I absolutely love the transition of propofol sedation. It's like the moment you dive into your pillow after a very, very long tiresome day. Where sleepiness feels more than justified, and you're allowed to follow.
Weird thing, I always start to talk English (German native speaker) while drifting away. Since I was a little ashamed of that, I once told the technician beforehand and he replied it's quite common and a known observation.
This happened to me when I had general anesthesia with propofol a few days ago. I am a Norwegian native speaker, but when I woke up on the operating table I spoke English to the nurses for 2-3 minutes. They pointed out to me several times that I was speaking in English, but at first I wasn't really able to switch to Norwegian. Don't know why. I was quite groggy and elated and told them a few quite private things which are now a bit embarrassing to think about, all in English.
When I finally switched to Norwegian they seemed pleased and left me alone.
I’m wondering what exactly is the commonly observed effect. Is it that English specifically dominates over any language? Or is it the 2nd language, whatever they may be, that surfaces?
I hypothesize a foreign language might require some mental effort and isn't accessed the same as the native language. The fading consciousness might lose a native language sooner, maybe.
N=2, but I've apparently talked in my (very poor and broken) Japanese while going out before. It's just sort of gobbledegook of whatever thoughts are going across your brain apparently.
Had propofol a few years ago when I went in to get some kidney stones blasted out. Can confirm what others are saying. They inserted the needle and a few seconds later I went from fully conscious to waking up at the end of the procedure with no recollection of time having passed, as if someone toggled my power switch off and on. When I came to, I was babbling incoherently to the nurses for a minute or so, but after that I was fully awake and felt as if I had just woken up from the best, most restful sleep I'd had in a very long time; it was a very pleasant feeling.
Yip. Can concur. Went in once during the first emergency episode and woke up feeling strangely tranquil. Happy is the only word I’d use during a time of my life riddled with chaos and uncertainty.
I went under a second time for the removal of the stent and used this second experience to confirm that it was indeed the anesthetic that confers this happy feeling post op.
I wouldn’t wish kidney stones for my worst enemies though. That pain is horrible.
If you trigger memories in a PTSD patient and then knock them out with propofol, you may disrupt the long-term storage of those memories or even create a window in which they can be changed. It's Eternal Sunshine of the Spotless Mind, essentially.
Am I understanding correctly that they found they can give you this chemical and then if you experience negative things you won’t remember them (or you will but without negative connotations)?
When I was doing my anaesthetics terms we used more than just propofol. We used a cocktail for various effects. Propofol to knock you out. Volatile gas to keep you under. Opioid (usually fentanyl) so you don't feel pain. Suxamethonium to relax your muscles. Benzodiazepine (e.g. midazolam) so you don't remember anything.
Of course it's more complex than that since most of those also make it easier to keep you under.
I am amazed we somehow found out about all these concoctions. They seem to go so far from the norm without killing you. How are they engineered in the first place?
My moment was not propofol but another medicine for nausea/vomit - it worked in seconds just when I had resigned myself to throw up. I was shocked. How?
Usually nausea is caused by the perception that your body "doesn't feel right." Serotonin is responsible for the feeling of wellbeing. Just so happens that subreceptor 3 is more about well being feeling of the body :-)
After a surgery I temember waking up in the recovery room, suffocating (or whatever you call it when you can't breathe), asking for my regular drugs, hearing my doctor telling it was all ok during my surgery, and sleeping again.
It’s not an analgesic (drug that reduces pain), but it’s true that if you give enough propofol, you will be so unconscious, you won’t feel pain.
Sometimes, anesthesiologists will give opiates so that you don’t wake up abruptly in pain, or give benzodiazepines so you feel less anxious afterwards.
Depends on what they did - if you had a dislocated shoulder, the pain is much less once it has been ‘reduced’ (Put back), so you probably wouldn’t have (too) much pain, relatively speaking, once you wake up. But if someone just cut open your abdomen, you will have lots of pain on waking, so makes more sense to give some opiate beforehand, to make your wake-up ‘nicer’.
Propofol also tends to lower your blood pressure a lot, so some docs feel you can get the same level of sedation with less low blood pressure by giving a bit of benzodiazepines + propofol
After propofol I came to mid-sentence. I immediately asked how long I’d been talking, as I had zero recollection of being awake or talking, and was told I’d been telling jokes non-stop for the last 5 minutes. When I say I have no memory of that, I mean like I have no feeling I even existed in the period between telling the doctor I was going under up until I apparently woke and was well into my spontaneous comedy routine.
Psychiatry is undergoing a phase change, what with esketamine[Spravato]/ketamine and now propofol[Diprivan] becoming part of everyday practice. Look for MDMA and psilocybin to join them in the near future.
My mother is a nursing assistant at a hospital. She's in the gastro wing where they do endoscopies and colonoscopies, most times with propofol sedation.
This stuff is true. She tells me people often experience discomfort and pain, and even complain during the examination (they don't go completely unconscious), but after they've woken up, they don't remember it! They may have some lingering pain, but they don't feel bad about the examination. The doctors say it went well, and they believe it.
This is interesting. A number of drugs are thought to function similarly from an interesting mix of classes such as propranolol (a beta blocker) and even steroids like dexamethasone.
Propofol sedation is a pretty big proposal for something like this so they'd need a comparative effectiveness trial I think.
Imagine what you could do with soldiers if you gave them this every night. I imagine it'd also work wonders on political dissidents: just keep interviewing and drugging them until they can't remember their anger.
This is a truly magnificent achievement for all mankind.
And how great the effect is. If you recruited only 5 healthy humans at random and administered a new drug and 100% of them died instantly, you can probably make some useful predictions.
Yes, and the effect was tiny. See the caption in figure 2 for a summary:
Scores (percentage) for each story per group:
group A (n = 25 participants) reactivated mean (SEM) = 53.49 (2.29);
nonreactivated mean = 59.20 (2.60);
group B (n = 24 participants) reactivated mean = 59.52 (1.97);
nonreactivated mean = 61.19 (2.11).
That's 6.03% difference between the groups on reactivated means and 2% on the nonreactivated means. Each group was 25 people.
What's the predictive power of this? What's the explanatory power? What did we learn? That 25 people reacted a little differently than 25 other people on a test after the same drug was administered and some more time elapsed between the times when the two groups took the tests.
There's nothing to see here.
Edit: Btw, both groups received endoscopy and midazolam or phenylpiperidine derivatives- so not only the effect measured was small it was also not possible to clearly attribute it to propofol, rather than the endoscopy or the additional drugs administered.
My comment used a hypothetical toxicity study where 100% of people died instantly as an example of a very large effect size. It did not address the Propofol sedation study.
You fall out of consciousness insanely fast. One moment you're talking to the anaesthetist about your name, what you're there for. You feel a cool sensation where the needle is. Before it's grown to your whole arm, you've vanished. I mean you're not dreaming, you're gone.
The only way you know you were gone is that there's no sensation of time. When you sleep, you feel like there's time. Under propofol I felt like my arm was cold, then I was groggy and waking up. In one action.
Maybe it's like dying, I don't know. But there's definitely this "system was rebooted" sensation as you come back to consciousness.