The Wake-Up

One attending once told me, "You'll learn how to put someone to sleep in the first month of residency, but you'll spend the rest of the time learning how to wake someone up." Not to worry; waking a patient up is not hard, but perfecting the art is an immensely satisfying challenge. As I near the end of the case, I account for a dozen interacting factors: how quick the surgeons are to close, how much anesthetic the patient has received, how they are breathing; whether they will be in pain or feel nausea. And I've started getting the hang of that perfect wake-up: when the drapes come down, I whisper the patient's name, and she wakes up. The breathing tube comes out without any coughing, and within a minute, she's able to say she feels comfortable. Achieving that in a morbidly obese patient, a chronic pain patient, a long complicated surgery with blood loss, or a highly nauseating surgery can be very satisfying. In trying to reach this goal, I've come to respect multimodal pain and nausea management by using medications that act on several different receptors. I've also come to appreciate the difficulty of predicting how each patient will respond to an anesthetic. Nevertheless, with time, I've had fewer premature or prolonged wakeups, more comfortable and awake patients, less confusion and delirium, and more satisfying days.