3 signs you're AWAKE in surgery (and what to do)
Even under anesthesia, your body may signal that it’s awake
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3 Signs You’re Awake in Surgery (and What to Do)
Being awake during surgery - medically known as anesthesia awareness - is rare, but it is a real and well-documented phenomenon. Understanding how anesthesia works, how awareness is detected, and what patients can do to reduce risk can help improve surgical safety and peace of mind.
In this video, I explain three signs your body may signal awareness during surgery, even when you cannot consciously speak or move.
1. Autonomic Nervous System Changes
When anesthesia is insufficient, the body may activate its stress response, controlled by the autonomic nervous system. This can cause changes in heart rate, blood pressure, skin blood flow, breathing patterns, and oxygen saturation. Monitoring tools such as pulse oximetry and carbon dioxide measurements help anesthesiologists detect these stress signals early. Certain medications - especially heart rate or blood pressure drugs - can mask these signs, which is why anesthesia must be individualized.
2. Subtle Body Movements
Even under general anesthesia, the nervous system may produce small, involuntary movements or muscle tension if anesthetic depth is inadequate. These movements are not conscious actions, but they provide important feedback to the anesthesia team about the body’s response to surgery.
3. Psychological Stress and Trauma
In rare cases, anesthesia awareness can contribute to long-term psychological stress or PTSD. Research shows that the nervous system can store traumatic experiences even without full conscious memory. I discuss how the body “keeps score” of trauma and why awareness during surgery can have lasting effects for some patients.
What You Can Do to Reduce the Risk
One of the most important steps patients can take is honest communication with their anesthesiologist. Sharing details about prior anesthesia experiences, medications, substance use, mental health history, sleep issues, and heart health allows the anesthesia plan to be tailored to your individual physiology and risk factors.
Anesthesia awareness is uncommon, but understanding how it is detected—and how patients can actively participate in their care—leads to safer surgeries and better outcomes. This video is intended to educate, not frighten, and to empower patients with accurate, evidence-based information.
Anthony Kaveh MD
Dr. Kaveh is a Stanford and Harvard-trained anesthesiologist and integrative medicine specialist. He has over 1,000,000 followers on social media and has guided hundreds of patients throughout transformative healing experiences. He is an authority on Ketamine, NAD, SGB, and genomics-guided therapies. He is a continuing medical education lecturer in the Bay Area.
