I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.
A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.
For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
I have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.
Turning yourself off breaks far more than doctors realize i fear.
I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.
I think before you blame anaesthesia it's worth wondering what else happened to you on the table, or whether something else might be causing you the problems. A lot of other things happen during a surgery that can screw you up pretty badly. I'm pretty sure I was dropped off a table once.
Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.
So either I am an exception, or your "everyone I know" needs qualification. In any case, I'd be very interested in what aftereffects you noticed, maybe that helps me reflect.
Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.
Any phenomenon more widespread than the above is simply not supported by scientific studies to date.
I’m honestly a bit disappointed to find this comment on hacker news, as I feel the level of discourse here is usually higher. I wish you all the best and hope you recover from whatever you’re experiencing, but this is frankly fearmongering.
Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.
One of the joys of private healthcare: I've seen general anaesthesia used to allow the patient to claim on their inpatient cover instead of their (exhausted) outpatient cover.
I've done it (it's standard in many countries). Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable. Colonoscopy is definitely easier.
My only experience with global anesthesia was as a child waking up with a massive asthma attack unable to breathe so I try to avoid it.
Which end are we scoping? Colonoscopy is often done without anaesthesia but tends to take longer than 2 minutes, so I'm not sure if that's what OC is referring to. It's uncomfortable, but that's ok. Scoping nose/mouth->stomach also doesn't come with any drugs, just some lube.
Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.
Not the same thing of course but when our cat got sick with blood parasite, her blood turned to very diluted cranberry juice color and the body temperature dropped to almost room temperature(38C is the normal for cats) and the vet was double and triple checking the readings because it didn't make sense still being alive. After a few hours we were able to arrange a blood infusion and intensive care and by the morning she was "fine".
By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.
The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).
"Survival" here being, of course, not a black-and-white thing:
> Outcome and Follow-Up
> On day 59, the boy was discharged to inpatient neurorehabilitation. At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
That is incredible. 2.5 hours underwater, 1.5 hours of CPR. They were instructed not to start rewarming him until he could be given more comprehensive treatment at a hospital. They list 'death' as a differential diagnosis...
He didn't come out unscathed though. They describe his progress:
> At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
which is quite limited for an 8-year old, but remarkable considering the circumstances.
I remember that cryogenesis was deemed viable in the 80ies but essentially surface area is your enemy. Anything larger than a cat can’t be resurrected. It’s pretty bizarre really, they froze mice and microwaved them back to life.
Weird! I wonder if there is some exponential complexity going on. More neural pathways leaving more stuff that can potentially break from an uneven freeze/thaw? Or is it literally that the freezing and thawing can't happen evenly when you're too big? A brief transistional period with unfrozen outsides and frozen solid insides is probably not great for you.
> As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram.
Reminds of Chris Lemons, who survived for 30+ minutes without oxygen at the bottom of the North Sea. Cold water (and experience, like staying calm) probably played a large part.
He went back to diving a few weeks after!
That passage bears quoting at length, it's where I really teared up:
> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...
Unlikely. The issue is cold and the speed of the cold. Children have a higher surface-to-mass ratio along with less subcutaneous fat which allows them to cool quickly. The article quotes the breakpoint:
If water temperature is >6 °C (43 °F), survival is unlikely for submersion >30 minutes.
And even still, it isn't like the child came out unscathed.
Well written article. Life is a miracle. We are trying to understand it & there is more to learn everyday. I remember a couple of years ago, a 50yr patient (someone I know) was saved from a severe heart attack using induced hypothermia and recovering them slowly.
The timeline lists "Sled tracks seen to broken bond ice, EMS called" at 16:44. He was pulled from the water at 18:57. The article text further clarifies:
Parents discovered sled tracks from home onto broken pond ice through which he fell.
He left the house at 16:00, which is why they give the range of 147 to 177 minutes.
It seems below about ~80F you lose consciousness. This kid was nearly half that. Moreover, there have been other similar cases: https://pubmed.ncbi.nlm.nih.gov/32482520/
I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.
A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.
For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
> For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.
And what if you might be able to make decisions again tomorrow. Or the day after? Or in two weeks time.. ? These things are never all that 'clear'.
The paper has the warning phrased differently. "He can at least be an organ donor", basically, in the summary.
Your comment and the thread it started helps me a little with dealing with a close person's father's dementia.
When Breath Becomes Air was a great book that seems relevant here
While I don't know, I suspect the boy's parents do not share your views. He is able to ride a tricycle and improving.
I have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.
Turning yourself off breaks far more than doctors realize i fear.
I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.
I think before you blame anaesthesia it's worth wondering what else happened to you on the table, or whether something else might be causing you the problems. A lot of other things happen during a surgery that can screw you up pretty badly. I'm pretty sure I was dropped off a table once.
I think if there was such a side-effect with such a commonly-used tool, someone would have noticed by now.
Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.
So either I am an exception, or your "everyone I know" needs qualification. In any case, I'd be very interested in what aftereffects you noticed, maybe that helps me reflect.
Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.
Any phenomenon more widespread than the above is simply not supported by scientific studies to date.
I’m honestly a bit disappointed to find this comment on hacker news, as I feel the level of discourse here is usually higher. I wish you all the best and hope you recover from whatever you’re experiencing, but this is frankly fearmongering.
Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.
One of the joys of private healthcare: I've seen general anaesthesia used to allow the patient to claim on their inpatient cover instead of their (exhausted) outpatient cover.
You're suggesting people undergo endoscopy without anesthesia? You go first, bud.
Conscious sedation, which is not the same thing as general anesthesia, is often used for endoscopy:
https://www.northerncarealliance.nhs.uk/patient-information/...
And sometimes it doesn't work. Patients are then given the option of going ahead without sedation, or rescheduling for general anaesthesia.
I've done it (it's standard in many countries). Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable. Colonoscopy is definitely easier.
My only experience with global anesthesia was as a child waking up with a massive asthma attack unable to breathe so I try to avoid it.
Which end are we scoping? Colonoscopy is often done without anaesthesia but tends to take longer than 2 minutes, so I'm not sure if that's what OC is referring to. It's uncomfortable, but that's ok. Scoping nose/mouth->stomach also doesn't come with any drugs, just some lube.
very common. doing it routinely. you never heard of it?
Evidence?
there is litterature on that. you need to assume that no medical intervention has no effect, by default.
Oh yes, I'm in agreement with you there
Could you elaborate on specific effects?
>40-60 years
Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.
Not the same thing of course but when our cat got sick with blood parasite, her blood turned to very diluted cranberry juice color and the body temperature dropped to almost room temperature(38C is the normal for cats) and the vet was double and triple checking the readings because it didn't make sense still being alive. After a few hours we were able to arrange a blood infusion and intensive care and by the morning she was "fine".
By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.
The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).
"Survival" here being, of course, not a black-and-white thing:
That is incredible. 2.5 hours underwater, 1.5 hours of CPR. They were instructed not to start rewarming him until he could be given more comprehensive treatment at a hospital. They list 'death' as a differential diagnosis...
He didn't come out unscathed though. They describe his progress:
> At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
which is quite limited for an 8-year old, but remarkable considering the circumstances.
at this age the chances of continuous improvement are probably decent
I remember that cryogenesis was deemed viable in the 80ies but essentially surface area is your enemy. Anything larger than a cat can’t be resurrected. It’s pretty bizarre really, they froze mice and microwaved them back to life.
Weird! I wonder if there is some exponential complexity going on. More neural pathways leaving more stuff that can potentially break from an uneven freeze/thaw? Or is it literally that the freezing and thawing can't happen evenly when you're too big? A brief transistional period with unfrozen outsides and frozen solid insides is probably not great for you.
> Or is it literally that the freezing and thawing can't happen evenly when you're too big?
This. You literally can’t evaporate all the thawing agent out of the blood of the organism without substantial burns by sheer volume
I would assume it is purely because of the mass.
They’re not dead until they’re warm and dead.
> As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram.
Dunno about you, but this does things to me.
Reminds of Chris Lemons, who survived for 30+ minutes without oxygen at the bottom of the North Sea. Cold water (and experience, like staying calm) probably played a large part. He went back to diving a few weeks after!
They made a movie about it: https://en.wikipedia.org/wiki/Last_Breath_(2019_film)
I was rewatching The Abyss for the first time since 1989 and wondered just what is the process for reviving an asystole heart[^1].
[^1]: It was only relatively recently that I learned you can't shock an asystole heart. e.g. https://medicalsciences.stackexchange.com/questions/5874/can...
CPR and a boatload of epinephrine, it seems.
That passage bears quoting at length, it's where I really teared up:
> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...
Incredible. I wonder if they can make progress on survivability of regular drowning.
Unlikely. The issue is cold and the speed of the cold. Children have a higher surface-to-mass ratio along with less subcutaneous fat which allows them to cool quickly. The article quotes the breakpoint:
And even still, it isn't like the child came out unscathed.Reminds me of the extended description of what it might be like to drown in an ice lake in the book Stella Maris — it wouldn't be quick.
Well written article. Life is a miracle. We are trying to understand it & there is more to learn everyday. I remember a couple of years ago, a 50yr patient (someone I know) was saved from a severe heart attack using induced hypothermia and recovering them slowly.
I am sceptical about the 147 minutes, the child could have still clinging onto the ice and just drowned a minute before the parents reached the pond.
The timeline lists "Sled tracks seen to broken bond ice, EMS called" at 16:44. He was pulled from the water at 18:57. The article text further clarifies:
Parents discovered sled tracks from home onto broken pond ice through which he fell.
He left the house at 16:00, which is why they give the range of 147 to 177 minutes.
Yes but ultimatively it could been 16:43 to 18:57 which is 134 Minutes.
It seems below about ~80F you lose consciousness. This kid was nearly half that. Moreover, there have been other similar cases: https://pubmed.ncbi.nlm.nih.gov/32482520/
Problem is that he could have drowned at 16:43.
Why are we not told how deep the pond was and confirm the % body submersion?
There was some medical terminology that I didn't understand. The NotebookLLM podcast version is disturbingly good: https://notebooklm.google.com/notebook/21c5eddb-ada4-4726-85...
Do you give slow CPR in these cases?
Wim hof has a similar childhood story (maybe not quite as extreme)...
Wim hof has a lot of stories, hard to tell which ones are true or not unfortunately.
I believe the stories of him being convicted of domestic abuse since that was in a court