February 28, 2009
On believing you died during the operation:
I just found this interesting paper in the medical journal Anesthesiology on fear of imminent death or the delusion that death has actually occurred, both linked to anaesthetic intoxication.
Despite our repeated explanations that she had suffered a local anesthetic-induced complication, the patient remained convinced that she had died and come back to life. This patient had been a non-practicing Christian who believed in an afterlife. She had not had any previous experience of this kind or know of others who had had. She had had no fear of death in the preoperative period.
The article notes that the delusional belief that one has died has been linked to complications with the use of lidocaine, procainamide, and procaine.
As with the drugs used in the Anesthesiology case study, all of these are local anaesthetics. They are just intended to numb a specific area, so the patient is not 'put under' with globally conscious altering substances.
It's also interesting because the delusion that one has died is also known in the psychiatric literature, usually in the context of diagnoses such as schizophrenia or after brain injury.
In these cases it is known as the Cotard delusion which is usually explained, rather unsatisfactorily, as being caused by a general emotional disconnection from the world, interpreted by the patient's faulty reasoning system as being convincing evidence that they are dead.
The case studies from the anaesthesiology literature suggest that these beliefs can be triggered in other ways, although the exact process still remains a mystery.
If you're put off by academic journals, give this article a try. It's well written, short and fascinating.
Link to Anesthesiology article on death delusions.
