By Barbara Mango, Ph.D.

     General anesthesia is administered during surgical procedures to block sensory, motor, and sympathetic nerve transmission.  It induces pain relief, amnesia (loss of ability to recall the procedure), motionlessness, reduced autonomic nerve responses, slowed heart and breathing rates, and lowered blood pressure. Anesthesia involves intensive efforts to maintain loss of consciousness during surgery, “and that essentially, the patient is dead to the world.”[i]

     Neurologist Robert Spetzler states the aim of adequately administered anesthesia is to:

             …bring the brain to a halt.  We don’t just want the brain to be asleep.  We want the metabolic activity of the brain to stop.  Every measurable output that the body puts out really disappears completely, so that you have no measurable neuronal activity whatsoever [ii]

     Cardiologist Pim van Lommel further explains:

             Registration of the electrical activity of the brain (EEG) in patients under general anesthesia has shown that unconsciousness during surgery is coupled with a clear change in the brain’s electrical activity, with lower frequencies and less extreme discharges. This is consistent with the neurophysiological hypothesis that brain function   is completely disrupted and impaired under general anesthesia.[iii]

     Thus, it appears medically inexplicable that highly lucid and enhanced consciousness can exist under properly administered anesthesia. Nonetheless, numerous NDEs occurring under general anesthesia have been verified.

Perhaps the most compelling case of a NDE ever documented under general anesthesia is that of Pam Reynolds. Cardiologist Michael Sabom emphasizes the significance of her case:

        Occasionally, a patient…reports exceptionally clear consciousness [under general anesthesia], including lucid thoughts, memories, emotions, and verifiable perceptions from a position outside and above their unconscious body, despite the total absence of loss of demonstrable brain activity.  There are only a few cases in which this loss of function has been carefully documented…Because she [Pam] had her NDE during brain surgery, when the activity of the cerebral cortex and brain stem were constantly monitored, hers is a good example of an NDE during carefully documented brain function. [iv]  

     Pam was diagnosed with a giant aneurysm in a cerebral artery near her brain stem. Although Neurosurgeon Robert Spetzler agreed to operate on Pam, her chance of surviving surgery was remote. The procedure necessitated that Pam’s body temperature be lowered to fifty degrees and all blood drained from her brain. She was additionally attached to a heart-lung machine (a mechanical circulation support of the heart and lungs, also known as cardiopulmonary bypass).  Finally, clicking devices were inserted into both ears to monitor her brain. Spetzler emphasizes:

             During standstill, Pam’s brain was found “dead” by all three clinical tests-her electroencephalogram was silent, her brain-stem response was absent, and no blood flowed through her brain. Her eyes were lubricated to prevent drying and then taped shut.  Additionally, she was under deep anesthesia.[v]

     Upon waking, however, Pam was able to describe with complete accuracy the entire procedure, the surgical instruments used, detailed conversations of the medical team, and a song playing on the radio during her surgery. She later concluded,

 When I came “back” and I was still deeply under general anesthesia, they were playing “Hotel California”, and the line was “You can check out anytime you like, but you can never leave.” I mentioned later [to the assisting surgeon] that was incredibly insensitive, and he told me I needed to sleep more. When I regained consciousness, I was still on the respirator. “I think death is an illusion. I think death is a really nasty bad lie.” [vi]

     Dr. Spetzler has acknowledged:

...I find it inconceivable that the normal sense, such as hearing, let alone the fact that she had clicking devices in each ear, that there was any way for her to hear those [sounds and conversations] through normal auditory pathways…I don’t have an explanation for it.  I don’t know how it’s possible for it to happen, considering the physiological state she was in.[vii]

     With an essentially “dead” brain any recall of this or other surgery under general anesthesia is medically incomprehensible. Skeptics, however, argue vigorously that surgical NDEs are merely the result of insufficiently administered anesthesia, which medical literature has termed, “awareness during surgery.” This hypothesis proposes that those who experience NDEs under general anesthesia may only appear to be unconsciousness and thus able to ‘imaginatively reconstruct’ surgical events. The strongest proponent of this model is British psychologist Susan Blackmore. She maintains:

             So what kinds of information can we pick up from what we hear?  Speech is probably the most important. The surgeon may issue instructions for the resuscitation, ask for instruments to be passed, or even start chatting to other people present; nurses may confer over procedures, check doses…or even pronounce the patient close to death.  Potentially, any of this may be heard by the patient.  Although patients appear to be unconscious, they may retain residual hearing, and thus, be aware of events happening around them. Through this information, they are able to construct a convincing and realistic impression of what was occurring during surgery and believe they have experienced a NDE.[viii]

     Blackmore’s postulation allows for primarily auditory, not visual perception while anesthetized. NDEs that occur under general anesthesia, however, are both visual and auditory in nature. Non-materialists challenge Blackmore’s hypothesis on several levels.

     First, awareness under general anesthesia is extraordinarily rare. According to Long and Perry “only one to three patients in one thousand experience anesthetic awareness.”[ix] The Journal of Anesthesia and Analgesia defines anesthetic awareness, also known as unintended intra-operational anesthesia, as a “rare event when a patient under general anesthesia becomes conscious during surgery, but can’t move or talk because paralytics are in effect”.

     Secondly, those who awaken during surgery describe their experience as painful, terrifying, and confusing.  This is contrary to NDErs who, nearly universally, describe their encounter as joyful, loving, and immensely peaceful.   

     This author explains her own personal experience with anesthetic awareness:

             My nose was broken badly during a traumatic sports injury. I required Rhinoplasty to reconstruct it-a surgical procedure which necessitated general anesthesia. I awakened at some point during surgery. I wasn’t groggy, ‘out of it’, ‘reconstructing memories’, or dreaming. I knew exactly where I was and what was happening to me. The overhead lights were shining in my eyes. I could see 2 nurses by the side of the table wearing green scrubs. The surgeon was standing directly over me, with what appeared to be a scalpel in his hand. I was terrified. I could see everything, hear every word being said, yet was completely paralyzed.  When the surgeon saw that I was conscious, he yelled, “She’s awake!  Get the gas NOW”. I could see the panic on his face. I thought to myself, he’s almost as frightened as I am. Then everything went black. In no way did the incident resembled any aspect of a NDE, nor could it possibly be confused with one.

     Furthermore, numerous procedures are intentionally performed under lighter sedation.  According to the American Society of Anesthesiologists,

           …certain procedures, however, do increase the risk of surgical [anesthetic] awareness, such as procedures performed under local or regional anesthesia with modest levels of sedation. In these circumstances, deep unconsciousness is not intended, and patients will predictably have varying levels of recall of events and surroundings.

     Finally, those who experience anesthetic awareness do not report out-of-body experiences. However, NDEs which occur under general anesthesia frequently report observations of the surgery from above their bodies. As Long explains:

             When near-death experiences occur during general anesthesia, there are often OBE observations of the operation. NDErs typically see their own resuscitation taking place on the operating table. These near-death experiencers are not seeing themselves with too little anesthesia; they are seeing themselves coding [x]   

     NDEs which occur under general anesthesia provide especially compelling evidence supporting the validity of both the experience itself and continuity of consciousness after life.

     Van lommel concludes: