(Written from the view of the patient)
What Brain Patients Should Know About Induced Comas
An induced coma is a normal process that follows most brain surgeries. At times it is also referred to as a medically induced coma. However, some patients may neglect or avoid asking the doctor before surgery what an induced coma entails. This next section may provide some useful insights.
A medically induced coma is a temporary coma or deep state of unconsciousness where the brain will be rendered inactive. During major brain or neurosurgery, medically induced comas are used to protect the brain. The coma is a controlled dose of as anesthetic drug. The coma is reversible.
Usually, a patient would be put in a medically induced coma after brain surgery when there is major trauma to the brain causing brain swelling. This gets the brain to be quiet and give it vital time to rest and heal after the surgery. Normally after brain surgery the brain swells, putting pressure on the brain. This pressure reduces blood flow and oxygen flow to the brain, which can cause brain tissue damage. The induced coma decreases electrical activity and metabolic rate in the brain.
The anaesthesiologist is responsible for the medically induced coma. They consult with the patient before surgery, are present during surgery and assist after surgery.
Once a patient is placed into an induced coma, the following happens:
- The patient is likely to completely lose respiratory drive and require mechanical ventilation – placed on life support.
- Gut motility is reduced.
- Hypotension can complicate efforts to maintain cerebral perfusion pressure and often requires the use of vasopressor drugs.
- The completely immobile patient is at increased risk of bed sores, infection from the ventilator, as well as infection from catheters.
The patient in most cases will be in a medically induced comas for a short period of time. Doctors typically use the procedure for a couple of days or for as long as two weeks. It is rare for medically induced comas to last for longer periods.
Complications that can occur from medically induced coma include:
- Infection, particularly pneumonia and other lung infections.
- Blood clots.
- Heart problems.
- Pressure sores and weakness from immobility.
- Vivid nightmares and hallucinations.
A medically induced coma eliminates pain. However, the underlying brain treatments may involve pain and discomfort once consciousness returns.
Brain patients are usually brought out of an induced coma very slowly. Signs of coming out of a coma include being able to keep their eyes open for longer and longer periods of time and being awakened from “sleep” easier—at first by pain (pinch), then by touch (like gently shaking of their shoulder), and finally by sound (calling their name). There are different states identified as the patients comes out of the induced coma.
During the unresponsive state the patient does not respond consistently or appropriately. You may hear this stage referred to as a coma. You may notice different movements in the patient. A reflex that causes straightening of the arms and legs. A reflex that causes bending of the arms and straightening of the legs. Random movement of the arms and legs for no specific reason.
During the early response state the patient starts to respond to things that are happening to them. The responses will be more appropriate but may be inconsistent or slow. The patient will start to have localized responses and follow simple commands. These are appropriate movements by the patient in response to sound, touch, or sight. Turning toward a sound, pulling away from something uncomfortable, or following movement with the eyes are examples. Opening and closing eyes, sticking the tongue out, or gripping and releasing hands when asked are examples.
At the agitated and confused state, the patient is responding more consistently. The patient will be confused about where he or she is and what has happened. The patient will have difficulty with memory and behavior. The patient’s confusion may lead to yelling, swearing, biting, or striking out. Do not be alarmed if soft wrist and ankle ties are used to protect the patient and prevent tubes from being pulled out. It is very important to remember this stage is a step toward recovery and this behavior is not intentional.
The higher level responses are seen when a patient completes routine tasks without difficulty, but still needs help with problem solving, making judgments and decisions. The patient may not understand his or her limitations and safety is a big concern. Unusual or high stress situations make activities more difficult. The patient may seem more like the person you knew before. However, there may be personality changes.
How long does it take for someone to wake up from induced coma? Well, normally a patient in a medically induced coma would wake up over the course of a day, or at times it can take nearly a week to wake up. It is important to know each patient is different.
Let us look at what patients need to expect during the recovery process after the coma:
- The length of time it takes to recover from a medically induced coma depends on several factors. This includes the underlying brain trauma and how long the coma lasted.
- In general, the longer the coma is necessary, the more time it will take to regain functions.
- Age.
- The length of time since surgery.
- Past mental and physical health of the patient are factors used when predicting the extent of recovery.
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