Are you awake during robotic surgery? What to know about anesthesia

September 21, 2025 •

5 min read

While the technology is advanced, one thing remains consistent across most robotic procedures: patient comfort and safety are paramount. For the vast majority of cases, are you awake during robotic surgery? The answer is a clear no, as patients are under general anesthesia for the duration.

Quick Summary

For complex or deep-tissue robotic surgeries, patients are fully unconscious via general anesthesia to ensure no movement and maximum safety. However, certain limited, specialized procedures, like some spine surgeries, can be performed with regional anesthesia, potentially allowing the patient to remain awake but sedated and comfortable.

Key Points

General Anesthesia is Standard: For most robotic surgeries, you are completely unconscious and immobile under general anesthesia for your safety.
Regional Anesthesia is Possible for Select Cases: Some specific, less invasive procedures like certain spinal fusions can be performed with regional anesthesia, where you are awake but sedated.
Patient Safety is the Top Priority: Anesthesiologists and the surgical team use advanced monitoring and protocols to ensure your safety and comfort during the entire procedure.
Anesthesia Team is at Your Side: While the surgeon is at a console, a specialized anesthesia team remains with you throughout the surgery, monitoring your vital signs and managing your care.
Immobility is Crucial for Robotics: Complete patient stillness, achieved through general anesthesia and muscle relaxants, is necessary to prevent injury from the precise movements of the robotic instruments.
Recovery Varies by Anesthesia Type: Patients waking from regional anesthesia may have a faster recovery than those who undergo general anesthesia.

Understanding the Anesthetic Plan

For most robotic-assisted surgeries, the primary goal of the anesthesia team is to ensure complete patient immobility and comfort. This is critical because the robot's arms, controlled by the surgeon at a console, must operate with precise movements in a fixed position. Any unexpected patient movement, such as coughing or shifting, could result in serious injury.

The Standard: General Anesthesia

General anesthesia is the standard protocol for the vast majority of robotic surgical procedures. Here's what that typically entails for the patient:

Complete Unconsciousness: You will be completely asleep and unaware of the surgery. Anesthesiologists administer a combination of medications to induce sleep, block pain signals, and relax muscles.
Total Muscle Relaxation: Special medications called neuromuscular blocking agents (NMBAs) are used to prevent all muscle movement. This total stillness is a non-negotiable requirement for delicate robotic maneuvers.
Breathing Assistance: A breathing tube is usually placed to help you breathe while you are under anesthesia, as the muscle relaxants also affect the respiratory muscles. Modern monitoring technology, like EEG, helps ensure the correct depth of anesthesia is maintained throughout the operation.

The Exception: Regional Anesthesia for Specific Procedures

While general anesthesia is the norm, it's not a universal rule. Some highly specialized robotic procedures can be performed using regional anesthesia, where only a specific area of the body is numbed. This is a possibility mainly for less complex or peripheral surgeries, with some doctors pioneering this approach for certain procedures like spinal fusions.

For an 'awake' robotic surgery under regional anesthesia:

A spinal or epidural block is administered to numb the lower body.
You may be given a sedative to help you relax or even drift into a light sleep, but you won't be fully unconscious.
You will be unable to feel pain in the surgical area, and your anesthesia care team will ensure you are comfortable and calm throughout.

The decision to use regional anesthesia is based on a careful assessment of the surgery's complexity, the patient's health, and the surgeon's and anesthesiologist's expertise with the specific technique.

Comparison of Anesthetic Options in Robotic Surgery


Feature	General Anesthesia	Regional Anesthesia
Level of Consciousness	Completely unconscious and unaware.	Conscious or lightly sedated; aware of surroundings but not pain.
Patient Movement	No movement, as muscle relaxants are used.	Minimal or no movement in the surgical area; movement in other areas possible.
Recovery Time	Longer recovery from the sedative effects of medication.	Often faster recovery and hospital discharge.
Post-Operative Pain	Managed with pain medication after waking up.	Reduced pain in the early post-op period due to continued block effect.
Risks	Associated risks include nausea, sore throat, and rare anesthesia awareness.	Associated risks include headache (with spinal), nerve injury, or block failure.
Typical Use	Most complex and deep-tissue robotic procedures.	Some spinal, orthopedic, or specialized procedures.

The Role of the Anesthesia Team

In any robotic procedure, the anesthesia care team—including the anesthesiologist and CRNA (Certified Registered Nurse Anesthetist)—plays an absolutely critical role. While the surgeon sits at a console controlling the robot, the anesthesia team remains at the patient's bedside, a key detail that can be reassuring for anxious patients. Their responsibilities are extensive and include:

Pre-operative assessment to create a personalized anesthetic plan.
Administering the anesthesia and closely monitoring the patient's vital signs, including heart rate, blood pressure, oxygen levels, and the depth of anesthesia.
Managing ventilation and ensuring the patient is breathing properly.
Handling any complications that may arise during the procedure.
Monitoring the patient during the undocking of the robot and waking them up safely afterward.

Patient Safety Protocols and Monitoring

Robotic surgery involves numerous advanced safety protocols to ensure patient well-being. Even though the surgeon is controlling the robot from a console, the system has built-in safeguards. For instance, some systems have head sensors that stop the robot's arms from moving if the surgeon looks away from the console.

Furthermore, the patient is continuously monitored using sophisticated equipment. These include:

Bispectral Index (BIS) Monitoring: An EEG-based monitor that provides a number reflecting the patient's level of consciousness, helping the anesthesiologist maintain an adequate depth of anesthesia.
Neuromuscular Monitoring: Devices that measure the level of muscle relaxation to ensure the patient is completely still and to guide the administration of NMBAs.
Standard Vital Signs: ECG, blood pressure, and pulse oximetry are continuously tracked to monitor for any physiological changes.

The Patient Experience: Before, During, and After

Before the Surgery

Ahead of your robotic procedure, you'll have a consultation with your surgical team and potentially your anesthesiologist. This is your opportunity to discuss any fears or preferences you have regarding anesthesia. It's also when you'll be given instructions, such as fasting guidelines, that are crucial for your safety.

During the Surgery

For the average patient under general anesthesia, the 'during' phase is a total blank. You won't feel, see, or hear anything. If you are having regional anesthesia, you may hear the sounds of the operating room and feel some pressure or manipulation, but you should not feel any pain. The anesthesia team will be there to make sure you remain calm and comfortable.

After the Surgery

After the procedure, you will wake up in a recovery area where the anesthesia team and nurses will continue to monitor you. Common side effects of general anesthesia can include grogginess, nausea, or a sore throat, but these are usually temporary. The time spent in recovery can vary, with some patients from procedures using regional anesthesia experiencing a faster recovery.

Conclusion

In summary, the question of 'are you awake during robotic surgery?' has a clear answer for most: no. General anesthesia is the standard for complex procedures, ensuring your complete unconsciousness and immobility for optimal safety. For some specific, less complex surgeries, regional anesthesia might be an option, but you will be carefully monitored and sedated to prevent discomfort. Ultimately, the decision on the type of anesthesia will be made with your safety as the highest priority, with the dedicated anesthesia team working alongside the robotic technology to ensure a successful and pain-free procedure. For more detailed medical information, consult a qualified healthcare professional. You can read more about anesthetic considerations for robotic surgery from the National Institutes of Health.

Frequently Asked Questions

No. Under general anesthesia, you will be completely unconscious and unable to feel any pain. If you have a special procedure with regional anesthesia, the surgical site will be fully numbed, and you may be sedated, so you won't feel pain.

Waking up during surgery (anesthesia awareness) is extremely rare, occurring in less than 1% of cases with modern monitoring. Anesthesiologists use sophisticated equipment, like BIS monitoring, to ensure you remain in the correct depth of anesthesia throughout the procedure.

The anesthesia itself is largely the same, but the protocols are specifically adapted for the robotic environment. For example, ensuring total muscle relaxation is even more critical in robotic procedures to prevent patient movement while the robot is docked. The anesthetic team must also account for the surgeon's position at a console away from the patient.

The anesthetic approach is decided based on the specific surgical procedure, your health, and what is safest. While regional anesthesia allows a patient to be awake, it's only feasible for specific surgeries. It's essential to discuss your preferences and any anxiety with your surgical and anesthesia teams during pre-operative consultations.

Not necessarily. The amount of anesthesia is tailored to each individual patient, and the duration of the surgery. Some studies suggest that the precise nature of robotic surgery may require less pain medication post-operatively, but the amount of anesthetic used during the procedure is determined by the anesthesiologist based on the patient's needs.

Robotic systems have multiple layers of safety features and backup systems. In the rare event of a system failure, the surgeon can quickly undock the robot and convert to a standard laparoscopic or open procedure if necessary. The patient is continuously monitored by the anesthesia team, which can manage the situation throughout.

Patients are carefully positioned on the operating table, sometimes in a steep angle (Trendelenburg position for pelvic surgery). This requires special padding and supports to prevent nerve damage and ensure stability. The anesthesia team ensures patient safety and comfort are maintained throughout this process.