Surgery can be lifesaving for people who experience a ruptured brain aneurysm or have an aneurysm at a high risk of rupturing. Not waking up after brain aneurysm surgery can happen for many reasons.

Surgical procedures used to treat brain aneurysms are generally performed under general anesthesia to put you asleep. They’re performed as emergency surgeries after an aneurysm has ruptured or as preventive surgeries before a rupture.

Some people don’t wake up right away after their procedure. Factors that can contribute to delayed wakefulness include:

  • sedation administered after surgery to help prevent complications
  • prolonged anesthesia effect
  • complications of surgery, such as bleeding or stroke

Read on to learn more about the reasons people don’t wake up after surgery to treat a brain aneurysm. We’ll also examine various states of unconsciousness that can develop and how long it might take to wake up from them.

A person may not wake up after brain aneurysm surgery for several reasons.

Postoperative sedation

People who receive general anesthesia before surgery often wake up within minutes to hours after their procedure. Sometimes, surgical teams administer postoperative sedation to keep a person asleep longer.

Sedation can help a person stay asleep and give their body more time to recover, which might help reduce swelling in the brain.

Recent evidence suggests that postoperative sedation is safe for people treated for ruptured brain aneurysms when the person is equipped with neuromonitoring and shows no signs of low blood pressure in their brain.

Delayed emergence from anesthesia

Doctors often consider remaining unconscious for 30 to 60 minutes after surgery as delayed emergence from anesthesia. Delayed emergence is fairly common and is often caused by prolonged action of the anesthesia.

Coma

A coma is a prolonged state of unconsciousness. Some people go into a coma after their surgery if they develop complications.

Complications that can lead to a coma include:

Disorders of consciousness are conditions that cause prolonged periods of unconsciousness. The main types include:

  • coma
  • vegetative state (unresponsive wakefulness syndrome)
  • minimally conscious state

Coma

A coma is a state of unconsciousness where a person has no signs of being awake and can’t be woken up. Some people can breathe independently while others might need a machine to help them.

People in a coma have no sleep-wake cycles and can’t:

  • open their eyes
  • recognize objects
  • speak or communicate
  • move consciously

Many comas last less than a few weeks but they can last years.

Vegetative state

A vegetative state is a conscious state where a person is unresponsive and unaware of their surroundings. They can usually regulate their breathing and heart rate without needing support from machines.

A person in this state may open their eyes and appear awake but have no capacity for:

  • speech
  • following commands
  • moving their limbs consciously
  • thinking consciously
  • being aware of their surroundings

Minimally conscious state

People in a minimally conscious state show some signs of awareness and response to their surroundings. They may have some capacity to communicate and respond to instructions. People in this state might be able to:

  • open and close their eyes
  • follow people and objects with their eyes
  • have sleep-wake cycles
  • answer with simple words or gestures like moving their fingers
  • make some motions like head-scratching

Many people wake up within minutes after a procedure requiring anesthesia, but it’s not uncommon for it to take longer. Taking longer than 30 to 60 minutes is considered delayed emergence from anesthesia.

How well you recover from your surgery depends on whether you received emergency or preventive surgery. Recovery is generally faster after preventative surgery. It might take 6 to 8 weeks to recover fully.

Once you return home from the hospital, it’s generally recommended that a family member or friend stay with you for at least a week.

Here are some tips to support recovery:

  • Eat a balanced diet with plenty of protein to support your healing.
  • Rest as much as possible but break up long periods of inactivity with movement to prevent deep vein thrombosis.
  • Wear compression socks for 6 weeks after your discharge.
  • Avoid strenuous activity for at least 4 weeks.
  • Don’t get your wounds wet for at least 72 hours.
  • Avoid or minimize your intake of alcohol.
  • Stop smoking, if you smoke, since smoking may make your aneurysm grow.

It’s important to seek immediate medical attention if you develop complications like:

  • severe headaches
  • vomiting
  • collapse

Is it normal not to wake up after brain surgery?

Most people wake up within a few hours of brain surgery. Not waking up right away isn’t uncommon and isn’t always a cause for concern.

What is the life expectancy after brain aneurysm surgery?

In a 2020 study, researchers found that 64% of people were alive without disability at a 5-year follow-up after receiving emergency surgery for a ruptured aneurysm.

What are the side effects of a brain aneurysm stent?

Potential side effects of receiving a brain aneurysm stent include:

Some people who receive surgery to treat a brain aneurysm don’t wake up right away. Waking may be delayed for several reasons like postoperative sedation, delayed wakefulness from general anesthesia, or a coma.