January 6th, 2018

Anesthesia and consciousness

Here’s a fascinating article on the mysterious working of anesthesia, which is as yet a poorly understood although highly effective and useful tool:

Anesthesiologists speak of patients descending through “the planes of anesthesia”—from the “plane of disorientation” through the “plane of delirium” toward the “surgical plane.” While we go under, they monitor our brain waves, titrating their “anesthetic cocktails” to make sure that we receive neither too little sedation nor too much. (A typical cocktail contains a painkiller, a paralytic, which prevents muscles from flinching at the knife—the early paralytics were based on curare, the drug South American warriors put on the poison-tipped arrows with which they shot Europeans—and a “hypnotic,” which brings unconsciousness.) But even as they operate the machinery of anesthesia with great skill, anesthesiologists remain uncertain about the drugs’ underlying mechanisms. “Obviously we give anesthetics and we’ve got very good control over it,” one doctor tells Cole-Adams, “but in real philosophical and physiological terms we don’t know how anesthesia works.” The root of the problem is that no one understands why we are conscious. If you don’t know why the sun comes up, it’s hard to say why it goes down.

The article contains a detailed description of the harrowing and yet transcendent experience of an Australian woman in 1993 who somehow became conscious during an operation and could feel all the pain involved, and yet was completely paralyzed and could not alert the doctors as to what was happening. That struck a nerve (to coin a phrase) with me because, when I had surgery in 1999, I had already read about that sort of phenomenon and the prospect had terrified me.

Its rarity at the time (it’s even rarer now, but it was very rare then, too) had failed to reassure me, and the day before surgery, when I had my little pre-surgery conference with the anesthesiologist, I mentioned my anxiety to him. Instead of pooh-poohing me, he was surprisingly kind. “Don’t worry,” he said. “I promise to keep you safe.” He explained that anesthesiologists had ways to monitor patients so they could tell, by changes in heart rate and blood pressure and other signs, if the patient was in distress. He swore that he’d make sure I was not aware of what was happening and that I wasn’t suffering.

Right before the surgery, when they wheeled me in under the bright lights and I saw the anesthesiologist again, I mentioned it again. He put his hand on my shoulder reassuringly and told me “I will not let that happen to you. I promise; trust me.”

And I did. After all, I really felt I had no choice. But I really did trust him; he seemed so certain and so kind.

That was almost twenty years ago, and I remain grateful to him, whoever he was.

23 Responses to “Anesthesia and consciousness”

  1. Sarah Rolph Says:

    What a great story. Kindness makes such a huge difference, especially in situations like this.

  2. parker Says:

    I am having knee replacemt surgery in Februray and the idea of anesthesia scares me. But I will look forward to walking without pain.

  3. vanderleun Says:

    Eliot in the Quartets:

    “Or as, when an underground train, in the tube, stops too long between stations
    And the conversation rises and slowly fades into silence
    And you see behind every face the mental emptiness deepen
    Leaving only the growing terror of nothing to think about;
    Or when, under ether, the mind is conscious but conscious of nothing—”

  4. vanderleun Says:

    Once upon a time in a hospital, a member of the staff there said to me, by way of a tip, “When you meet the Anesthesiologist always say to him, ‘Oh yes, you’re the one who is going to wake me up.'”

  5. vanderleun Says:

    The ceiling is moving
    Moving in time
    Like a conveyor belt
    Above my eyes

    When under ether
    The mind comes alive
    But conscious of nothing
    But the will to survive

    I lay on the bed
    Waist down undressed
    Look up at the ceiling
    Feeling happiness

    Human kindness

    The woman beside me
    Is holding my hand
    I point at the ceiling
    She smiles, so kind

    Something’s inside me
    Unborn and unblessed
    Disappears in the ether
    This world to the next
    Disappears in the ether
    One world to the next

    Human kindness

    PJ HARVEY

    https://www.youtube.com/watch?v=4ldlokmSw1o

  6. lynndh Says:

    I have a potential serious medical issue that necessitate that I have an Endoscopy every yr. One time I did come out some, I remember trying to talk, telling them I was aware, but too much stuff in my mouth. I then went back under. Not pleasant but then not really serious. But I certainly understand the fear.

  7. Philip Says:

    Anesthesiology must be a subtly fascinating undertaking. I’m glad, neo, that you had a good experience.

    Good wishes to you, parker!

  8. CapnRusty Says:

    I’ve been anesthetized a couple of times. Both times I told the medical personnel that I’m a lawyer . . . and that was the last thing I remembered!

  9. Stubbs Says:

    Two weeks ago I had a pacemaker installed. That involved pushing wires into my heart and securing them in the right spots. I remember the cardiologist saying hello and preparing the area for the cut. We talked a for a few seconds as I got woozy. The next thing knew I came to in what seemed like just a second and I began the trip back to my room. I remembered nothing of the intervening period. I still have traces of the purple, brown and yellow bruises that covered my left chest, I assume as results of working the wires into the correct spots.

    I saw one of the cardiologist’s helpers ten days later. He said that he remembered that I was very talkative during the procedure.

  10. Frog Says:

    It is as amusing to hear non-medical people ruminating on medical experiences, anesthesia in this case, as it is for lawyers to listen to mds ruminating on their legal experiences and the law.
    Neither is very enlightening.
    You should perhaps know that the practice of anesthesiology is regarded in medicine as 95% boredom (all is well) and 5% serious agitation (the patient’s crashing). Often the surgeon is a mere bystander in the latter event.

  11. parker Says:

    Frog,

    So you are willing to be the 5% dead? I accept the ricks aginst the benefits. I am not afraid to die.

  12. Yancey Ward Says:

    I was put under for a small surgery on my eyelids when I was around 6 or 7 years old, and again for two oral surgeries to remove teeth before I got braces and after I had the braces off to remove the wisdom teeth before they became bigger problem- those two surgeries were at age 12 and 14. It was disconcerting all three times- you are talking to the doctor as you go under, and the next thing you know you are being awakened. The sense that no time has passed it unnerving for me.

    I have often thought that the passing out part is what death itself is like, but no awakening on the other side. I don’t know if I find that a comfort or not.

  13. Sergey Says:

    Consciousness is well beyond competence of any science, being completely supernatural. It is a “common miracle”, so common that we tend to forget that it is, indeed, a miracle. Do not expect anybody will ever understand it in scientific terms.

  14. MHollywood Says:

    I recently was put under. Then, WHAT IS THE MAN doing in my room, at the head of my couch, his face so close to mine – and why are these other men in my room. And yet they do not seem threatening.
    AND THEN I made sense of it.
    THEN I felt protected, privileged to have such care.
    I was told this is a common dream pts report having: they are at home, in their own beds and what are these ppl doing there.
    Strikes me that the place to which we go feels deeply ours.
    Thx for the poem, Vanderleun.

  15. Frog Says:

    parker, you comment has nothing to do with mine except the same 5% number is cited.
    You didn’t get it.
    As to knee replacement, the operative mortality is trivial (thank the anesthesiologist, who does more than keep the patient asleep. His job is to keep the patient alive!) and the risk of wound infection is about 3%.

  16. Mike K Says:

    Dwight Harken was a famous surgeon in Boston who was having chest surgery and woke up. He was paralyzed but could feel all the pain. He thought to himself, “My blood pressure must be going through the roof. In a minute he will realize I’m feeling this.” At that moment he heard Henry Beecher, the chief of Anesthesia, say, “Harkin’s blood pressure is way up. He had better have that looked at after this is over.” Then he gave him something to bring the blood pressure down. NO anesthesia. When I was doing my cardiac surgery residency we had a woman come in who had awakened during a previous heart surgery and who spent a year in a psych hospital recovering. We were very careful and she did fine but everybody was on edge.

  17. neo-neocon Says:

    Mike K:

    I’m assuming both those incidents happened a long time ago, and that the way patients are monitored has changed.

    I’m hoping, anyway.

  18. Scott Robinson Says:

    A great discussion Neo and all. I am an Anesthesiologist. It is a compelling field of medical practice. Always respond when patients express anxiety of recall or awareness, that I can’t guarantee it won’t happen, and that I’ll do everything I can to avoid it. When patients say. “You’re the one who is going to put me to sleep,” I always say ” More importantly, I’m going to wake you up.” When I had my own surgery, I felt very confident that my fellow anesthesiologists would take care of me and keep me safe and pain free. As far as knee replacement surgery goes, the excellent option of spinal anesthesia which completely blocks any surgical pain during the procedure is always available.

  19. Mike K Says:

    Both incidents were many years ago.

    It is also probably not the best plan to have the chief of anesthesia at Mass General do your anesthetic. Rockefeller had the commanding surgeon of Walter Reed do Happy’s mastectomies and he took 7 hours.

  20. Frog Says:

    Never go to the Chief of anything for individual care. When I was at Duke, I saw each year several of the wealthy, well-connected who insisted Dr. Sabiston, Chairman of Surgery, operate on them. Their surgeries could have been better done by a 3rd year resident, their lung cancers often incompletely resected, or post-op air leaks. Some should not even have been operated upon.

    Surgery requires nimble fingers and meticulous attention to detail, not just a skilled brain!

    Sabiston headed a great surgery dept., especially the cardio-thoracic surgery division, in which trainees undertook eleven years of training, two spent doing research. His program generated many of the most able cardio-thoracic surgeons in the country. He was known (but not to his face) as The Great Saboo.

  21. Mike K Says:

    I was very unhappy that Sabiston did not get Blalock’s jpb after he died. I was in line to do the program there and decided to stay in Los Angeles. I should have gone to Duke or Stanford but was accepted at JH and didn’t go.

    I did have the chief of ortho at UCSF do a spine fusion on me 25 years ago. I’m sure his fellows did most of it.

  22. jon baker Says:

    October 2017 I had a ladder incident that resulted in a broken arm and the arm dislocated from the shoulder. They knocked me out twice that day with an IV to get it all back in to place. The thing I made sure they knew was that I had bad sleep Apnea. I felt nothing while under….. now before and after, that was a different story….

  23. Ymar Sakar Says:

    Human ignorance is only exceeded by the arrogance of the self proclaimed human experts.

    They, as the Pharisees, claim enlightenment due to credentials, degrees, and social acclaim. None of which counts as the authority or substance of truth or power. The only two true powers in mortal life: the power over life and death.

    Meanwhile, just a few years ago, many of these so called experts were losing their heads over Trum’s victory or loss, as if it was the end of the world. Certainly, it was the end of their nice little niche. The Pro Trum faction here was freaking out, literally panicking, over the Fear that came over them from the Leftist alliance. How sad and pathetic these self proclaimed human experts became, in the face of a power that exceeded theirs, which did not even come close to the threshold of the two true powers in mortality.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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