March 17, 2015 • 51 mins
The use of general anesthesia is less than 200 years old. Before doctors were able to cause unconsciousness in patients, surgery was brutal for all involved. But despite this advancement in medicine, science still has no idea how it works.
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Episode Transcript
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Speaker 1 (00:00):
Welcome to you stuff you should know from house stuff
Works dot com. Hey, and welcome to the podcast. I'm
Josh Clark. There's Charles W. Chuck Bryant. There's Jerry, who's
about to go to the hardware store any second now,
which no, Jerry doesn't find that very funny. Yeah, I
(00:23):
give the background there or to leave people wondering, well,
we need a trash cannon and dimmer background. But we've
been asking for I feel like months, but yeah, it
can't be months because we haven't even been here that long.
It's been like four days. But what what? What's the
problem here? Why isn't there any movement on this? There's
a home depot a thousand yards Crossromt. Yeah. I specifically
(00:46):
didn't mention their name, but yes, it is the closest
well in Orange big box hardware retailer. We could also
support local business and go to an ACE instead, yeah,
or we could just talk about and it's like we're
supposed to. ACE is a big chain too, though, Yeah,
but I think they're locally owned. Oh right, like Henry's
(01:07):
ACE Hardware. Sure. I like, Yeah, it's good stuff, very helpful,
very very knowledgeable staff, much more helpful. Than some of
the other big Bucks their orange and blue. Okay, that
was a great start to Uh, Chuck, Yes, do you
(01:31):
know how to spell anesthesia? I haven't. I struggle. It's
one of those And in fact, when you were out
of the room getting your coffee, Jerry was asking how
to spell it. I know, and I think she spelled
it right or maybe missed a letter. And Jerry, I
think she put an A where there was supposed to
(01:51):
be an E. Oh well, I think that it used
to be an accepted spelling. You know how in some
uh distant times, the forties the thirties, which Jerry identifies
with and like, anesthesia would have been spelled with an
A E rather than just an E because there was
another sound that. Yeah, it is a tricky one them.
(02:12):
Uh okay, Well, then my next question, Chuck, do you
know what anesthesia means? I do. Uh. It's from Greek,
like a lot of medical terms, and this one stands
for the loss of sensation. And uh, we'll talk about
our personal experience as I assume, but I've never been
under general anesthesia. Yeah the big Daddy, Yeah, fully under view. No,
(02:36):
so neither one of us has had major surgery like
that then no knock would yeah, because after doing some
research on this, like, I don't know that I ever
would want to It's scary, I mean. And let me
just say also to anybody who is listening to this
prior to undergoing a surgical procedure that requires general anesthesia,
(02:57):
we don't mean to scare you know, but because it's uh,
we'll talk about rate of death and and problems with it,
which there are still but it's super safe now for
the most part. But when you when you when I
was reading this, I was like, man, what they're doing
is is like bringing you toward death and then stopping
(03:18):
at a certain point, yeah, and just letting you hover
there then bringing you out when they're getting with a
lot of like crazy heavy heavy drugs that are only
slightly different from what they used in the like early history,
which we're about to talk about. But it's really like
it's it's kind of nuts that and they still don't
know exactly how it works. And the reason why they
(03:39):
don't know how it works, especially we understand local anesthesia
and um twilight sedation, sure, well we don't understand is
general anesthesia. And the reason why we don't understand because
we don't understand how consciousness works, so how can we
understand how unconsciousness works. Yeah, it's pretty weird, and which
is what it works? Yes, it definitely does, and although
(04:03):
there are some risks associated with it, it is far, far,
far better than the alternative, which is no anesthesia, which
was the way it was for a very long time.
I mean anesthesia is a relatively recent thing. Or getting
you super drunk, or hitting you in the head and
knocking you unconscious, which is not so knocking you unconscious
(04:23):
that qualifies anesthesia, but it's still not medical anesthesia. Giving
you drunk, giving you morphine, giving you marijuana, jim some weed, um, yeah,
rubbing stinging nettles on you to distract you from the
pain of having your leg cut off, belladonna, using ice,
all the stuff. These are so horrifics. These are narcotics.
These are just plain old distractions, um, but they don't
(04:47):
qualifies anesthesia. And the big difference, the the thing that
was such a huge, huge progression forward um with anesthesia
is that it doesn't just dull the pain. It dulls
the pain, it takes away your consciousness and it also
prevents you from creating memories during this experience, it gives
you amnesia. So it basically cuts a chunk out of
(05:10):
your lifetime that as far as your subjective experience goes,
does not exist. It didn't happen like you were on
the gurney going into the O. R room and you
wake up and you're in the hospital bed and you
have stitches, but there is nothing there in between, ideally
for general anesthesia, right, And that's how we can conduct surgery,
(05:33):
because before that there was surgery, but it was very
rare and it was very very awful. Yeah, and when
you know, we flew by some of those, but um,
we did mention a lot of this, uh sopaphorics and
narcotics that they use. They did knock you in the head,
they did get you drunk. Um. In fact, in the
mid forties, those were you know, opium and alcohol where
(05:55):
the two go toss like and a towel to bite on,
I guess, and just to make you like be able
to tolerate the pain, which didn't really help. No, I
mean I'm sure it helped. Uh, it dulled the pain,
but it's not gonna do what you want, which is
to kill it completely or knock you out. Or render
you an asiatic an asiatic right, um. But the so
(06:19):
the those were the two go to that they use.
I mean there were other ones to like um blood
lighting until a stupor or basically a coma was induced,
like you lost so much blood that's pretty dangerous. But
these were the These were the go to um pain
killers for surgery, and they still didn't work very well.
(06:39):
But what's weird is in the eighteen forties all that changed,
like not one, not two, but three anesthesia is UH
came into We're basically discovered for medical use, like almost
all at the same time. Yeah, people now they basically
(07:00):
say Crawford Long from right here in Georgia, University of
Georgia graduate fellow bulldog. UH. He was the first. He
performed a surgery removed a tumor from a neck from
a mr A bentable in UH late March eighteen forty two,
and also later did an amputation in a childbirth with
(07:22):
ether and UM. He was he was the guy, but
he was you know, it was pretty regional and people
just didn't know about it. Basically. I all think it's
the impression that he wasn't as much of a self
promoter as Dr William Morton. Uh, yeah, he did um
well William Morton in eighteen forty six. We might as
(07:42):
well go ahead and say he demonstrated it for the
first time in like a public surgical theater, right, and said,
here is what I'm doing, and this is new and
it's exciting, and I'm in Massachusetts on not some yokel
in Georgia pretty much, and that's how he gained the acclaim.
But yeah, I guess Crawford Long was able to prove
that he'd done he'd used ether earlier. He's just like
(08:02):
it just wasn't being a big shot about it. I
was just using it. But you know, he discovered ether
by hanging out with friends who were huffing ether at
a party and supposedly he saw one guy run into
a door and like cut his head open, and Crawford Long,
being a doctor, was like, are you okay? And the
guy was like, what are you talking about? With like
(08:23):
blood spurting out of his forehead, and Crawford Long went,
that's pretty funny. Uh. And he went on to uh
tell Congress about it, as did doctor Charles Jackson, who
said that he had done it before Morton as well.
They both independently went to Congress. I was okay, man,
I did that first. All right, it's a bit of
(08:43):
self promotion. Ye, but Morton is the guy who gets
who gets the credit. He's the one who really introduced
it to the public. Well, it gets your credit as
the first demonstrator. Yeah, he's the one that you hear
of typically. Yeah, I would say Crawford Long though. Yeah,
I guess you're right. Yeah. Lots of hospitals named after him,
at least one here, although now no it's not cropfit
(09:04):
Long anymore. Did they change it, yeah, to home depot um.
So a little bit later on, there was a dentist,
Dr Horace Wells, who used the first dude to use
nitrous oxide bull teeth, and then chloroform was used by
Dr James Simpson and these things. You know, you don't
(09:26):
want to be using that though, it's toxic. So Dr
Horace Wells actually is a pretty interesting story. It's where
chloroform um and nitrous oxide converge as a beautiful place.
So he tried. He extracted one of his own teeth
on nitrous and was like, this is great. Did you
read that history of Hippie crack article? Yeah, so this
(09:48):
all came after somebody, a guy named Joseph Priestley in
the eighteenth century synthesized nitrous oxide, and then very shortly
after that, a teenage prodigy named Humphrey Davy started huffing it.
And he actually had a box built for himself and
was placed in it for over an hour once, just
huffing nitrous oxide. That I am too, and he did
(10:13):
because that's so dangerous. Yes it is, but this guy
was huffing it like crazy. There must have been like
some escaping or other air getting at something, but he
huffed it for like an hour just for self experimentation.
By the time Horace Wells tried it on a tooth um,
there was a lot of confidence and understanding of nitrous oxide. Um.
(10:33):
He was able to successfully remove his own own tooth
when he demonstrated it. He didn't dose the patient properly,
and the patient apparently cried out, and so Wells had
staked all his reputation on this demonstration just failed utterly
and ended up on skid row in New York. Went
on a chloroform bender and ended up throwing acid on
(10:54):
a couple of women. Was put in, yeah, was put
in jail and ended up committing aside by slashing his
fomoral artery with the razor from a shaving kit. But
he was on chloroform, so he was anesthetized ironically when
he died. Oh well that's good. Weird, Yeah, what it's
strange history. But so the point is in in the chloroform,
(11:18):
nitrous ox side in ether all emerged to form anesthesia. Yeah,
and um, I mean it would have come around eventually,
but it's not so different today. Like I said that,
we're still using heavy duty drugs to knock people clean
out and monitor them so they don't die from it.
It's pretty crazy. Well, what one other thing about the
(11:39):
introduction of anesthesia is that it took another fifty or
so years before the medical establishment said yes, we need,
we need to use this widely and and as part
of standard and best practices. And part of that was
because pain was seen as necessary. It was a sign
that the patient was alive, was still idle. Um, there's
(12:01):
a bit of a macho edge to it from what
I understand. Uh. And then um, there was also a
reluctance to draw attention to the fact that surgery is
extremely painful. Yeah, because they didn't want people to not
go to the doctor much. Yea. So it took like
fifty years to catch on. So imagine being one of
those patients where the modern medicine is well aware of anesthesia,
(12:26):
but it hasn't adopted it yet. That's worse than being
a patient before they understood there was such a thing
as anesthesia. Yeah, Or imagine being because there was a
lot of figuring it out along the way, you know,
as far as dosage and stuff like that. Because so
there are a lot of you know, unwitting guinea pigs.
I guess there were Doc that hurts, don't take a
(12:47):
little more that, or Doc, I'm dead, you know. Like
you remember the castration episode we did, and they talked
about how they would use opium as an anesthesia, but
it was very easy to accidentally overdose the little boys
when you were removing their testicles. I think the same
thing happened when you were cutting off a man's leg
(13:07):
in the Civil War. Wait, removing testicles. Yeah, for castration, circumcision.
The castration said circumcision, man, We've we've done both. Yeah,
But I thought I was like, man, I thought circumcision
was something different. No, that's that means the circumcision is
going horribly awry. Yeah. Man, we've covered some gruesome stuff.
(13:27):
We really have, you know. All right, well, I guess
we'll take a break here and talk about some of
the different methods UH of anesthesia right after this. All right,
(13:52):
before we broke, we teased you a little bit with
the different types, and here we go. And up first
is my favorite twilight sleep. UH. If you've had your
wisdom teeth out or maybe an endoscopy. Um, there's plenty
of procedures that use it. You might have had twilight
sleep or conscious sedation or twilight anesthesia, and UM, I
(14:14):
had some for when I had my my tooth replaced
my front tooth. And it's always fun because it feels
great going in. You just relish those like ten or
fifteen seconds, and then it feels fun coming out because
you know you don't know what's going on. It's more
fun when you're picking up you're a loved one. Picked
(14:35):
up Emily after her endoscopy and I went in and
I don't know why I didn't think that my video
going already, but she was like, I think everyone's throwing
a party for me. Like what the people behind the curtain.
They're throwing a party. I saw balloons and it was
very cute because they're like so out of it. And
when I came out of my wisdom teeth, I think
I may have told this before, but I my friend
(14:55):
told me that this particular doctor put bunny ears on
you and took a picture because you're all puffed up
and you have bandages around your face. And I was like,
that's not gonna happen to me. I guarantee it. And
I remember distinctly seeing the lady come in with the
bunny ears, put them on my head and get the
polaroid out and said smile, and I just went I
(15:17):
gave a big smile, so that that actually, that's well,
that's definitely twilight sedation, Yes, because you are out of it.
You're but you're still conscious and you're still able to
follow instructions. Yeah, but you don't know that. When you
wake up, quote unquote, you feel like I did nothing happen,
but they're like, no, you were talking to us and stuff.
(15:40):
So weird. It is very weird. Um, the Twilight sedation,
they used virtually the same drugs in a lot of
cases that they used for general anesthesia, right, just smaller doses.
So they'll use a sedative or something like that, like ketamine. Right,
Like we said major drugs. I mean, if you've heard
of you know, falling into a k hole. Uh, that's
(16:04):
the same drug. Yeah, it's just crazy. That's like we're like, oh,
back in the days, they use cocaine on people and
that's nuts, right, Kee, big difference. Um. Yeah, so there's
like ketamine there. They might use something like valium or
at a van or something like that. Um. They'll probably
also use the dissociative, which apparently disconnects your nerves from
(16:29):
your brain. Yeah, that's what value is. Okay, that makes sense. Yeah. Um.
And then also they'll use an analgesic, which is just
another word for pain killer. So you've got all these
strings working in combination, probably given to you intravenously, and
you're a little bit wasted. But the point of twilight sleep,
and the thing that that um, that separates it from
(16:50):
other types of anesthesia, is that you are not so
wasted that you can't breathe on your own, that your
heart beat, your heart can't beat on its own, it
needs to be you'll be monitored, but really they've given
you such a low dose of this cocktail of chemicals
that you're you're still able to do things like smile
when the the dnnis put twenty years on you. Yeah to.
(17:14):
I also remember, Um, when I woke up, I remember
seeing a poster that said locomotive Lasagna on the wall,
and Um, of course it didn't say that unless they
went so far to like switch out posters to mess
with you. I could see that because this didn't clearly
had a sense of humor. It's putting bunny ears on people.
(17:35):
It's like Tim Watley from Seinfeld. Yeah, but I was
a little kid, you know. You know, I've never even
had a drop of alcohol, so I've never had my
head altered in anyway. So I was like, this is crazy.
Did you start going to dentist every Friday at all?
Fifty wisdom teeth removed? You're like, I know there's another
one in there. Uh. The only uh. The other good
(17:56):
thing about UM the Twilight Sleep is it's not going
to have the after effects is general like, um, probably
won't be nausea, have nausea or dizziness or vomiting. Maybe
a little bit like they will give you a prescription
probably but um, you probably want need to use it, right,
you know, Yeah, anti nausea stuff. So that's uh, that's
twilight sleep a k A procedural sedation. I don't know
(18:19):
if we ever called it that. That's the clinical term
for it. Twilight sleep is the prettier name for it. UM.
Then there's also a local anesthetic, which is the other
common type of anesthesia UM, where basically a is a
small area or a specific region of the body is
um basically numbed. Yeah, that's when you get the worst
(18:41):
thing that can happen to you in life, which is uh,
shots into the gum, a needle in the gum in
the dentist, which is why the dentist will frequently use
a topical um. A topical anesthesia. It helps a little, right, Uh,
so that they'll it will numb your gum when they
put the needle in. Yeah, they'll put like that gel
(19:03):
and that will them in a little bit. Or if
you're getting sometimes like an ivy in the arm, they'll
spray it with the cold stuff and that all helps,
for sure. It does. You'll still feel the pressure of
the needle going into your jaws, but you don't feel
the pain, right and the the reason why these things
work is, Uh, they a local anesthetic actually goes to
(19:25):
the area it's delivered to and blocks the nerve receptors.
It actually keeps your potassium and your sodium ions um
from firing, right, which means that it's not conducting electricity,
which means that your nerves aren't capable of passing along
the sensation of pain to your brain. They're just shut down.
That's what a local anesthetic does. And if you pay attention,
(19:48):
the local anesthetics all in an ain and for a
pretty good reason, like light decane or no vocaine. Even
they don't use novocaine that much anymore. Um. It's a
derivative of cocaine, and cocaine has a topical numbing effect,
and they used to use it to do that, right.
And then they said, why is everybody showing up to
the dentist all the time? Uh? And then they said, oh, yes,
(20:11):
it's because of the cocaine. So let's figure out a
a synthesized version of it. And they came up with
no vocane, lydocane all that, UM. And they stopped using
no vocane apparently because there were a lot the potential
for adverse reactions was greater UM, but people still do
have allergies to UM local anesthetics once amount, but it
(20:33):
turns out it's not the local anesthetic itself. It's not
the no vocane, it's not the lydocane. What it is
is UM. When you use a local anesthetic, it has
the effect of vasodilation, which means that it makes your
blood vessels relax, which lowers your blood pressure UM, which
is good, but it also is not so good. So
(20:54):
they add epinephrine, which is a vasso constrictor, and it
actually makes the local anesthetic work better. So if you
get a local anesthetic, you're getting the local anesthetic like
Clyda cane mixed with epinefrin and a preservative to keep
the epine and fresh. And it's the preservative that you're
having the adverse reaction to. Yeah, and again just a
(21:16):
well balanced cocktail to give you exactly what you need. UM.
Local is gonna wear off in a few hours, It
depends on how much you have UM. When you leave
the dentist, you know you'll still have your mouth numb
for a while, and they always want you not to
eat or talk too much because UM. You can accidentally
bite your tongue in your cheek and not know it, uh,
(21:37):
which actually happened to me recently, and I did bite
my cheek man a lot, Yeah, bled a little bit too. Yeah,
I'm fine. So it's such just um, it's such just
dental that you're gonna get like a local anesthetic. You
could also be given a local anesthetic for what's called
awake brain surgery. But yes, so in some some type
(22:00):
some brain surgery, you need to be conscious. You can't
be unconscious. They need to keep track of what the
brain is doing and they need it to be in
a conscious state. So they will give you some drugs
where you're not necessarily like you you might be sedated
in the like you might be on a little bit
of valium or something like that, but you're not. You're
still conscious, you're still able to respond to questions. But
(22:22):
they give you a local and aesthetic because they take
the top of your head off and work on your brain.
I think it's in Hell Raiser there's like awake brain
surgery is shown. Yeah, I think I've seen that in
another movie too. Um. Yeah, because they need to be
able to ask you things like in the nuts, can
you believe that your brain is exposed that crazy. Oh
(22:43):
it is weird. Um are we onto regional? I believe? Uh?
Local regional anesthesia is sort of like local, but it's
covers a wider area of your body. Um. So like
if you need your whole leg numbed for an operation,
um and just like a small portion of your leg,
that would be regional. Uh. It's also called a nerve
(23:05):
block basically because they're just taking a single nerve or
bundle of nerves and blocking that. Right, they're going after
like one of the big dad he's rather than a
little one. But again localized. Um. Like if you know
women who have given birth, sometimes we'll get an epidural uh,
and that's what that is. It is injected via catheter
into the epidural space in the lower back. But that
(23:29):
doesn't necessarily mean uh, directly into the spine, which also
can happen with a spinal block, right into that cerebro
spinal fluid, which is about as direct as you can get.
And if you get a c section or maybe hurning
a surgery, and that's when they want you awake again,
um during the surgery, like with epidurals. Chuck I was wondering,
(23:51):
So an epidural, it's in the space outside of the
spinal column um, but it's used to numb you're from
the waist down, like when you're give birth or something
like that. Right, And it's actually a catheter is introduced
in a continuous I V. Cocktails given to your into
your almost your spine, but not into the spine. No,
that would be a spinal right. I wondered, how do
(24:15):
they make it so it's it's your waist down that's
getting numb. Why isn't your waist up? Oh? Like, how
does how do they know the path is going downward? Yes?
So I looked it up and it turns out it
doesn't always. Sometimes it can reverse and numb you from
the waist up, in which case you're in like, that's
a problem because your breathing can stop. Um, your heart
(24:38):
can stop. There's a bunch of stuff that can stop.
But apparently it's extraordinarily rare, but it can happen. Where
like the the intended area is reversed when they give
you an epidural, there can also be complications from the
epidural um that aren't great. Um, hopefully that doesn't happen
giving birth right, well, the same same with this final
(25:00):
as well. Like there there there are complications, like you
can get a meningel infection or an abscess something like that.
I happen to be a friend of ours. That's why
I got dodgy. I didn't want to say it on
the air. I'll tell you after, just write it down, okay. Um, yeah,
I talked about the spinal block. Um, there's a little
(25:22):
bit more risk, like we said, then local obviously like
seizures and heart attacks. Um. And sometimes it doesn't give
enough pain relief and you have to move on to general.
They're like, Doc, this ain't working right. Um, can you
just knock me out? Because some patients want to be
awake and some patients don't. And sometimes they will defer
(25:44):
to you on that. Who will defer to who? The doctor?
And like you want to be awake for this or not,
especially during childbirth, to like give me the drugs, give
me the drugs or the common refrain, yeah, or I
want to be awake at least, um, but give me
the epidural. Uh. Like I'll go in thinking natural childbirth
(26:06):
is the way to go, and then I changed my mind,
which is, hey, that's you're right, Yeah, sure, given birth,
you should do it. However you want to totes at
home in a tub, uh water boat with a goat.
Very funny. Uh So, Chuck, you had a pretty great
segue that we just trod all over into general anesthesia again.
(26:31):
The big Daddy is what I think most people call it.
That's when you're put under, and that is when you
are out. You don't remember anything, you're asleep, you're you're unconscious,
and that's the one where they don't completely understand how
it works, which is a little scary. It is a
little scary UM and there have been people who have
tried to figure out how to quantify it UM using
(26:53):
magical boxes and trans magnetic transcranial magnetic stimulation stimulation, and
I flubbed that one the thinking yeah, um, but ultimately
we just we don't know. So there's there's a there's
a general idea, basically a working theory, and that is
that UM anesthesia the drugs that we use, and it's
(27:14):
a bunch of different ones working in conjunction, but they
depressed the activity of the spinal cord, so you're paralyzed UM.
The brain stem rearticular activating system which is basically they
think responsible for sleepiness and wakefulness that's stimulated or depressed,
depending on your way of looking at it. And then, um,
(27:35):
your cerebral cortex is affected as well, so you're not thinking,
you're not forming memories, you're not um making associations with
any of this, and all of that in conjunction with
one another, comes to anesthesia. General anesthesia, which is utter
and complete unconsciousness. That's right, And it can last a
few hours or up to six hours. Um, if you're
(27:58):
having like serious comp gated surgery. But there is a limit.
They can't just be like this is a twelve hour surgery. Um. Yeah,
I thought there are worse surgeries like that where they're
like the surgery lasted seventy two hours, but the guy
was successfully transplanted. Yeah, that is true. How do they
do that? Because really dangerous to get someone under general
(28:20):
anesthesia for that long. Yeah, that's a good point. I
didn't I meant to look into that. Someone will let
us know. Sure, we'll follow up on that for sure. Uh,
if you are going to be put under general anesthes
you don't just walk in and start huffing the gash.
There there's a lot of work that goes into that. Um,
you have to be invited. You have to be invited
(28:42):
by her. You have to get a a party invite
from your anesthesiologist. Um, you will meet with them and
he or she will basically ask you a bunch of
questions about your lifestyle and your medical history. Are you
a natural redhead? Yeah? Because we covered that in the
Redhead episode. You might need a little more. Are you
a little kid are you? Yeah? I can tell by
(29:04):
looking Yeah, because little kids livers process these drugs a
lot faster, so they need uh higher dose. Basically, Um,
are you a huge alcoholic? Not? Well, depends on what
you say, sir. Are you heroin addict? Not anymore? So,
like the depending on the answers to these questions, they're
gonna need to adjust your dose depending do you have
(29:26):
low blood pressure? High blood pressure? Yeah? And this is
where you want to be super honest about your drinking
and drugs. Yeah. If you're a heroin addict, you need
to fast up. You can be like, hey man, can
you be cool and keep a secret? You don't like
lie like you do to your shrink, Right, you know
you really want to be honest because you want this
to work well and be safe. Um. After they have
all that, they're gonna basically, um, put together your your
(29:50):
program on what you're gonna need, and then they're going
to tell you not to eat because if you eat
before you go under anesthesia, you can aspirate and basically
breathe in what's in your stomach. So this is not
everybody believes this any longer, supposedly about eating before surgery.
There's what I understand is that when there are so
(30:15):
few cases of aspiration under anesthesia, especially twilight sedation, because
that well, no, oh, yeah, that's a pretty good that's
a good point. I hadn't thought of, um, but apparently, well, yeah,
you just answered that question. You say, Well, from what
I understood, there was a study that looked at all
these different um the cases of aspiration and found it's
(30:38):
very rare. And they concluded that the danger, the potential
danger of aspirating under sedation is low enough that it's
it's outweighed by the benefits of eating. Because if you
don't eat and you undergo sedation on an empty stomach,
which is what they want you to do, it's a
lot harder on your system. You're much or likely to
(31:00):
be nauseated, to vomit afterward, be dizzy, whereas if you
eat something, you can your body can process these drugs
a little better. So are they advising people to eat now.
I think that they're starting to get to that point,
but I don't believe it's like current widespread practice. Yeah,
I don't think I would. I don't know, Maybe I'm superstitious.
I don't know if i'd be chowing on a burrito
(31:22):
before I go in for my heart surgery. Well, just
for the surgeon's benefit, I think you might want to
avoid burritos before going under for being knocked on content. Yeah,
you're right. Um, you will be wearing a breathing mask
when you're under general anesthesia or a breathing too, because
uh you basically your your muscles are so relaxed that
(31:43):
your air was airways won't stay open. So that's a
little creepy in itself. Um. And they're going to monitoring
lots and lots of things while you're under there in
the room, and probably have an assistant in the room
with them to monitor all this stuff like blood pressure,
heart rate, O two levels, um CEO two levels, temperature,
(32:06):
brain activity, and there's even a little alarm if you're
O two level drops, which is great. I think they
should have an alarmed for everything. Yeah, you know, the
more alarm is better in that case. And I guess
we should talk about the four stages um of general
anesthetic YEP. Stage one is the induction stage, or the
one you were talking about those fifteen seconds where you're
like pure bliss, right uh, and then stay that quickly
(32:30):
moves to stage two, which is the twitchy stage where
you're just kind of like well twitching, it's your body
going like what the heck is going on? What is this?
And then you move quickly to stage three, which is
the stage that they're after, where you're not twitching anymore,
you're not conscious any longer, and you are under a
(32:50):
state of general anesthesia. You're anesticized, right uh. And this
is where you want to be. But there is, like
you said, a fourth stage. You don't want to go there. No,
that's the over dose stage. And once you're in this stage,
it is now a medical emergency and you have to
be managed brought out of before you suffer brain damage
or death or all sorts of other problems. Yeah, and
(33:12):
I remember when I read this the first time, I thought,
why did they even have this fourth stage? I don't
think they think it's just there. Yeah, but it's you know,
anesthesia is a thing. It doesn't mean like if you
don't have a great anesthesiologist, there can be that fourth stage.
I think even with a good anesthesiologists having a bad day,
(33:32):
things can happen. You know, Um, I hit a squirrel
and now this guy is dead. When you do go under,
you are um, like I said, gonna get the gas
or an ivy or both. Um. There are lots of
different drugs that they will combine again, katamine, valium, sodium pentethal. Well,
(33:53):
the go to is they're going to knock you out
first with the I V usually and almost across the
board it's propafile Michael Jackson's milk, that's right, Uh, And
that's what they do to initially knock you out. And
then they're gonna put ad that. He actually needed that
to sleep and it didn't even work. It's a crazy thing,
like he was so wound up that even probe fall
(34:14):
wouldn't work. Unbelievable. Um. You might also get a muscle
relaxer to make sure that paralysis really takes hold. Yeah,
and if this is all kind of familiar, go back
and listen to our lethal injection episode, because that is
stage four and technically stage five and general anesthesia is
(34:39):
lethal injection. Yeah, that's again, that's why this is so nuts.
Is there there almost killing you? Yeah, well maybe that's
overstating it, but they're they're not bringing you to the
brink of death, but they went to close enough to
where you're out. You know. Um, after surgery, Um, you
don't just get up and dance out of the room.
(34:59):
You're gonna go to the pack you the post anesthes
anesthesia care unit, and then you're gonna keep getting monitored.
You're gonna be dehydrated and cold because you're heading toward death,
so they're gonna warm you up some warm I v s.
There are also some drugs that they've started to use. Now, Um,
I had some oral surgery and you mean picked me up,
and I can't remember any of the stories or whatever,
(35:21):
but I remember going from being out to just being
totally with it. And apparently I've been given a drug
that's like a revers sedation drug to wake you up. Yeah,
there's one called flu mazanell, another called nax alone, and
it's just basically they also used them for overdoses of
certain kinds in the e R. But they can use
(35:41):
them post sedation to get you going again pretty quickly.
They stick it directly into your heart. Yeah, just sit
up and inhale deeply. It's not like I had that
when I had mine. Yeah, I'm cutting edge. Yeah. Uh,
I still couldn't eat ahead of time. Oh really, yeah,
(36:04):
but you did anyway, You're like, I read that it
was fine, I could have a breed. Um. You might
actually get a little morphine too for the pain after
your room. Yeah. Um, but you might also have those
side effects like we talked about with the vomiting and nausea. Um,
and maybe we're pretty out of it, you know, Yeah,
(36:25):
you might fall over if you get up to use
the bathroom. There is a help. There's a probably the
worst potential side effect of anesthesia possible. It's something called
anesthesia awareness. And we'll would say death, but we'll talk
about both of those, right, we'll get into both after this, So, Chuck,
(36:57):
we're gonna talk about anesthesia awareness, but we should probably
talk about anesthesiologists first, right, Yeah, there's um many levels
of anesthesiology g jobs. You can be an anesthesiologist full blown,
which means you've gone to PREMD undergrad, you've gone to
med school, you have done your to year residency. Sometimes
(37:21):
three in your income goes to malpractice insurance doesn't really
I would guess not that much, but a lot um
and you can. I didn't see where you had to
be certified, but you were eligible to take the A
B A exam I think, and that I think if
you want to be a physician an stysiologist, you actually
(37:43):
have to be certified. All you have to do is
be able to say anthologists correct, Actually that's not true.
It's physician. Anesthesiologists are certified and most of these physicians
an aestusiologists um do a one year of specialty training
as well. Um with either there are several different subspecialties
(38:04):
like hospice and palliative medicine, critical care medicine, and pain medicine.
So basically just it's almost like postgraduate graduate school. Or
you can be an assistant, which means you have your
four year undergrad in pre med and then you've gone
through an accredited program and then take an exam. Or
(38:25):
you can be a nurse anesthesia anesthesias anesthetist. Anesthetist, Man,
that sounds like such a dope. It's this is some
tough words, man. I know. It's a lot of stuff
going on in there, a lot of teas and ages.
And that means you're a registered nurse who has completed
UM a training program which last two to three years.
(38:49):
You're gonna have to have your b s. Degree and
at the end of one year of practice experience UM
is when you go through that training program and take
an exam, so again many years. It's like serious, serious stuff.
It's not like, oh, I want to you know, I
want to be a doctor, but I don't want to
go through all the schooling, so I'll just be an anesthesiologist.
(39:09):
I want to have access to the finest drugs available
on the planet Earth. Right now, it's still serious, like
you're a doctor, you know, well, you're not like you're
any lesser of a You're a nurse. What do you
mean And an estatistic said, was a nurse? I No,
I'm just talking about all of those jobs require lots
and lots of schooling. It's not like the easy way out,
I certainly hope. No, No, it's very serious. Job. Okay,
(39:33):
so it is a very serious job. Again, we said
you are being brought to the brink of death or
stupor unconsciousness or whatever you want to call it, and
then brought back without any side effects as few side
effects as possible. That's right, and certainly no lasting side effects.
But there is something. There's a pernicious UH syndrome that
(39:56):
doctors have been aware of, the anesthesiologists have been aware
of at least since the six these, which is called
anesthesia awareness. And basically, anesthesia awareness is where you are
given anesthesia, which includes a paralytic which means you can't
move your body at all UH, and your eyes have
(40:16):
been taped shut so you can't see, but you are conscious.
You are aware during surgery, so you're the pain killers
would have probably worked too, but something went wrong and
you're not unconscious, so you're able to form memories. You're
able to hear the doctors talking about you like you're
a piece of meat. You're able to hear the cutting,
(40:37):
the squishing, the tearing of your organs being moved around.
You can smell the singed hair and claterized flesh. You're
able to feel genuine fear in some cases if the
pain reliever hasn't worked, you're able to experience this excruciating
pain and you're not able as badly as you want
(40:58):
to to alert and anybody on the surgical teams like
you're locked in that you're, yes, that your experienced. It's yes,
you're It's like performing surgery on a locked in person. Yeah,
without any kind of pain killer or anything like that. Yeah.
I didn't know your eyes were taped shut during surgery either, because, Um,
you never see that on TV shows, do you. I've
(41:19):
never noticed that. Uh, yeah I don't. I've seen it before,
but I'm probably on like one of those like remember
they used to have real surgeries on Any Discovery in
the early days. Yeah, back when they were doing stuff
like that. I looked into that though, and um, that's
for a couple of reasons. Obviously, to keep the eyes
from drying out, because apparently eyelids do not close in
(41:42):
fifty of patients when under general anesthesia. They'll just say
it's so as to keep the eyes from drying. And
I didn't realize this is to prevent corneal abration. Apparently
that had been or can be a real problem. Um,
even if your surgery is not on your eyes. There's
just a lot of activity around your face like a
(42:03):
stethoscope and scratch your eye or yeah, a lot of
stuff can happen. So we'll take your eyes shut, so
they tape it shut so you can't see. But again
you can still here. You can still feel and even
if you're not feeling pain, you can still feel the pressure. Remember,
even with like a local and aesthetic, you can't feel
the pain, but you can feel the pressure of the
needle going in your jaw. This is the same thing
(42:24):
with like stomach surgery or your heart being taken from
your chest or what have you. Um So a lot
of people, apparently, studies have found since the sixties that
about two out of every thousand patients or centuries will
experience anesthesia awareness. Yeah, they said that's super rare. That's
(42:44):
not rare enough for now. I was hoping to see
like one in a hundred thousand or a hundred million. Yeah, yeah, No,
it's like two out of every thousand, and supposedly seventy
of people who experience anesthesia awareness suffered from clinical petz TSD,
which is five times more than soldiers returning from Iraq
and Afghanistan. And we're getting this stuff from an Atlantic
(43:07):
article called Awakening by Joshua Lang. Just go read it.
It's um it's a really great article. Yeah, they gave
this one case. There's a bunch of cases in there,
but this one. Um. Sherman Sizemore Jr. Was a Baptist
minister and coal miner, former coal miner. He's seventy three,
and he had exploratory uh laparotomy that right in two
(43:29):
thousand six. And any kind of exploratory surgery is you know,
it's not fun because they're basically looking around for stuff, well,
moving things around. Yeah, they cut away like the flesh
and his belly fat and all that stuff. And we're
looking um at the the film that holds your guts
in place. Yeah, they're poking around in there and um.
(43:51):
He of course had interoperative recall, which is another term
for anesthesia awareness, that's right, and he um Basically his
family couldn't understand what was going on with them. You
know a lot of times you'll have these bad dreams,
these nightmares about blood and people coming at you and
trapping you, and it's it's severe PTSD. And he eventually
(44:16):
uh killed himself even though he had no history of
psychiatric illness. Within two weeks of his surgery, yeah, shot
himself dead. And his family had settled with a lawsuit
because they claim that no one even said that this
could happen or you should see counseling or anything like that.
So sad. Oh, yeah, it's very sad. Supposedly, people who
(44:36):
suffer from PTSD, from anesthesia awareness um almost across the board,
can't lay down and sleep. They have to sleep in
chairs because laying down with uh memories of you know,
being on the O R table. It's uh yeah. And again, anesthesiologists, philosophers,
any kind of scientists, they don't know how this is
happening because we don't understand consciousness, so we don't understand
(44:59):
the mechan aism that produces unconsciousness. And then even further,
we don't understand when that mechanism that's supposed to produce
unconsciousness fails to produce unconsciousness and someone remains conscious and
experiences anesthesia awareness. Yeah, I would think there's got to
be some fail safe for this. Untake the eyes midway
(45:22):
and say like blink, if you can feel me, feel this,
but you're you've been paralyzed. You can't move, you can't
even blink. It seems like they should. It's got I mean,
I don't know. It seems like there's gotta be something
that could do, Like there's a machine that has to
breathe for you because your lungs can't even move well.
And that's why they take your eyes shut to begin with.
(45:42):
I guess because you can't blink. That's creepy that people
like their eyes remain open. Yeah, I wonder it's like
the mom from Throw Mama from the Train, Like even
if you can't blink, I wonder if there's any kind
of sign like that you could give. Well. So in
this awakening Um article they talk about there was a
guy who like came up with this box that was
(46:04):
meant to it gave like a number between zero and
a hundred that supposedly reflected a level of consciousness to
be used in the operating room for anesthesia, so that
that anesthesiologist could be confident that somebody wasn't experiencing anesthesia awareness.
And they found that it doesn't really work. So there
are there are people who have undertaken this quest to
(46:28):
two basically show somehow there's some outward sign of whether
someone's conscious or not. But we just haven't licked it yet. Yeah.
I can't believe there's not some sort of machine that
could pick up on that. But they've tried, or maybe
they're just like, uh, it's two in every thousand. Yeah.
I can live with those numbers and that that's no,
that's not that's way too common, man. That scares me
(46:51):
to death. Yeah, well you said that's the worst thing
that can happen. I vote for death is the worst thing. UM.
In the nineteen forties, uh, for every one million patients
who had full anesthesia, six hundred and forty of them died.
By the eighties, that was down to four for every million,
which to me, that's good and rare, four out of
(47:12):
every million. Yeah, but that number is actually scarily on
the rise since the nineteen eighties. UM a German publication
called Deutscheses uh arts ablat it's the German Medical Association's
UM science journal, and they said that worldwide death rate
is on the rise to about seven now per million,
(47:35):
and the number of deaths within one year after general
anesthesia is one in twenty or if you're over sixty
one and ten what and that's within the year after. Yeah,
but even still that's not good. No, and that that
doesn't necessarily mean that's due to the anesthesia, because they
make the point that it's not like the quality of
(47:55):
anesthesiological care is different. It's that older people are having
surgery these that's that's so good point. Yeah, that's probably
what it's due to. But yeah, I mean they said,
for a patient to actually die on the operating table
is super super rare from anesthesiology. Um, it's apparently much
(48:15):
more common to experience anesthesia awareness two and every thousand.
Why don't they say one in five? Yeah, really trying
to you know, when every thousand nah, and that's not
one in five patients surgeries. There's a lot more surgeries
(48:36):
than patients. Yeah. And you know when you go, when
you take your pets in, they undergo general anesthesi too
for surgery. They always say like your pet could die,
like it's rare and it happens this often. But um,
it can happen. And you know, you have to sign
the waivers and that's always especially if of an older animal.
It's a little bit of a quandary you're in, you know,
(48:59):
whether or not to get the surgery. Is it worth
the risk? All that stuff? That's all I got. I
got nothing else to Uh, it's anesthesia. If you are
feeling confident about spelling that word correctly, go ahead and
type it into the search bar at how stuff works
dot com. And I said search for everybody, which means
it's time for a listener mail. Uh, this one, I'm
(49:22):
gonna call ESP. We heard from a lot of people
on this one so far. Yeah, but it wasn't as
bad as I thought. No. Um, hey, guys, just listen
to ESP. It was great as usual. Your podcast help
me get through my work day and make me laugh
because I learned new and random things. With regards to
ESP or whatever people want to call it. I don't
know if I believe in it exactly, but I do
(49:42):
strongly believe that some individuals are much more intuitive or
connected than others. Uh. And here's an example. When I
was eleven, my mother died. We were living in Vancouver
at the time, and she had died at home. We
had not yet called any of the family to notify
them until a few hours later. But about fifteen minutes
after she passed away, my paternal grandmother, who was in
Hong Kong called and said, is Lana okay. I suddenly
(50:04):
got a very strong and bad feeling about her, and
I thought I should call uh. And again we hadn't
told anyone yet and it had only been fifteen minutes.
My grandmother has always been very intuitive. It always felt
like no matter where our family was, she always somehow
had her eye on us in a comforting way, not creepy. Right.
She points out she was devout in practicing Buddhist her
(50:25):
whole life, and it is partly her devotion to Buddhism
somehow makes me believe that she was a soul deeply
connected to the rest of the world. Uh yeah, kind
of cool. YEA explain that I think we pointed out
in the ESP podcast that probably the likeliest explanations that
the Buddha hands it out to his most devout followers.
There you have. It looks like granny Uh. I don't
(50:47):
have her last name, but that is from Joy and
can in Hong Kong. Uh. That's right, even though Joy
is in Australia can Canberra, Canberra, Canberra, Australia and Thesia,
Hong Kong. Joy. Thanks Joy, Yeah, thanks a lot. Joy.
That's a good story. Uh, and we got some like that,
(51:09):
Actually didn't We probably more of those than Peter doesn't work.
We got very few of those. I was really surprised. Yeah,
I thought we did a good job of laying it
out there. Uh. Well, if you want to share a
good family story like Joy did, you can tweet to
us at s Y s K podcast. You can join
us on Facebook dot com, slash stuff you Should Know.
(51:31):
You can send us an email to Stuff Podcast at
how stuff Works dot com, and you can visit our
home on the web, Stuff you Should Know dot com
for more on this and thousands of other topics. Does
it how stuff Works dot com
Welcome to you stuff you should know from house stuff
Works dot com. Hey, and welcome to the podcast. I'm
Josh Clark. There's Charles W. Chuck Bryant. There's Jerry, who's
about to go to the hardware store any second now,
which no, Jerry doesn't find that very funny. Yeah, I
(00:23):
give the background there or to leave people wondering, well,
we need a trash cannon and dimmer background. But we've
been asking for I feel like months, but yeah, it
can't be months because we haven't even been here that long.
It's been like four days. But what what? What's the
problem here? Why isn't there any movement on this? There's
a home depot a thousand yards Crossromt. Yeah. I specifically
(00:46):
didn't mention their name, but yes, it is the closest
well in Orange big box hardware retailer. We could also
support local business and go to an ACE instead, yeah,
or we could just talk about and it's like we're
supposed to. ACE is a big chain too, though, Yeah,
but I think they're locally owned. Oh right, like Henry's
(01:07):
ACE Hardware. Sure. I like, Yeah, it's good stuff, very helpful,
very very knowledgeable staff, much more helpful. Than some of
the other big Bucks their orange and blue. Okay, that
was a great start to Uh, Chuck, Yes, do you
(01:31):
know how to spell anesthesia? I haven't. I struggle. It's
one of those And in fact, when you were out
of the room getting your coffee, Jerry was asking how
to spell it. I know, and I think she spelled
it right or maybe missed a letter. And Jerry, I
think she put an A where there was supposed to
(01:51):
be an E. Oh well, I think that it used
to be an accepted spelling. You know how in some
uh distant times, the forties the thirties, which Jerry identifies
with and like, anesthesia would have been spelled with an
A E rather than just an E because there was
another sound that. Yeah, it is a tricky one them.
(02:12):
Uh okay, Well, then my next question, Chuck, do you
know what anesthesia means? I do. Uh. It's from Greek,
like a lot of medical terms, and this one stands
for the loss of sensation. And uh, we'll talk about
our personal experience as I assume, but I've never been
under general anesthesia. Yeah the big Daddy, Yeah, fully under view. No,
(02:36):
so neither one of us has had major surgery like
that then no knock would yeah, because after doing some
research on this, like, I don't know that I ever
would want to It's scary, I mean. And let me
just say also to anybody who is listening to this
prior to undergoing a surgical procedure that requires general anesthesia,
(02:57):
we don't mean to scare you know, but because it's uh,
we'll talk about rate of death and and problems with it,
which there are still but it's super safe now for
the most part. But when you when you when I
was reading this, I was like, man, what they're doing
is is like bringing you toward death and then stopping
(03:18):
at a certain point, yeah, and just letting you hover
there then bringing you out when they're getting with a
lot of like crazy heavy heavy drugs that are only
slightly different from what they used in the like early history,
which we're about to talk about. But it's really like
it's it's kind of nuts that and they still don't
know exactly how it works. And the reason why they
(03:39):
don't know how it works, especially we understand local anesthesia
and um twilight sedation, sure, well we don't understand is
general anesthesia. And the reason why we don't understand because
we don't understand how consciousness works, so how can we
understand how unconsciousness works. Yeah, it's pretty weird, and which
is what it works? Yes, it definitely does, and although
(04:03):
there are some risks associated with it, it is far, far,
far better than the alternative, which is no anesthesia, which
was the way it was for a very long time.
I mean anesthesia is a relatively recent thing. Or getting
you super drunk, or hitting you in the head and
knocking you unconscious, which is not so knocking you unconscious
(04:23):
that qualifies anesthesia, but it's still not medical anesthesia. Giving
you drunk, giving you morphine, giving you marijuana, jim some weed, um, yeah,
rubbing stinging nettles on you to distract you from the
pain of having your leg cut off, belladonna, using ice,
all the stuff. These are so horrifics. These are narcotics.
These are just plain old distractions, um, but they don't
(04:47):
qualifies anesthesia. And the big difference, the the thing that
was such a huge, huge progression forward um with anesthesia
is that it doesn't just dull the pain. It dulls
the pain, it takes away your consciousness and it also
prevents you from creating memories during this experience, it gives
you amnesia. So it basically cuts a chunk out of
(05:10):
your lifetime that as far as your subjective experience goes,
does not exist. It didn't happen like you were on
the gurney going into the O. R room and you
wake up and you're in the hospital bed and you
have stitches, but there is nothing there in between, ideally
for general anesthesia, right, And that's how we can conduct surgery,
(05:33):
because before that there was surgery, but it was very
rare and it was very very awful. Yeah, and when
you know, we flew by some of those, but um,
we did mention a lot of this, uh sopaphorics and
narcotics that they use. They did knock you in the head,
they did get you drunk. Um. In fact, in the
mid forties, those were you know, opium and alcohol where
(05:55):
the two go toss like and a towel to bite on,
I guess, and just to make you like be able
to tolerate the pain, which didn't really help. No, I
mean I'm sure it helped. Uh, it dulled the pain,
but it's not gonna do what you want, which is
to kill it completely or knock you out. Or render
you an asiatic an asiatic right, um. But the so
(06:19):
the those were the two go to that they use.
I mean there were other ones to like um blood
lighting until a stupor or basically a coma was induced,
like you lost so much blood that's pretty dangerous. But
these were the These were the go to um pain
killers for surgery, and they still didn't work very well.
(06:39):
But what's weird is in the eighteen forties all that changed,
like not one, not two, but three anesthesia is UH
came into We're basically discovered for medical use, like almost
all at the same time. Yeah, people now they basically
(07:00):
say Crawford Long from right here in Georgia, University of
Georgia graduate fellow bulldog. UH. He was the first. He
performed a surgery removed a tumor from a neck from
a mr A bentable in UH late March eighteen forty two,
and also later did an amputation in a childbirth with
(07:22):
ether and UM. He was he was the guy, but
he was you know, it was pretty regional and people
just didn't know about it. Basically. I all think it's
the impression that he wasn't as much of a self
promoter as Dr William Morton. Uh, yeah, he did um
well William Morton in eighteen forty six. We might as
(07:42):
well go ahead and say he demonstrated it for the
first time in like a public surgical theater, right, and said,
here is what I'm doing, and this is new and
it's exciting, and I'm in Massachusetts on not some yokel
in Georgia pretty much, and that's how he gained the acclaim.
But yeah, I guess Crawford Long was able to prove
that he'd done he'd used ether earlier. He's just like
(08:02):
it just wasn't being a big shot about it. I
was just using it. But you know, he discovered ether
by hanging out with friends who were huffing ether at
a party and supposedly he saw one guy run into
a door and like cut his head open, and Crawford Long,
being a doctor, was like, are you okay? And the
guy was like, what are you talking about? With like
(08:23):
blood spurting out of his forehead, and Crawford Long went,
that's pretty funny. Uh. And he went on to uh
tell Congress about it, as did doctor Charles Jackson, who
said that he had done it before Morton as well.
They both independently went to Congress. I was okay, man,
I did that first. All right, it's a bit of
(08:43):
self promotion. Ye, but Morton is the guy who gets
who gets the credit. He's the one who really introduced
it to the public. Well, it gets your credit as
the first demonstrator. Yeah, he's the one that you hear
of typically. Yeah, I would say Crawford Long though. Yeah,
I guess you're right. Yeah. Lots of hospitals named after him,
at least one here, although now no it's not cropfit
(09:04):
Long anymore. Did they change it, yeah, to home depot um.
So a little bit later on, there was a dentist,
Dr Horace Wells, who used the first dude to use
nitrous oxide bull teeth, and then chloroform was used by
Dr James Simpson and these things. You know, you don't
(09:26):
want to be using that though, it's toxic. So Dr
Horace Wells actually is a pretty interesting story. It's where
chloroform um and nitrous oxide converge as a beautiful place.
So he tried. He extracted one of his own teeth
on nitrous and was like, this is great. Did you
read that history of Hippie crack article? Yeah, so this
(09:48):
all came after somebody, a guy named Joseph Priestley in
the eighteenth century synthesized nitrous oxide, and then very shortly
after that, a teenage prodigy named Humphrey Davy started huffing it.
And he actually had a box built for himself and
was placed in it for over an hour once, just
huffing nitrous oxide. That I am too, and he did
(10:13):
because that's so dangerous. Yes it is, but this guy
was huffing it like crazy. There must have been like
some escaping or other air getting at something, but he
huffed it for like an hour just for self experimentation.
By the time Horace Wells tried it on a tooth um,
there was a lot of confidence and understanding of nitrous oxide. Um.
(10:33):
He was able to successfully remove his own own tooth
when he demonstrated it. He didn't dose the patient properly,
and the patient apparently cried out, and so Wells had
staked all his reputation on this demonstration just failed utterly
and ended up on skid row in New York. Went
on a chloroform bender and ended up throwing acid on
(10:54):
a couple of women. Was put in, yeah, was put
in jail and ended up committing aside by slashing his
fomoral artery with the razor from a shaving kit. But
he was on chloroform, so he was anesthetized ironically when
he died. Oh well that's good. Weird, Yeah, what it's
strange history. But so the point is in in the chloroform,
(11:18):
nitrous ox side in ether all emerged to form anesthesia. Yeah,
and um, I mean it would have come around eventually,
but it's not so different today. Like I said that,
we're still using heavy duty drugs to knock people clean
out and monitor them so they don't die from it.
It's pretty crazy. Well, what one other thing about the
(11:39):
introduction of anesthesia is that it took another fifty or
so years before the medical establishment said yes, we need,
we need to use this widely and and as part
of standard and best practices. And part of that was
because pain was seen as necessary. It was a sign
that the patient was alive, was still idle. Um, there's
(12:01):
a bit of a macho edge to it from what
I understand. Uh. And then um, there was also a
reluctance to draw attention to the fact that surgery is
extremely painful. Yeah, because they didn't want people to not
go to the doctor much. Yea. So it took like
fifty years to catch on. So imagine being one of
those patients where the modern medicine is well aware of anesthesia,
(12:26):
but it hasn't adopted it yet. That's worse than being
a patient before they understood there was such a thing
as anesthesia. Yeah, Or imagine being because there was a
lot of figuring it out along the way, you know,
as far as dosage and stuff like that. Because so
there are a lot of you know, unwitting guinea pigs.
I guess there were Doc that hurts, don't take a
(12:47):
little more that, or Doc, I'm dead, you know. Like
you remember the castration episode we did, and they talked
about how they would use opium as an anesthesia, but
it was very easy to accidentally overdose the little boys
when you were removing their testicles. I think the same
thing happened when you were cutting off a man's leg
(13:07):
in the Civil War. Wait, removing testicles. Yeah, for castration, circumcision.
The castration said circumcision, man, We've we've done both. Yeah,
But I thought I was like, man, I thought circumcision
was something different. No, that's that means the circumcision is
going horribly awry. Yeah. Man, we've covered some gruesome stuff.
(13:27):
We really have, you know. All right, well, I guess
we'll take a break here and talk about some of
the different methods UH of anesthesia right after this. All right,
(13:52):
before we broke, we teased you a little bit with
the different types, and here we go. And up first
is my favorite twilight sleep. UH. If you've had your
wisdom teeth out or maybe an endoscopy. Um, there's plenty
of procedures that use it. You might have had twilight
sleep or conscious sedation or twilight anesthesia, and UM, I
(14:14):
had some for when I had my my tooth replaced
my front tooth. And it's always fun because it feels
great going in. You just relish those like ten or
fifteen seconds, and then it feels fun coming out because
you know you don't know what's going on. It's more
fun when you're picking up you're a loved one. Picked
(14:35):
up Emily after her endoscopy and I went in and
I don't know why I didn't think that my video
going already, but she was like, I think everyone's throwing
a party for me. Like what the people behind the curtain.
They're throwing a party. I saw balloons and it was
very cute because they're like so out of it. And
when I came out of my wisdom teeth, I think
I may have told this before, but I my friend
(14:55):
told me that this particular doctor put bunny ears on
you and took a picture because you're all puffed up
and you have bandages around your face. And I was like,
that's not gonna happen to me. I guarantee it. And
I remember distinctly seeing the lady come in with the
bunny ears, put them on my head and get the
polaroid out and said smile, and I just went I
(15:17):
gave a big smile, so that that actually, that's well,
that's definitely twilight sedation, Yes, because you are out of it.
You're but you're still conscious and you're still able to
follow instructions. Yeah, but you don't know that. When you
wake up, quote unquote, you feel like I did nothing happen,
but they're like, no, you were talking to us and stuff.
(15:40):
So weird. It is very weird. Um, the Twilight sedation,
they used virtually the same drugs in a lot of
cases that they used for general anesthesia, right, just smaller doses.
So they'll use a sedative or something like that, like ketamine. Right,
Like we said major drugs. I mean, if you've heard
of you know, falling into a k hole. Uh, that's
(16:04):
the same drug. Yeah, it's just crazy. That's like we're like, oh,
back in the days, they use cocaine on people and
that's nuts, right, Kee, big difference. Um. Yeah, so there's
like ketamine there. They might use something like valium or
at a van or something like that. Um. They'll probably
also use the dissociative, which apparently disconnects your nerves from
(16:29):
your brain. Yeah, that's what value is. Okay, that makes sense. Yeah. Um.
And then also they'll use an analgesic, which is just
another word for pain killer. So you've got all these
strings working in combination, probably given to you intravenously, and
you're a little bit wasted. But the point of twilight sleep,
and the thing that that um, that separates it from
(16:50):
other types of anesthesia, is that you are not so
wasted that you can't breathe on your own, that your
heart beat, your heart can't beat on its own, it
needs to be you'll be monitored, but really they've given
you such a low dose of this cocktail of chemicals
that you're you're still able to do things like smile
when the the dnnis put twenty years on you. Yeah to.
(17:14):
I also remember, Um, when I woke up, I remember
seeing a poster that said locomotive Lasagna on the wall,
and Um, of course it didn't say that unless they
went so far to like switch out posters to mess
with you. I could see that because this didn't clearly
had a sense of humor. It's putting bunny ears on people.
(17:35):
It's like Tim Watley from Seinfeld. Yeah, but I was
a little kid, you know. You know, I've never even
had a drop of alcohol, so I've never had my
head altered in anyway. So I was like, this is crazy.
Did you start going to dentist every Friday at all?
Fifty wisdom teeth removed? You're like, I know there's another
one in there. Uh. The only uh. The other good
(17:56):
thing about UM the Twilight Sleep is it's not going
to have the after effects is general like, um, probably
won't be nausea, have nausea or dizziness or vomiting. Maybe
a little bit like they will give you a prescription
probably but um, you probably want need to use it, right,
you know, Yeah, anti nausea stuff. So that's uh, that's
twilight sleep a k A procedural sedation. I don't know
(18:19):
if we ever called it that. That's the clinical term
for it. Twilight sleep is the prettier name for it. UM.
Then there's also a local anesthetic, which is the other
common type of anesthesia UM, where basically a is a
small area or a specific region of the body is
um basically numbed. Yeah, that's when you get the worst
(18:41):
thing that can happen to you in life, which is uh,
shots into the gum, a needle in the gum in
the dentist, which is why the dentist will frequently use
a topical um. A topical anesthesia. It helps a little, right, Uh,
so that they'll it will numb your gum when they
put the needle in. Yeah, they'll put like that gel
(19:03):
and that will them in a little bit. Or if
you're getting sometimes like an ivy in the arm, they'll
spray it with the cold stuff and that all helps,
for sure. It does. You'll still feel the pressure of
the needle going into your jaws, but you don't feel
the pain, right and the the reason why these things
work is, Uh, they a local anesthetic actually goes to
(19:25):
the area it's delivered to and blocks the nerve receptors.
It actually keeps your potassium and your sodium ions um
from firing, right, which means that it's not conducting electricity,
which means that your nerves aren't capable of passing along
the sensation of pain to your brain. They're just shut down.
That's what a local anesthetic does. And if you pay attention,
(19:48):
the local anesthetics all in an ain and for a
pretty good reason, like light decane or no vocaine. Even
they don't use novocaine that much anymore. Um. It's a
derivative of cocaine, and cocaine has a topical numbing effect,
and they used to use it to do that, right.
And then they said, why is everybody showing up to
the dentist all the time? Uh? And then they said, oh, yes,
(20:11):
it's because of the cocaine. So let's figure out a
a synthesized version of it. And they came up with
no vocane, lydocane all that, UM. And they stopped using
no vocane apparently because there were a lot the potential
for adverse reactions was greater UM, but people still do
have allergies to UM local anesthetics once amount, but it
(20:33):
turns out it's not the local anesthetic itself. It's not
the no vocane, it's not the lydocane. What it is
is UM. When you use a local anesthetic, it has
the effect of vasodilation, which means that it makes your
blood vessels relax, which lowers your blood pressure UM, which
is good, but it also is not so good. So
(20:54):
they add epinephrine, which is a vasso constrictor, and it
actually makes the local anesthetic work better. So if you
get a local anesthetic, you're getting the local anesthetic like
Clyda cane mixed with epinefrin and a preservative to keep
the epine and fresh. And it's the preservative that you're
having the adverse reaction to. Yeah, and again just a
(21:16):
well balanced cocktail to give you exactly what you need. UM.
Local is gonna wear off in a few hours, It
depends on how much you have UM. When you leave
the dentist, you know you'll still have your mouth numb
for a while, and they always want you not to
eat or talk too much because UM. You can accidentally
bite your tongue in your cheek and not know it, uh,
(21:37):
which actually happened to me recently, and I did bite
my cheek man a lot, Yeah, bled a little bit too. Yeah,
I'm fine. So it's such just um, it's such just
dental that you're gonna get like a local anesthetic. You
could also be given a local anesthetic for what's called
awake brain surgery. But yes, so in some some type
(22:00):
some brain surgery, you need to be conscious. You can't
be unconscious. They need to keep track of what the
brain is doing and they need it to be in
a conscious state. So they will give you some drugs
where you're not necessarily like you you might be sedated
in the like you might be on a little bit
of valium or something like that, but you're not. You're
still conscious, you're still able to respond to questions. But
(22:22):
they give you a local and aesthetic because they take
the top of your head off and work on your brain.
I think it's in Hell Raiser there's like awake brain
surgery is shown. Yeah, I think I've seen that in
another movie too. Um. Yeah, because they need to be
able to ask you things like in the nuts, can
you believe that your brain is exposed that crazy. Oh
(22:43):
it is weird. Um are we onto regional? I believe? Uh?
Local regional anesthesia is sort of like local, but it's
covers a wider area of your body. Um. So like
if you need your whole leg numbed for an operation,
um and just like a small portion of your leg,
that would be regional. Uh. It's also called a nerve
(23:05):
block basically because they're just taking a single nerve or
bundle of nerves and blocking that. Right, they're going after
like one of the big dad he's rather than a
little one. But again localized. Um. Like if you know
women who have given birth, sometimes we'll get an epidural uh,
and that's what that is. It is injected via catheter
into the epidural space in the lower back. But that
(23:29):
doesn't necessarily mean uh, directly into the spine, which also
can happen with a spinal block, right into that cerebro
spinal fluid, which is about as direct as you can get.
And if you get a c section or maybe hurning
a surgery, and that's when they want you awake again,
um during the surgery, like with epidurals. Chuck I was wondering,
(23:51):
So an epidural, it's in the space outside of the
spinal column um, but it's used to numb you're from
the waist down, like when you're give birth or something
like that. Right, And it's actually a catheter is introduced
in a continuous I V. Cocktails given to your into
your almost your spine, but not into the spine. No,
that would be a spinal right. I wondered, how do
(24:15):
they make it so it's it's your waist down that's
getting numb. Why isn't your waist up? Oh? Like, how
does how do they know the path is going downward? Yes?
So I looked it up and it turns out it
doesn't always. Sometimes it can reverse and numb you from
the waist up, in which case you're in like, that's
a problem because your breathing can stop. Um, your heart
(24:38):
can stop. There's a bunch of stuff that can stop.
But apparently it's extraordinarily rare, but it can happen. Where
like the the intended area is reversed when they give
you an epidural, there can also be complications from the
epidural um that aren't great. Um, hopefully that doesn't happen
giving birth right, well, the same same with this final
(25:00):
as well. Like there there there are complications, like you
can get a meningel infection or an abscess something like that.
I happen to be a friend of ours. That's why
I got dodgy. I didn't want to say it on
the air. I'll tell you after, just write it down, okay. Um, yeah,
I talked about the spinal block. Um, there's a little
(25:22):
bit more risk, like we said, then local obviously like
seizures and heart attacks. Um. And sometimes it doesn't give
enough pain relief and you have to move on to general.
They're like, Doc, this ain't working right. Um, can you
just knock me out? Because some patients want to be
awake and some patients don't. And sometimes they will defer
(25:44):
to you on that. Who will defer to who? The doctor?
And like you want to be awake for this or not,
especially during childbirth, to like give me the drugs, give
me the drugs or the common refrain, yeah, or I
want to be awake at least, um, but give me
the epidural. Uh. Like I'll go in thinking natural childbirth
(26:06):
is the way to go, and then I changed my mind,
which is, hey, that's you're right, Yeah, sure, given birth,
you should do it. However you want to totes at
home in a tub, uh water boat with a goat.
Very funny. Uh So, Chuck, you had a pretty great
segue that we just trod all over into general anesthesia again.
(26:31):
The big Daddy is what I think most people call it.
That's when you're put under, and that is when you
are out. You don't remember anything, you're asleep, you're you're unconscious,
and that's the one where they don't completely understand how
it works, which is a little scary. It is a
little scary UM and there have been people who have
tried to figure out how to quantify it UM using
(26:53):
magical boxes and trans magnetic transcranial magnetic stimulation stimulation, and
I flubbed that one the thinking yeah, um, but ultimately
we just we don't know. So there's there's a there's
a general idea, basically a working theory, and that is
that UM anesthesia the drugs that we use, and it's
(27:14):
a bunch of different ones working in conjunction, but they
depressed the activity of the spinal cord, so you're paralyzed UM.
The brain stem rearticular activating system which is basically they
think responsible for sleepiness and wakefulness that's stimulated or depressed,
depending on your way of looking at it. And then, um,
(27:35):
your cerebral cortex is affected as well, so you're not thinking,
you're not forming memories, you're not um making associations with
any of this, and all of that in conjunction with
one another, comes to anesthesia. General anesthesia, which is utter
and complete unconsciousness. That's right, And it can last a
few hours or up to six hours. Um, if you're
(27:58):
having like serious comp gated surgery. But there is a limit.
They can't just be like this is a twelve hour surgery. Um. Yeah,
I thought there are worse surgeries like that where they're
like the surgery lasted seventy two hours, but the guy
was successfully transplanted. Yeah, that is true. How do they
do that? Because really dangerous to get someone under general
(28:20):
anesthesia for that long. Yeah, that's a good point. I
didn't I meant to look into that. Someone will let
us know. Sure, we'll follow up on that for sure. Uh,
if you are going to be put under general anesthes
you don't just walk in and start huffing the gash.
There there's a lot of work that goes into that. Um,
you have to be invited. You have to be invited
(28:42):
by her. You have to get a a party invite
from your anesthesiologist. Um, you will meet with them and
he or she will basically ask you a bunch of
questions about your lifestyle and your medical history. Are you
a natural redhead? Yeah? Because we covered that in the
Redhead episode. You might need a little more. Are you
a little kid are you? Yeah? I can tell by
(29:04):
looking Yeah, because little kids livers process these drugs a
lot faster, so they need uh higher dose. Basically, Um,
are you a huge alcoholic? Not? Well, depends on what
you say, sir. Are you heroin addict? Not anymore? So,
like the depending on the answers to these questions, they're
gonna need to adjust your dose depending do you have
(29:26):
low blood pressure? High blood pressure? Yeah? And this is
where you want to be super honest about your drinking
and drugs. Yeah. If you're a heroin addict, you need
to fast up. You can be like, hey man, can
you be cool and keep a secret? You don't like
lie like you do to your shrink, Right, you know
you really want to be honest because you want this
to work well and be safe. Um. After they have
all that, they're gonna basically, um, put together your your
(29:50):
program on what you're gonna need, and then they're going
to tell you not to eat because if you eat
before you go under anesthesia, you can aspirate and basically
breathe in what's in your stomach. So this is not
everybody believes this any longer, supposedly about eating before surgery.
There's what I understand is that when there are so
(30:15):
few cases of aspiration under anesthesia, especially twilight sedation, because
that well, no, oh, yeah, that's a pretty good that's
a good point. I hadn't thought of, um, but apparently, well, yeah,
you just answered that question. You say, Well, from what
I understood, there was a study that looked at all
these different um the cases of aspiration and found it's
(30:38):
very rare. And they concluded that the danger, the potential
danger of aspirating under sedation is low enough that it's
it's outweighed by the benefits of eating. Because if you
don't eat and you undergo sedation on an empty stomach,
which is what they want you to do, it's a
lot harder on your system. You're much or likely to
(31:00):
be nauseated, to vomit afterward, be dizzy, whereas if you
eat something, you can your body can process these drugs
a little better. So are they advising people to eat now.
I think that they're starting to get to that point,
but I don't believe it's like current widespread practice. Yeah,
I don't think I would. I don't know, Maybe I'm superstitious.
I don't know if i'd be chowing on a burrito
(31:22):
before I go in for my heart surgery. Well, just
for the surgeon's benefit, I think you might want to
avoid burritos before going under for being knocked on content. Yeah,
you're right. Um, you will be wearing a breathing mask
when you're under general anesthesia or a breathing too, because
uh you basically your your muscles are so relaxed that
(31:43):
your air was airways won't stay open. So that's a
little creepy in itself. Um. And they're going to monitoring
lots and lots of things while you're under there in
the room, and probably have an assistant in the room
with them to monitor all this stuff like blood pressure,
heart rate, O two levels, um CEO two levels, temperature,
(32:06):
brain activity, and there's even a little alarm if you're
O two level drops, which is great. I think they
should have an alarmed for everything. Yeah, you know, the
more alarm is better in that case. And I guess
we should talk about the four stages um of general
anesthetic YEP. Stage one is the induction stage, or the
one you were talking about those fifteen seconds where you're
like pure bliss, right uh, and then stay that quickly
(32:30):
moves to stage two, which is the twitchy stage where
you're just kind of like well twitching, it's your body
going like what the heck is going on? What is this?
And then you move quickly to stage three, which is
the stage that they're after, where you're not twitching anymore,
you're not conscious any longer, and you are under a
(32:50):
state of general anesthesia. You're anesticized, right uh. And this
is where you want to be. But there is, like
you said, a fourth stage. You don't want to go there. No,
that's the over dose stage. And once you're in this stage,
it is now a medical emergency and you have to
be managed brought out of before you suffer brain damage
or death or all sorts of other problems. Yeah, and
(33:12):
I remember when I read this the first time, I thought,
why did they even have this fourth stage? I don't
think they think it's just there. Yeah, but it's you know,
anesthesia is a thing. It doesn't mean like if you
don't have a great anesthesiologist, there can be that fourth stage.
I think even with a good anesthesiologists having a bad day,
(33:32):
things can happen. You know, Um, I hit a squirrel
and now this guy is dead. When you do go under,
you are um, like I said, gonna get the gas
or an ivy or both. Um. There are lots of
different drugs that they will combine again, katamine, valium, sodium pentethal. Well,
(33:53):
the go to is they're going to knock you out
first with the I V usually and almost across the
board it's propafile Michael Jackson's milk, that's right, Uh, And
that's what they do to initially knock you out. And
then they're gonna put ad that. He actually needed that
to sleep and it didn't even work. It's a crazy thing,
like he was so wound up that even probe fall
(34:14):
wouldn't work. Unbelievable. Um. You might also get a muscle
relaxer to make sure that paralysis really takes hold. Yeah,
and if this is all kind of familiar, go back
and listen to our lethal injection episode, because that is
stage four and technically stage five and general anesthesia is
(34:39):
lethal injection. Yeah, that's again, that's why this is so nuts.
Is there there almost killing you? Yeah, well maybe that's
overstating it, but they're they're not bringing you to the
brink of death, but they went to close enough to
where you're out. You know. Um, after surgery, Um, you
don't just get up and dance out of the room.
(34:59):
You're gonna go to the pack you the post anesthes
anesthesia care unit, and then you're gonna keep getting monitored.
You're gonna be dehydrated and cold because you're heading toward death,
so they're gonna warm you up some warm I v s.
There are also some drugs that they've started to use. Now, Um,
I had some oral surgery and you mean picked me up,
and I can't remember any of the stories or whatever,
(35:21):
but I remember going from being out to just being
totally with it. And apparently I've been given a drug
that's like a revers sedation drug to wake you up. Yeah,
there's one called flu mazanell, another called nax alone, and
it's just basically they also used them for overdoses of
certain kinds in the e R. But they can use
(35:41):
them post sedation to get you going again pretty quickly.
They stick it directly into your heart. Yeah, just sit
up and inhale deeply. It's not like I had that
when I had mine. Yeah, I'm cutting edge. Yeah. Uh,
I still couldn't eat ahead of time. Oh really, yeah,
(36:04):
but you did anyway, You're like, I read that it
was fine, I could have a breed. Um. You might
actually get a little morphine too for the pain after
your room. Yeah. Um, but you might also have those
side effects like we talked about with the vomiting and nausea. Um,
and maybe we're pretty out of it, you know, Yeah,
(36:25):
you might fall over if you get up to use
the bathroom. There is a help. There's a probably the
worst potential side effect of anesthesia possible. It's something called
anesthesia awareness. And we'll would say death, but we'll talk
about both of those, right, we'll get into both after this, So, Chuck,
(36:57):
we're gonna talk about anesthesia awareness, but we should probably
talk about anesthesiologists first, right, Yeah, there's um many levels
of anesthesiology g jobs. You can be an anesthesiologist full blown,
which means you've gone to PREMD undergrad, you've gone to
med school, you have done your to year residency. Sometimes
(37:21):
three in your income goes to malpractice insurance doesn't really
I would guess not that much, but a lot um
and you can. I didn't see where you had to
be certified, but you were eligible to take the A
B A exam I think, and that I think if
you want to be a physician an stysiologist, you actually
(37:43):
have to be certified. All you have to do is
be able to say anthologists correct, Actually that's not true.
It's physician. Anesthesiologists are certified and most of these physicians
an aestusiologists um do a one year of specialty training
as well. Um with either there are several different subspecialties
(38:04):
like hospice and palliative medicine, critical care medicine, and pain medicine.
So basically just it's almost like postgraduate graduate school. Or
you can be an assistant, which means you have your
four year undergrad in pre med and then you've gone
through an accredited program and then take an exam. Or
(38:25):
you can be a nurse anesthesia anesthesias anesthetist. Anesthetist, Man,
that sounds like such a dope. It's this is some
tough words, man. I know. It's a lot of stuff
going on in there, a lot of teas and ages.
And that means you're a registered nurse who has completed
UM a training program which last two to three years.
(38:49):
You're gonna have to have your b s. Degree and
at the end of one year of practice experience UM
is when you go through that training program and take
an exam, so again many years. It's like serious, serious stuff.
It's not like, oh, I want to you know, I
want to be a doctor, but I don't want to
go through all the schooling, so I'll just be an anesthesiologist.
(39:09):
I want to have access to the finest drugs available
on the planet Earth. Right now, it's still serious, like
you're a doctor, you know, well, you're not like you're
any lesser of a You're a nurse. What do you
mean And an estatistic said, was a nurse? I No,
I'm just talking about all of those jobs require lots
and lots of schooling. It's not like the easy way out,
I certainly hope. No, No, it's very serious. Job. Okay,
(39:33):
so it is a very serious job. Again, we said
you are being brought to the brink of death or
stupor unconsciousness or whatever you want to call it, and
then brought back without any side effects as few side
effects as possible. That's right, and certainly no lasting side effects.
But there is something. There's a pernicious UH syndrome that
(39:56):
doctors have been aware of, the anesthesiologists have been aware
of at least since the six these, which is called
anesthesia awareness. And basically, anesthesia awareness is where you are
given anesthesia, which includes a paralytic which means you can't
move your body at all UH, and your eyes have
(40:16):
been taped shut so you can't see, but you are conscious.
You are aware during surgery, so you're the pain killers
would have probably worked too, but something went wrong and
you're not unconscious, so you're able to form memories. You're
able to hear the doctors talking about you like you're
a piece of meat. You're able to hear the cutting,
(40:37):
the squishing, the tearing of your organs being moved around.
You can smell the singed hair and claterized flesh. You're
able to feel genuine fear in some cases if the
pain reliever hasn't worked, you're able to experience this excruciating
pain and you're not able as badly as you want
(40:58):
to to alert and anybody on the surgical teams like
you're locked in that you're, yes, that your experienced. It's yes,
you're It's like performing surgery on a locked in person. Yeah,
without any kind of pain killer or anything like that. Yeah.
I didn't know your eyes were taped shut during surgery either, because, Um,
you never see that on TV shows, do you. I've
(41:19):
never noticed that. Uh, yeah I don't. I've seen it before,
but I'm probably on like one of those like remember
they used to have real surgeries on Any Discovery in
the early days. Yeah, back when they were doing stuff
like that. I looked into that though, and um, that's
for a couple of reasons. Obviously, to keep the eyes
from drying out, because apparently eyelids do not close in
(41:42):
fifty of patients when under general anesthesia. They'll just say
it's so as to keep the eyes from drying. And
I didn't realize this is to prevent corneal abration. Apparently
that had been or can be a real problem. Um,
even if your surgery is not on your eyes. There's
just a lot of activity around your face like a
(42:03):
stethoscope and scratch your eye or yeah, a lot of
stuff can happen. So we'll take your eyes shut, so
they tape it shut so you can't see. But again
you can still here. You can still feel and even
if you're not feeling pain, you can still feel the pressure. Remember,
even with like a local and aesthetic, you can't feel
the pain, but you can feel the pressure of the
needle going in your jaw. This is the same thing
(42:24):
with like stomach surgery or your heart being taken from
your chest or what have you. Um So a lot
of people, apparently, studies have found since the sixties that
about two out of every thousand patients or centuries will
experience anesthesia awareness. Yeah, they said that's super rare. That's
(42:44):
not rare enough for now. I was hoping to see
like one in a hundred thousand or a hundred million. Yeah, yeah, No,
it's like two out of every thousand, and supposedly seventy
of people who experience anesthesia awareness suffered from clinical petz TSD,
which is five times more than soldiers returning from Iraq
and Afghanistan. And we're getting this stuff from an Atlantic
(43:07):
article called Awakening by Joshua Lang. Just go read it.
It's um it's a really great article. Yeah, they gave
this one case. There's a bunch of cases in there,
but this one. Um. Sherman Sizemore Jr. Was a Baptist
minister and coal miner, former coal miner. He's seventy three,
and he had exploratory uh laparotomy that right in two
(43:29):
thousand six. And any kind of exploratory surgery is you know,
it's not fun because they're basically looking around for stuff, well,
moving things around. Yeah, they cut away like the flesh
and his belly fat and all that stuff. And we're
looking um at the the film that holds your guts
in place. Yeah, they're poking around in there and um.
(43:51):
He of course had interoperative recall, which is another term
for anesthesia awareness, that's right, and he um Basically his
family couldn't understand what was going on with them. You
know a lot of times you'll have these bad dreams,
these nightmares about blood and people coming at you and
trapping you, and it's it's severe PTSD. And he eventually
(44:16):
uh killed himself even though he had no history of
psychiatric illness. Within two weeks of his surgery, yeah, shot
himself dead. And his family had settled with a lawsuit
because they claim that no one even said that this
could happen or you should see counseling or anything like that.
So sad. Oh, yeah, it's very sad. Supposedly, people who
(44:36):
suffer from PTSD, from anesthesia awareness um almost across the board,
can't lay down and sleep. They have to sleep in
chairs because laying down with uh memories of you know,
being on the O R table. It's uh yeah. And again, anesthesiologists, philosophers,
any kind of scientists, they don't know how this is
happening because we don't understand consciousness, so we don't understand
(44:59):
the mechan aism that produces unconsciousness. And then even further,
we don't understand when that mechanism that's supposed to produce
unconsciousness fails to produce unconsciousness and someone remains conscious and
experiences anesthesia awareness. Yeah, I would think there's got to
be some fail safe for this. Untake the eyes midway
(45:22):
and say like blink, if you can feel me, feel this,
but you're you've been paralyzed. You can't move, you can't
even blink. It seems like they should. It's got I mean,
I don't know. It seems like there's gotta be something
that could do, Like there's a machine that has to
breathe for you because your lungs can't even move well.
And that's why they take your eyes shut to begin with.
(45:42):
I guess because you can't blink. That's creepy that people
like their eyes remain open. Yeah, I wonder it's like
the mom from Throw Mama from the Train, Like even
if you can't blink, I wonder if there's any kind
of sign like that you could give. Well. So in
this awakening Um article they talk about there was a
guy who like came up with this box that was
(46:04):
meant to it gave like a number between zero and
a hundred that supposedly reflected a level of consciousness to
be used in the operating room for anesthesia, so that
that anesthesiologist could be confident that somebody wasn't experiencing anesthesia awareness.
And they found that it doesn't really work. So there
are there are people who have undertaken this quest to
(46:28):
two basically show somehow there's some outward sign of whether
someone's conscious or not. But we just haven't licked it yet. Yeah.
I can't believe there's not some sort of machine that
could pick up on that. But they've tried, or maybe
they're just like, uh, it's two in every thousand. Yeah.
I can live with those numbers and that that's no,
that's not that's way too common, man. That scares me
(46:51):
to death. Yeah, well you said that's the worst thing
that can happen. I vote for death is the worst thing. UM.
In the nineteen forties, uh, for every one million patients
who had full anesthesia, six hundred and forty of them died.
By the eighties, that was down to four for every million,
which to me, that's good and rare, four out of
(47:12):
every million. Yeah, but that number is actually scarily on
the rise since the nineteen eighties. UM a German publication
called Deutscheses uh arts ablat it's the German Medical Association's
UM science journal, and they said that worldwide death rate
is on the rise to about seven now per million,
(47:35):
and the number of deaths within one year after general
anesthesia is one in twenty or if you're over sixty
one and ten what and that's within the year after. Yeah,
but even still that's not good. No, and that that
doesn't necessarily mean that's due to the anesthesia, because they
make the point that it's not like the quality of
(47:55):
anesthesiological care is different. It's that older people are having
surgery these that's that's so good point. Yeah, that's probably
what it's due to. But yeah, I mean they said,
for a patient to actually die on the operating table
is super super rare from anesthesiology. Um, it's apparently much
(48:15):
more common to experience anesthesia awareness two and every thousand.
Why don't they say one in five? Yeah, really trying
to you know, when every thousand nah, and that's not
one in five patients surgeries. There's a lot more surgeries
(48:36):
than patients. Yeah. And you know when you go, when
you take your pets in, they undergo general anesthesi too
for surgery. They always say like your pet could die,
like it's rare and it happens this often. But um,
it can happen. And you know, you have to sign
the waivers and that's always especially if of an older animal.
It's a little bit of a quandary you're in, you know,
(48:59):
whether or not to get the surgery. Is it worth
the risk? All that stuff? That's all I got. I
got nothing else to Uh, it's anesthesia. If you are
feeling confident about spelling that word correctly, go ahead and
type it into the search bar at how stuff works
dot com. And I said search for everybody, which means
it's time for a listener mail. Uh, this one, I'm
(49:22):
gonna call ESP. We heard from a lot of people
on this one so far. Yeah, but it wasn't as
bad as I thought. No. Um, hey, guys, just listen
to ESP. It was great as usual. Your podcast help
me get through my work day and make me laugh
because I learned new and random things. With regards to
ESP or whatever people want to call it. I don't
know if I believe in it exactly, but I do
(49:42):
strongly believe that some individuals are much more intuitive or
connected than others. Uh. And here's an example. When I
was eleven, my mother died. We were living in Vancouver
at the time, and she had died at home. We
had not yet called any of the family to notify
them until a few hours later. But about fifteen minutes
after she passed away, my paternal grandmother, who was in
Hong Kong called and said, is Lana okay. I suddenly
(50:04):
got a very strong and bad feeling about her, and
I thought I should call uh. And again we hadn't
told anyone yet and it had only been fifteen minutes.
My grandmother has always been very intuitive. It always felt
like no matter where our family was, she always somehow
had her eye on us in a comforting way, not creepy. Right.
She points out she was devout in practicing Buddhist her
(50:25):
whole life, and it is partly her devotion to Buddhism
somehow makes me believe that she was a soul deeply
connected to the rest of the world. Uh yeah, kind
of cool. YEA explain that I think we pointed out
in the ESP podcast that probably the likeliest explanations that
the Buddha hands it out to his most devout followers.
There you have. It looks like granny Uh. I don't
(50:47):
have her last name, but that is from Joy and
can in Hong Kong. Uh. That's right, even though Joy
is in Australia can Canberra, Canberra, Canberra, Australia and Thesia,
Hong Kong. Joy. Thanks Joy, Yeah, thanks a lot. Joy.
That's a good story. Uh, and we got some like that,
(51:09):
Actually didn't We probably more of those than Peter doesn't work.
We got very few of those. I was really surprised. Yeah,
I thought we did a good job of laying it
out there. Uh. Well, if you want to share a
good family story like Joy did, you can tweet to
us at s Y s K podcast. You can join
us on Facebook dot com, slash stuff you Should Know.
(51:31):
You can send us an email to Stuff Podcast at
how stuff Works dot com, and you can visit our
home on the web, Stuff you Should Know dot com
for more on this and thousands of other topics. Does
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