How Anesthesia Works

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 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 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

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 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. 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, 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, 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 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 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 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

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

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 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, 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 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 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.

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 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 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 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 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 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 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 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 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 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 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. 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

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, 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 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 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,

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

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 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. 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, 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 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 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 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 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. 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 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

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 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.

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. 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 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 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 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

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 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, 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, 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 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 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 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, 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 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 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 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 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 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, 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 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 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 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 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 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 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. 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 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 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, 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 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 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 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 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

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 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 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

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 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 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 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, 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 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 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 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, 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, 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 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

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. 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, 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 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, 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, 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, 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 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 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 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 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.

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. 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,

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 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 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, 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 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 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 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 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 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 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 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 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. 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 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 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 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 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. 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 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 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 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 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, 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 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 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 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, 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 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 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 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 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 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, 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. 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