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How Anesthesia Works · Stuff You Should Know

0:00
Speaker 1: Welcome to you stuff you should know from house stuff
0:03
Speaker 1: Works dot com. Hey, and welcome to the podcast. I'm
0:12
Speaker 1: Josh Clark. There's Charles W. Chuck Bryant. There's Jerry, who's
0:15
Speaker 1: about to go to the hardware store any second now,
0:18
Speaker 1: which no, Jerry doesn't find that very funny. Yeah, I
0:23
Speaker 1: give the background there or to leave people wondering, well,
0:26
Speaker 1: we need a trash cannon and dimmer background. But we've
0:29
Speaker 1: been asking for I feel like months, but yeah, it
0:33
Speaker 1: can't be months because we haven't even been here that long.
0:35
Speaker 1: It's been like four days. But what what? What's the
0:38
Speaker 1: problem here? Why isn't there any movement on this? There's
0:41
Speaker 1: a home depot a thousand yards Crossromt. Yeah. I specifically
0:46
Speaker 1: didn't mention their name, but yes, it is the closest
0:48
Speaker 1: well in Orange big box hardware retailer. We could also
0:53
Speaker 1: support local business and go to an ACE instead, yeah,
0:58
Speaker 1: or we could just talk about and it's like we're
1:00
Speaker 1: supposed to. ACE is a big chain too, though, Yeah,
1:03
Speaker 1: but I think they're locally owned. Oh right, like Henry's
1:07
Speaker 1: ACE Hardware. Sure. I like, Yeah, it's good stuff, very helpful,
1:13
Speaker 1: very very knowledgeable staff, much more helpful. Than some of
1:18
Speaker 1: the other big Bucks their orange and blue. Okay, that
1:25
Speaker 1: was a great start to Uh, Chuck, Yes, do you
1:31
Speaker 1: know how to spell anesthesia? I haven't. I struggle. It's
1:35
Speaker 1: one of those And in fact, when you were out
1:37
Speaker 1: of the room getting your coffee, Jerry was asking how
1:41
Speaker 1: to spell it. I know, and I think she spelled
1:43
Speaker 1: it right or maybe missed a letter. And Jerry, I
1:48
Speaker 1: think she put an A where there was supposed to
1:51
Speaker 1: be an E. Oh well, I think that it used
1:53
Speaker 1: to be an accepted spelling. You know how in some
1:57
Speaker 1: uh distant times, the forties the thirties, which Jerry identifies
2:02
Speaker 1: with and like, anesthesia would have been spelled with an
2:06
Speaker 1: A E rather than just an E because there was
2:08
Speaker 1: another sound that. Yeah, it is a tricky one them.
2:12
Speaker 1: Uh okay, Well, then my next question, Chuck, do you
2:16
Speaker 1: know what anesthesia means? I do. Uh. It's from Greek,
2:20
Speaker 1: like a lot of medical terms, and this one stands
2:23
Speaker 1: for the loss of sensation. And uh, we'll talk about
2:27
Speaker 1: our personal experience as I assume, but I've never been
2:29
Speaker 1: under general anesthesia. Yeah the big Daddy, Yeah, fully under view. No,
2:36
Speaker 1: so neither one of us has had major surgery like
2:38
Speaker 1: that then no knock would yeah, because after doing some
2:43
Speaker 1: research on this, like, I don't know that I ever
2:45
Speaker 1: would want to It's scary, I mean. And let me
2:49
Speaker 1: just say also to anybody who is listening to this
2:53
Speaker 1: prior to undergoing a surgical procedure that requires general anesthesia,
2:57
Speaker 1: we don't mean to scare you know, but because it's uh,
3:01
Speaker 1: we'll talk about rate of death and and problems with it,
3:04
Speaker 1: which there are still but it's super safe now for
3:07
Speaker 1: the most part. But when you when you when I
3:10
Speaker 1: was reading this, I was like, man, what they're doing
3:13
Speaker 1: is is like bringing you toward death and then stopping
3:18
Speaker 1: at a certain point, yeah, and just letting you hover
3:20
Speaker 1: there then bringing you out when they're getting with a
3:23
Speaker 1: lot of like crazy heavy heavy drugs that are only
3:28
Speaker 1: slightly different from what they used in the like early history,
3:32
Speaker 1: which we're about to talk about. But it's really like
3:34
Speaker 1: it's it's kind of nuts that and they still don't
3:36
Speaker 1: know exactly how it works. And the reason why they
3:39
Speaker 1: don't know how it works, especially we understand local anesthesia
3:44
Speaker 1: and um twilight sedation, sure, well we don't understand is
3:48
Speaker 1: general anesthesia. And the reason why we don't understand because
3:50
Speaker 1: we don't understand how consciousness works, so how can we
3:54
Speaker 1: understand how unconsciousness works. Yeah, it's pretty weird, and which
3:58
Speaker 1: is what it works? Yes, it definitely does, and although
4:03
Speaker 1: there are some risks associated with it, it is far, far,
4:06
Speaker 1: far better than the alternative, which is no anesthesia, which
4:11
Speaker 1: was the way it was for a very long time.
4:13
Speaker 1: I mean anesthesia is a relatively recent thing. Or getting
4:17
Speaker 1: you super drunk, or hitting you in the head and
4:19
Speaker 1: knocking you unconscious, which is not so knocking you unconscious
4:23
Speaker 1: that qualifies anesthesia, but it's still not medical anesthesia. Giving
4:27
Speaker 1: you drunk, giving you morphine, giving you marijuana, jim some weed, um, yeah,
4:33
Speaker 1: rubbing stinging nettles on you to distract you from the
4:36
Speaker 1: pain of having your leg cut off, belladonna, using ice,
4:39
Speaker 1: all the stuff. These are so horrifics. These are narcotics.
4:42
Speaker 1: These are just plain old distractions, um, but they don't
4:47
Speaker 1: qualifies anesthesia. And the big difference, the the thing that
4:51
Speaker 1: was such a huge, huge progression forward um with anesthesia
4:57
Speaker 1: is that it doesn't just dull the pain. It dulls
5:00
Speaker 1: the pain, it takes away your consciousness and it also
5:04
Speaker 1: prevents you from creating memories during this experience, it gives
5:07
Speaker 1: you amnesia. So it basically cuts a chunk out of
5:10
Speaker 1: your lifetime that as far as your subjective experience goes,
5:15
Speaker 1: does not exist. It didn't happen like you were on
5:18
Speaker 1: the gurney going into the O. R room and you
5:20
Speaker 1: wake up and you're in the hospital bed and you
5:23
Speaker 1: have stitches, but there is nothing there in between, ideally
5:28
Speaker 1: for general anesthesia, right, And that's how we can conduct surgery,
5:33
Speaker 1: because before that there was surgery, but it was very
5:36
Speaker 1: rare and it was very very awful. Yeah, and when
5:41
Speaker 1: you know, we flew by some of those, but um,
5:43
Speaker 1: we did mention a lot of this, uh sopaphorics and
5:45
Speaker 1: narcotics that they use. They did knock you in the head,
5:48
Speaker 1: they did get you drunk. Um. In fact, in the
5:51
Speaker 1: mid forties, those were you know, opium and alcohol where
5:55
Speaker 1: the two go toss like and a towel to bite on,
5:58
Speaker 1: I guess, and just to make you like be able
6:01
Speaker 1: to tolerate the pain, which didn't really help. No, I
6:05
Speaker 1: mean I'm sure it helped. Uh, it dulled the pain,
6:07
Speaker 1: but it's not gonna do what you want, which is
6:11
Speaker 1: to kill it completely or knock you out. Or render
6:14
Speaker 1: you an asiatic an asiatic right, um. But the so
6:19
Speaker 1: the those were the two go to that they use.
6:22
Speaker 1: I mean there were other ones to like um blood
6:25
Speaker 1: lighting until a stupor or basically a coma was induced,
6:28
Speaker 1: like you lost so much blood that's pretty dangerous. But
6:33
Speaker 1: these were the These were the go to um pain
6:36
Speaker 1: killers for surgery, and they still didn't work very well.
6:39
Speaker 1: But what's weird is in the eighteen forties all that changed,
6:44
Speaker 1: like not one, not two, but three anesthesia is UH
6:51
Speaker 1: came into We're basically discovered for medical use, like almost
6:56
Speaker 1: all at the same time. Yeah, people now they basically
7:00
Speaker 1: say Crawford Long from right here in Georgia, University of
7:04
Speaker 1: Georgia graduate fellow bulldog. UH. He was the first. He
7:09
Speaker 1: performed a surgery removed a tumor from a neck from
7:13
Speaker 1: a mr A bentable in UH late March eighteen forty two,
7:17
Speaker 1: and also later did an amputation in a childbirth with
7:22
Speaker 1: ether and UM. He was he was the guy, but
7:26
Speaker 1: he was you know, it was pretty regional and people
7:29
Speaker 1: just didn't know about it. Basically. I all think it's
7:32
Speaker 1: the impression that he wasn't as much of a self
7:34
Speaker 1: promoter as Dr William Morton. Uh, yeah, he did um
7:39
Speaker 1: well William Morton in eighteen forty six. We might as
7:42
Speaker 1: well go ahead and say he demonstrated it for the
7:43
Speaker 1: first time in like a public surgical theater, right, and said,
7:47
Speaker 1: here is what I'm doing, and this is new and
7:49
Speaker 1: it's exciting, and I'm in Massachusetts on not some yokel
7:53
Speaker 1: in Georgia pretty much, and that's how he gained the acclaim.
7:57
Speaker 1: But yeah, I guess Crawford Long was able to prove
7:59
Speaker 1: that he'd done he'd used ether earlier. He's just like
8:02
Speaker 1: it just wasn't being a big shot about it. I
8:05
Speaker 1: was just using it. But you know, he discovered ether
8:08
Speaker 1: by hanging out with friends who were huffing ether at
8:11
Speaker 1: a party and supposedly he saw one guy run into
8:15
Speaker 1: a door and like cut his head open, and Crawford Long,
8:19
Speaker 1: being a doctor, was like, are you okay? And the
8:21
Speaker 1: guy was like, what are you talking about? With like
8:23
Speaker 1: blood spurting out of his forehead, and Crawford Long went,
8:28
Speaker 1: that's pretty funny. Uh. And he went on to uh
8:31
Speaker 1: tell Congress about it, as did doctor Charles Jackson, who
8:35
Speaker 1: said that he had done it before Morton as well.
8:37
Speaker 1: They both independently went to Congress. I was okay, man,
8:40
Speaker 1: I did that first. All right, it's a bit of
8:43
Speaker 1: self promotion. Ye, but Morton is the guy who gets
8:46
Speaker 1: who gets the credit. He's the one who really introduced
8:49
Speaker 1: it to the public. Well, it gets your credit as
8:51
Speaker 1: the first demonstrator. Yeah, he's the one that you hear
8:54
Speaker 1: of typically. Yeah, I would say Crawford Long though. Yeah,
8:58
Speaker 1: I guess you're right. Yeah. Lots of hospitals named after him,
9:01
Speaker 1: at least one here, although now no it's not cropfit
9:04
Speaker 1: Long anymore. Did they change it, yeah, to home depot um.
9:11
Speaker 1: So a little bit later on, there was a dentist,
9:14
Speaker 1: Dr Horace Wells, who used the first dude to use
9:17
Speaker 1: nitrous oxide bull teeth, and then chloroform was used by
9:22
Speaker 1: Dr James Simpson and these things. You know, you don't
9:26
Speaker 1: want to be using that though, it's toxic. So Dr
9:29
Speaker 1: Horace Wells actually is a pretty interesting story. It's where
9:33
Speaker 1: chloroform um and nitrous oxide converge as a beautiful place.
9:39
Speaker 1: So he tried. He extracted one of his own teeth
9:41
Speaker 1: on nitrous and was like, this is great. Did you
9:44
Speaker 1: read that history of Hippie crack article? Yeah, so this
9:48
Speaker 1: all came after somebody, a guy named Joseph Priestley in
9:51
Speaker 1: the eighteenth century synthesized nitrous oxide, and then very shortly
9:56
Speaker 1: after that, a teenage prodigy named Humphrey Davy started huffing it.
10:02
Speaker 1: And he actually had a box built for himself and
10:05
Speaker 1: was placed in it for over an hour once, just
10:08
Speaker 1: huffing nitrous oxide. That I am too, and he did
10:13
Speaker 1: because that's so dangerous. Yes it is, but this guy
10:15
Speaker 1: was huffing it like crazy. There must have been like
10:18
Speaker 1: some escaping or other air getting at something, but he
10:21
Speaker 1: huffed it for like an hour just for self experimentation.
10:24
Speaker 1: By the time Horace Wells tried it on a tooth um,
10:28
Speaker 1: there was a lot of confidence and understanding of nitrous oxide. Um.
10:33
Speaker 1: He was able to successfully remove his own own tooth
10:36
Speaker 1: when he demonstrated it. He didn't dose the patient properly,
10:40
Speaker 1: and the patient apparently cried out, and so Wells had
10:44
Speaker 1: staked all his reputation on this demonstration just failed utterly
10:49
Speaker 1: and ended up on skid row in New York. Went
10:51
Speaker 1: on a chloroform bender and ended up throwing acid on
10:54
Speaker 1: a couple of women. Was put in, yeah, was put
10:57
Speaker 1: in jail and ended up committing aside by slashing his
11:01
Speaker 1: fomoral artery with the razor from a shaving kit. But
11:04
Speaker 1: he was on chloroform, so he was anesthetized ironically when
11:09
Speaker 1: he died. Oh well that's good. Weird, Yeah, what it's
11:14
Speaker 1: strange history. But so the point is in in the chloroform,
11:18
Speaker 1: nitrous ox side in ether all emerged to form anesthesia. Yeah,
11:22
Speaker 1: and um, I mean it would have come around eventually,
11:24
Speaker 1: but it's not so different today. Like I said that,
11:27
Speaker 1: we're still using heavy duty drugs to knock people clean
11:33
Speaker 1: out and monitor them so they don't die from it.
11:37
Speaker 1: It's pretty crazy. Well, what one other thing about the
11:39
Speaker 1: introduction of anesthesia is that it took another fifty or
11:43
Speaker 1: so years before the medical establishment said yes, we need,
11:47
Speaker 1: we need to use this widely and and as part
11:50
Speaker 1: of standard and best practices. And part of that was
11:53
Speaker 1: because pain was seen as necessary. It was a sign
11:57
Speaker 1: that the patient was alive, was still idle. Um, there's
12:01
Speaker 1: a bit of a macho edge to it from what
12:03
Speaker 1: I understand. Uh. And then um, there was also a
12:08
Speaker 1: reluctance to draw attention to the fact that surgery is
12:11
Speaker 1: extremely painful. Yeah, because they didn't want people to not
12:15
Speaker 1: go to the doctor much. Yea. So it took like
12:18
Speaker 1: fifty years to catch on. So imagine being one of
12:20
Speaker 1: those patients where the modern medicine is well aware of anesthesia,
12:26
Speaker 1: but it hasn't adopted it yet. That's worse than being
12:29
Speaker 1: a patient before they understood there was such a thing
12:32
Speaker 1: as anesthesia. Yeah, Or imagine being because there was a
12:35
Speaker 1: lot of figuring it out along the way, you know,
12:38
Speaker 1: as far as dosage and stuff like that. Because so
12:40
Speaker 1: there are a lot of you know, unwitting guinea pigs.
12:43
Speaker 1: I guess there were Doc that hurts, don't take a
12:47
Speaker 1: little more that, or Doc, I'm dead, you know. Like
12:51
Speaker 1: you remember the castration episode we did, and they talked
12:54
Speaker 1: about how they would use opium as an anesthesia, but
12:58
Speaker 1: it was very easy to accidentally overdose the little boys
13:01
Speaker 1: when you were removing their testicles. I think the same
13:04
Speaker 1: thing happened when you were cutting off a man's leg
13:07
Speaker 1: in the Civil War. Wait, removing testicles. Yeah, for castration, circumcision.
13:12
Speaker 1: The castration said circumcision, man, We've we've done both. Yeah,
13:16
Speaker 1: But I thought I was like, man, I thought circumcision
13:19
Speaker 1: was something different. No, that's that means the circumcision is
13:23
Speaker 1: going horribly awry. Yeah. Man, we've covered some gruesome stuff.
13:27
Speaker 1: We really have, you know. All right, well, I guess
13:30
Speaker 1: we'll take a break here and talk about some of
13:33
Speaker 1: the different methods UH of anesthesia right after this. All right,
13:52
Speaker 1: before we broke, we teased you a little bit with
13:54
Speaker 1: the different types, and here we go. And up first
13:57
Speaker 1: is my favorite twilight sleep. UH. If you've had your
14:01
Speaker 1: wisdom teeth out or maybe an endoscopy. Um, there's plenty
14:06
Speaker 1: of procedures that use it. You might have had twilight
14:08
Speaker 1: sleep or conscious sedation or twilight anesthesia, and UM, I
14:14
Speaker 1: had some for when I had my my tooth replaced
14:18
Speaker 1: my front tooth. And it's always fun because it feels
14:21
Speaker 1: great going in. You just relish those like ten or
14:25
Speaker 1: fifteen seconds, and then it feels fun coming out because
14:29
Speaker 1: you know you don't know what's going on. It's more
14:31
Speaker 1: fun when you're picking up you're a loved one. Picked
14:35
Speaker 1: up Emily after her endoscopy and I went in and
14:38
Speaker 1: I don't know why I didn't think that my video
14:40
Speaker 1: going already, but she was like, I think everyone's throwing
14:43
Speaker 1: a party for me. Like what the people behind the curtain.
14:46
Speaker 1: They're throwing a party. I saw balloons and it was
14:49
Speaker 1: very cute because they're like so out of it. And
14:51
Speaker 1: when I came out of my wisdom teeth, I think
14:53
Speaker 1: I may have told this before, but I my friend
14:55
Speaker 1: told me that this particular doctor put bunny ears on
14:59
Speaker 1: you and took a picture because you're all puffed up
15:01
Speaker 1: and you have bandages around your face. And I was like,
15:04
Speaker 1: that's not gonna happen to me. I guarantee it. And
15:07
Speaker 1: I remember distinctly seeing the lady come in with the
15:10
Speaker 1: bunny ears, put them on my head and get the
15:13
Speaker 1: polaroid out and said smile, and I just went I
15:17
Speaker 1: gave a big smile, so that that actually, that's well,
15:22
Speaker 1: that's definitely twilight sedation, Yes, because you are out of it.
15:27
Speaker 1: You're but you're still conscious and you're still able to
15:30
Speaker 1: follow instructions. Yeah, but you don't know that. When you
15:34
Speaker 1: wake up, quote unquote, you feel like I did nothing happen,
15:37
Speaker 1: but they're like, no, you were talking to us and stuff.
15:40
Speaker 1: So weird. It is very weird. Um, the Twilight sedation,
15:44
Speaker 1: they used virtually the same drugs in a lot of
15:47
Speaker 1: cases that they used for general anesthesia, right, just smaller doses.
15:52
Speaker 1: So they'll use a sedative or something like that, like ketamine. Right,
15:58
Speaker 1: Like we said major drugs. I mean, if you've heard
16:00
Speaker 1: of you know, falling into a k hole. Uh, that's
16:04
Speaker 1: the same drug. Yeah, it's just crazy. That's like we're like, oh,
16:09
Speaker 1: back in the days, they use cocaine on people and
16:10
Speaker 1: that's nuts, right, Kee, big difference. Um. Yeah, so there's
16:16
Speaker 1: like ketamine there. They might use something like valium or
16:20
Speaker 1: at a van or something like that. Um. They'll probably
16:23
Speaker 1: also use the dissociative, which apparently disconnects your nerves from
16:29
Speaker 1: your brain. Yeah, that's what value is. Okay, that makes sense. Yeah. Um.
16:33
Speaker 1: And then also they'll use an analgesic, which is just
16:37
Speaker 1: another word for pain killer. So you've got all these
16:39
Speaker 1: strings working in combination, probably given to you intravenously, and
16:44
Speaker 1: you're a little bit wasted. But the point of twilight sleep,
16:47
Speaker 1: and the thing that that um, that separates it from
16:50
Speaker 1: other types of anesthesia, is that you are not so
16:54
Speaker 1: wasted that you can't breathe on your own, that your
16:57
Speaker 1: heart beat, your heart can't beat on its own, it
17:00
Speaker 1: needs to be you'll be monitored, but really they've given
17:04
Speaker 1: you such a low dose of this cocktail of chemicals
17:07
Speaker 1: that you're you're still able to do things like smile
17:10
Speaker 1: when the the dnnis put twenty years on you. Yeah to.
17:14
Speaker 1: I also remember, Um, when I woke up, I remember
17:19
Speaker 1: seeing a poster that said locomotive Lasagna on the wall,
17:24
Speaker 1: and Um, of course it didn't say that unless they
17:27
Speaker 1: went so far to like switch out posters to mess
17:30
Speaker 1: with you. I could see that because this didn't clearly
17:33
Speaker 1: had a sense of humor. It's putting bunny ears on people.
17:35
Speaker 1: It's like Tim Watley from Seinfeld. Yeah, but I was
17:38
Speaker 1: a little kid, you know. You know, I've never even
17:40
Speaker 1: had a drop of alcohol, so I've never had my
17:43
Speaker 1: head altered in anyway. So I was like, this is crazy.
17:46
Speaker 1: Did you start going to dentist every Friday at all?
17:49
Speaker 1: Fifty wisdom teeth removed? You're like, I know there's another
17:53
Speaker 1: one in there. Uh. The only uh. The other good
17:56
Speaker 1: thing about UM the Twilight Sleep is it's not going
17:58
Speaker 1: to have the after effects is general like, um, probably
18:01
Speaker 1: won't be nausea, have nausea or dizziness or vomiting. Maybe
18:04
Speaker 1: a little bit like they will give you a prescription
18:07
Speaker 1: probably but um, you probably want need to use it, right,
18:11
Speaker 1: you know, Yeah, anti nausea stuff. So that's uh, that's
18:15
Speaker 1: twilight sleep a k A procedural sedation. I don't know
18:19
Speaker 1: if we ever called it that. That's the clinical term
18:21
Speaker 1: for it. Twilight sleep is the prettier name for it. UM.
18:25
Speaker 1: Then there's also a local anesthetic, which is the other
18:29
Speaker 1: common type of anesthesia UM, where basically a is a
18:34
Speaker 1: small area or a specific region of the body is
18:37
Speaker 1: um basically numbed. Yeah, that's when you get the worst
18:41
Speaker 1: thing that can happen to you in life, which is uh,
18:43
Speaker 1: shots into the gum, a needle in the gum in
18:46
Speaker 1: the dentist, which is why the dentist will frequently use
18:50
Speaker 1: a topical um. A topical anesthesia. It helps a little, right, Uh,
18:56
Speaker 1: so that they'll it will numb your gum when they
19:00
Speaker 1: put the needle in. Yeah, they'll put like that gel
19:03
Speaker 1: and that will them in a little bit. Or if
19:04
Speaker 1: you're getting sometimes like an ivy in the arm, they'll
19:08
Speaker 1: spray it with the cold stuff and that all helps,
19:11
Speaker 1: for sure. It does. You'll still feel the pressure of
19:14
Speaker 1: the needle going into your jaws, but you don't feel
19:16
Speaker 1: the pain, right and the the reason why these things
19:20
Speaker 1: work is, Uh, they a local anesthetic actually goes to
19:25
Speaker 1: the area it's delivered to and blocks the nerve receptors.
19:29
Speaker 1: It actually keeps your potassium and your sodium ions um
19:34
Speaker 1: from firing, right, which means that it's not conducting electricity,
19:38
Speaker 1: which means that your nerves aren't capable of passing along
19:41
Speaker 1: the sensation of pain to your brain. They're just shut down.
19:44
Speaker 1: That's what a local anesthetic does. And if you pay attention,
19:48
Speaker 1: the local anesthetics all in an ain and for a
19:51
Speaker 1: pretty good reason, like light decane or no vocaine. Even
19:54
Speaker 1: they don't use novocaine that much anymore. Um. It's a
19:57
Speaker 1: derivative of cocaine, and cocaine has a topical numbing effect,
20:01
Speaker 1: and they used to use it to do that, right.
20:04
Speaker 1: And then they said, why is everybody showing up to
20:07
Speaker 1: the dentist all the time? Uh? And then they said, oh, yes,
20:11
Speaker 1: it's because of the cocaine. So let's figure out a
20:14
Speaker 1: a synthesized version of it. And they came up with
20:16
Speaker 1: no vocane, lydocane all that, UM. And they stopped using
20:19
Speaker 1: no vocane apparently because there were a lot the potential
20:22
Speaker 1: for adverse reactions was greater UM, but people still do
20:27
Speaker 1: have allergies to UM local anesthetics once amount, but it
20:33
Speaker 1: turns out it's not the local anesthetic itself. It's not
20:36
Speaker 1: the no vocane, it's not the lydocane. What it is
20:39
Speaker 1: is UM. When you use a local anesthetic, it has
20:42
Speaker 1: the effect of vasodilation, which means that it makes your
20:46
Speaker 1: blood vessels relax, which lowers your blood pressure UM, which
20:51
Speaker 1: is good, but it also is not so good. So
20:54
Speaker 1: they add epinephrine, which is a vasso constrictor, and it
20:58
Speaker 1: actually makes the local anesthetic work better. So if you
21:02
Speaker 1: get a local anesthetic, you're getting the local anesthetic like
21:05
Speaker 1: Clyda cane mixed with epinefrin and a preservative to keep
21:09
Speaker 1: the epine and fresh. And it's the preservative that you're
21:12
Speaker 1: having the adverse reaction to. Yeah, and again just a
21:16
Speaker 1: well balanced cocktail to give you exactly what you need. UM.
21:21
Speaker 1: Local is gonna wear off in a few hours, It
21:23
Speaker 1: depends on how much you have UM. When you leave
21:26
Speaker 1: the dentist, you know you'll still have your mouth numb
21:28
Speaker 1: for a while, and they always want you not to
21:31
Speaker 1: eat or talk too much because UM. You can accidentally
21:34
Speaker 1: bite your tongue in your cheek and not know it, uh,
21:37
Speaker 1: which actually happened to me recently, and I did bite
21:40
Speaker 1: my cheek man a lot, Yeah, bled a little bit too. Yeah,
21:44
Speaker 1: I'm fine. So it's such just um, it's such just
21:47
Speaker 1: dental that you're gonna get like a local anesthetic. You
21:51
Speaker 1: could also be given a local anesthetic for what's called
21:54
Speaker 1: awake brain surgery. But yes, so in some some type
22:00
Speaker 1: some brain surgery, you need to be conscious. You can't
22:02
Speaker 1: be unconscious. They need to keep track of what the
22:06
Speaker 1: brain is doing and they need it to be in
22:08
Speaker 1: a conscious state. So they will give you some drugs
22:11
Speaker 1: where you're not necessarily like you you might be sedated
22:15
Speaker 1: in the like you might be on a little bit
22:17
Speaker 1: of valium or something like that, but you're not. You're
22:19
Speaker 1: still conscious, you're still able to respond to questions. But
22:22
Speaker 1: they give you a local and aesthetic because they take
22:24
Speaker 1: the top of your head off and work on your brain.
22:27
Speaker 1: I think it's in Hell Raiser there's like awake brain
22:30
Speaker 1: surgery is shown. Yeah, I think I've seen that in
22:32
Speaker 1: another movie too. Um. Yeah, because they need to be
22:36
Speaker 1: able to ask you things like in the nuts, can
22:38
Speaker 1: you believe that your brain is exposed that crazy. Oh
22:43
Speaker 1: it is weird. Um are we onto regional? I believe? Uh?
22:48
Speaker 1: Local regional anesthesia is sort of like local, but it's
22:52
Speaker 1: covers a wider area of your body. Um. So like
22:55
Speaker 1: if you need your whole leg numbed for an operation,
22:59
Speaker 1: um and just like a small portion of your leg,
23:02
Speaker 1: that would be regional. Uh. It's also called a nerve
23:05
Speaker 1: block basically because they're just taking a single nerve or
23:09
Speaker 1: bundle of nerves and blocking that. Right, they're going after
23:11
Speaker 1: like one of the big dad he's rather than a
23:13
Speaker 1: little one. But again localized. Um. Like if you know
23:17
Speaker 1: women who have given birth, sometimes we'll get an epidural uh,
23:21
Speaker 1: and that's what that is. It is injected via catheter
23:25
Speaker 1: into the epidural space in the lower back. But that
23:29
Speaker 1: doesn't necessarily mean uh, directly into the spine, which also
23:34
Speaker 1: can happen with a spinal block, right into that cerebro
23:38
Speaker 1: spinal fluid, which is about as direct as you can get.
23:41
Speaker 1: And if you get a c section or maybe hurning
23:43
Speaker 1: a surgery, and that's when they want you awake again,
23:47
Speaker 1: um during the surgery, like with epidurals. Chuck I was wondering,
23:51
Speaker 1: So an epidural, it's in the space outside of the
23:54
Speaker 1: spinal column um, but it's used to numb you're from
23:58
Speaker 1: the waist down, like when you're give birth or something
24:00
Speaker 1: like that. Right, And it's actually a catheter is introduced
24:03
Speaker 1: in a continuous I V. Cocktails given to your into
24:07
Speaker 1: your almost your spine, but not into the spine. No,
24:11
Speaker 1: that would be a spinal right. I wondered, how do
24:15
Speaker 1: they make it so it's it's your waist down that's
24:18
Speaker 1: getting numb. Why isn't your waist up? Oh? Like, how
24:21
Speaker 1: does how do they know the path is going downward? Yes?
24:24
Speaker 1: So I looked it up and it turns out it
24:26
Speaker 1: doesn't always. Sometimes it can reverse and numb you from
24:31
Speaker 1: the waist up, in which case you're in like, that's
24:34
Speaker 1: a problem because your breathing can stop. Um, your heart
24:38
Speaker 1: can stop. There's a bunch of stuff that can stop.
24:40
Speaker 1: But apparently it's extraordinarily rare, but it can happen. Where
24:45
Speaker 1: like the the intended area is reversed when they give
24:49
Speaker 1: you an epidural, there can also be complications from the
24:51
Speaker 1: epidural um that aren't great. Um, hopefully that doesn't happen
24:57
Speaker 1: giving birth right, well, the same same with this final
25:00
Speaker 1: as well. Like there there there are complications, like you
25:03
Speaker 1: can get a meningel infection or an abscess something like that.
25:08
Speaker 1: I happen to be a friend of ours. That's why
25:09
Speaker 1: I got dodgy. I didn't want to say it on
25:10
Speaker 1: the air. I'll tell you after, just write it down, okay. Um, yeah,
25:20
Speaker 1: I talked about the spinal block. Um, there's a little
25:22
Speaker 1: bit more risk, like we said, then local obviously like
25:26
Speaker 1: seizures and heart attacks. Um. And sometimes it doesn't give
25:31
Speaker 1: enough pain relief and you have to move on to general.
25:34
Speaker 1: They're like, Doc, this ain't working right. Um, can you
25:37
Speaker 1: just knock me out? Because some patients want to be
25:40
Speaker 1: awake and some patients don't. And sometimes they will defer
25:44
Speaker 1: to you on that. Who will defer to who? The doctor?
25:47
Speaker 1: And like you want to be awake for this or not,
25:50
Speaker 1: especially during childbirth, to like give me the drugs, give
25:54
Speaker 1: me the drugs or the common refrain, yeah, or I
25:58
Speaker 1: want to be awake at least, um, but give me
26:02
Speaker 1: the epidural. Uh. Like I'll go in thinking natural childbirth
26:06
Speaker 1: is the way to go, and then I changed my mind,
26:10
Speaker 1: which is, hey, that's you're right, Yeah, sure, given birth,
26:13
Speaker 1: you should do it. However you want to totes at
26:15
Speaker 1: home in a tub, uh water boat with a goat.
26:22
Speaker 1: Very funny. Uh So, Chuck, you had a pretty great
26:26
Speaker 1: segue that we just trod all over into general anesthesia again.
26:31
Speaker 1: The big Daddy is what I think most people call it.
26:35
Speaker 1: That's when you're put under, and that is when you
26:37
Speaker 1: are out. You don't remember anything, you're asleep, you're you're unconscious,
26:42
Speaker 1: and that's the one where they don't completely understand how
26:45
Speaker 1: it works, which is a little scary. It is a
26:47
Speaker 1: little scary UM and there have been people who have
26:49
Speaker 1: tried to figure out how to quantify it UM using
26:53
Speaker 1: magical boxes and trans magnetic transcranial magnetic stimulation stimulation, and
27:00
Speaker 1: I flubbed that one the thinking yeah, um, but ultimately
27:05
Speaker 1: we just we don't know. So there's there's a there's
27:07
Speaker 1: a general idea, basically a working theory, and that is
27:10
Speaker 1: that UM anesthesia the drugs that we use, and it's
27:14
Speaker 1: a bunch of different ones working in conjunction, but they
27:17
Speaker 1: depressed the activity of the spinal cord, so you're paralyzed UM.
27:22
Speaker 1: The brain stem rearticular activating system which is basically they
27:27
Speaker 1: think responsible for sleepiness and wakefulness that's stimulated or depressed,
27:32
Speaker 1: depending on your way of looking at it. And then, um,
27:35
Speaker 1: your cerebral cortex is affected as well, so you're not thinking,
27:40
Speaker 1: you're not forming memories, you're not um making associations with
27:43
Speaker 1: any of this, and all of that in conjunction with
27:46
Speaker 1: one another, comes to anesthesia. General anesthesia, which is utter
27:52
Speaker 1: and complete unconsciousness. That's right, And it can last a
27:55
Speaker 1: few hours or up to six hours. Um, if you're
27:58
Speaker 1: having like serious comp gated surgery. But there is a limit.
28:02
Speaker 1: They can't just be like this is a twelve hour surgery. Um. Yeah,
28:06
Speaker 1: I thought there are worse surgeries like that where they're
28:08
Speaker 1: like the surgery lasted seventy two hours, but the guy
28:12
Speaker 1: was successfully transplanted. Yeah, that is true. How do they
28:17
Speaker 1: do that? Because really dangerous to get someone under general
28:20
Speaker 1: anesthesia for that long. Yeah, that's a good point. I
28:25
Speaker 1: didn't I meant to look into that. Someone will let
28:27
Speaker 1: us know. Sure, we'll follow up on that for sure. Uh,
28:30
Speaker 1: if you are going to be put under general anesthes
28:33
Speaker 1: you don't just walk in and start huffing the gash.
28:37
Speaker 1: There there's a lot of work that goes into that. Um,
28:40
Speaker 1: you have to be invited. You have to be invited
28:42
Speaker 1: by her. You have to get a a party invite
28:45
Speaker 1: from your anesthesiologist. Um, you will meet with them and
28:50
Speaker 1: he or she will basically ask you a bunch of
28:53
Speaker 1: questions about your lifestyle and your medical history. Are you
28:56
Speaker 1: a natural redhead? Yeah? Because we covered that in the
29:00
Speaker 1: Redhead episode. You might need a little more. Are you
29:02
Speaker 1: a little kid are you? Yeah? I can tell by
29:04
Speaker 1: looking Yeah, because little kids livers process these drugs a
29:08
Speaker 1: lot faster, so they need uh higher dose. Basically, Um,
29:12
Speaker 1: are you a huge alcoholic? Not? Well, depends on what
29:16
Speaker 1: you say, sir. Are you heroin addict? Not anymore? So,
29:21
Speaker 1: like the depending on the answers to these questions, they're
29:23
Speaker 1: gonna need to adjust your dose depending do you have
29:26
Speaker 1: low blood pressure? High blood pressure? Yeah? And this is
29:29
Speaker 1: where you want to be super honest about your drinking
29:31
Speaker 1: and drugs. Yeah. If you're a heroin addict, you need
29:33
Speaker 1: to fast up. You can be like, hey man, can
29:35
Speaker 1: you be cool and keep a secret? You don't like
29:37
Speaker 1: lie like you do to your shrink, Right, you know
29:40
Speaker 1: you really want to be honest because you want this
29:42
Speaker 1: to work well and be safe. Um. After they have
29:46
Speaker 1: all that, they're gonna basically, um, put together your your
29:50
Speaker 1: program on what you're gonna need, and then they're going
29:54
Speaker 1: to tell you not to eat because if you eat
29:56
Speaker 1: before you go under anesthesia, you can aspirate and basically
30:01
Speaker 1: breathe in what's in your stomach. So this is not
30:04
Speaker 1: everybody believes this any longer, supposedly about eating before surgery.
30:09
Speaker 1: There's what I understand is that when there are so
30:15
Speaker 1: few cases of aspiration under anesthesia, especially twilight sedation, because
30:20
Speaker 1: that well, no, oh, yeah, that's a pretty good that's
30:23
Speaker 1: a good point. I hadn't thought of, um, but apparently, well, yeah,
30:28
Speaker 1: you just answered that question. You say, Well, from what
30:32
Speaker 1: I understood, there was a study that looked at all
30:34
Speaker 1: these different um the cases of aspiration and found it's
30:38
Speaker 1: very rare. And they concluded that the danger, the potential
30:43
Speaker 1: danger of aspirating under sedation is low enough that it's
30:49
Speaker 1: it's outweighed by the benefits of eating. Because if you
30:53
Speaker 1: don't eat and you undergo sedation on an empty stomach,
30:55
Speaker 1: which is what they want you to do, it's a
30:58
Speaker 1: lot harder on your system. You're much or likely to
31:00
Speaker 1: be nauseated, to vomit afterward, be dizzy, whereas if you
31:04
Speaker 1: eat something, you can your body can process these drugs
31:07
Speaker 1: a little better. So are they advising people to eat now.
31:10
Speaker 1: I think that they're starting to get to that point,
31:12
Speaker 1: but I don't believe it's like current widespread practice. Yeah,
31:17
Speaker 1: I don't think I would. I don't know, Maybe I'm superstitious.
31:20
Speaker 1: I don't know if i'd be chowing on a burrito
31:22
Speaker 1: before I go in for my heart surgery. Well, just
31:25
Speaker 1: for the surgeon's benefit, I think you might want to
31:28
Speaker 1: avoid burritos before going under for being knocked on content. Yeah,
31:32
Speaker 1: you're right. Um, you will be wearing a breathing mask
31:36
Speaker 1: when you're under general anesthesia or a breathing too, because
31:40
Speaker 1: uh you basically your your muscles are so relaxed that
31:43
Speaker 1: your air was airways won't stay open. So that's a
31:46
Speaker 1: little creepy in itself. Um. And they're going to monitoring
31:51
Speaker 1: lots and lots of things while you're under there in
31:54
Speaker 1: the room, and probably have an assistant in the room
31:56
Speaker 1: with them to monitor all this stuff like blood pressure,
32:01
Speaker 1: heart rate, O two levels, um CEO two levels, temperature,
32:06
Speaker 1: brain activity, and there's even a little alarm if you're
32:09
Speaker 1: O two level drops, which is great. I think they
32:11
Speaker 1: should have an alarmed for everything. Yeah, you know, the
32:14
Speaker 1: more alarm is better in that case. And I guess
32:16
Speaker 1: we should talk about the four stages um of general
32:19
Speaker 1: anesthetic YEP. Stage one is the induction stage, or the
32:23
Speaker 1: one you were talking about those fifteen seconds where you're
32:25
Speaker 1: like pure bliss, right uh, and then stay that quickly
32:30
Speaker 1: moves to stage two, which is the twitchy stage where
32:34
Speaker 1: you're just kind of like well twitching, it's your body
32:37
Speaker 1: going like what the heck is going on? What is this?
32:40
Speaker 1: And then you move quickly to stage three, which is
32:42
Speaker 1: the stage that they're after, where you're not twitching anymore,
32:46
Speaker 1: you're not conscious any longer, and you are under a
32:50
Speaker 1: state of general anesthesia. You're anesticized, right uh. And this
32:55
Speaker 1: is where you want to be. But there is, like
32:57
Speaker 1: you said, a fourth stage. You don't want to go there. No,
32:59
Speaker 1: that's the over dose stage. And once you're in this stage,
33:03
Speaker 1: it is now a medical emergency and you have to
33:05
Speaker 1: be managed brought out of before you suffer brain damage
33:09
Speaker 1: or death or all sorts of other problems. Yeah, and
33:12
Speaker 1: I remember when I read this the first time, I thought,
33:14
Speaker 1: why did they even have this fourth stage? I don't
33:17
Speaker 1: think they think it's just there. Yeah, but it's you know,
33:21
Speaker 1: anesthesia is a thing. It doesn't mean like if you
33:25
Speaker 1: don't have a great anesthesiologist, there can be that fourth stage.
33:28
Speaker 1: I think even with a good anesthesiologists having a bad day,
33:32
Speaker 1: things can happen. You know, Um, I hit a squirrel
33:36
Speaker 1: and now this guy is dead. When you do go under,
33:40
Speaker 1: you are um, like I said, gonna get the gas
33:43
Speaker 1: or an ivy or both. Um. There are lots of
33:47
Speaker 1: different drugs that they will combine again, katamine, valium, sodium pentethal. Well,
33:53
Speaker 1: the go to is they're going to knock you out
33:55
Speaker 1: first with the I V usually and almost across the
33:59
Speaker 1: board it's propafile Michael Jackson's milk, that's right, Uh, And
34:03
Speaker 1: that's what they do to initially knock you out. And
34:05
Speaker 1: then they're gonna put ad that. He actually needed that
34:07
Speaker 1: to sleep and it didn't even work. It's a crazy thing,
34:10
Speaker 1: like he was so wound up that even probe fall
34:14
Speaker 1: wouldn't work. Unbelievable. Um. You might also get a muscle
34:21
Speaker 1: relaxer to make sure that paralysis really takes hold. Yeah,
34:24
Speaker 1: and if this is all kind of familiar, go back
34:27
Speaker 1: and listen to our lethal injection episode, because that is
34:33
Speaker 1: stage four and technically stage five and general anesthesia is
34:39
Speaker 1: lethal injection. Yeah, that's again, that's why this is so nuts.
34:42
Speaker 1: Is there there almost killing you? Yeah, well maybe that's
34:45
Speaker 1: overstating it, but they're they're not bringing you to the
34:49
Speaker 1: brink of death, but they went to close enough to
34:52
Speaker 1: where you're out. You know. Um, after surgery, Um, you
34:57
Speaker 1: don't just get up and dance out of the room.
34:59
Speaker 1: You're gonna go to the pack you the post anesthes
35:02
Speaker 1: anesthesia care unit, and then you're gonna keep getting monitored.
35:05
Speaker 1: You're gonna be dehydrated and cold because you're heading toward death,
35:10
Speaker 1: so they're gonna warm you up some warm I v s.
35:13
Speaker 1: There are also some drugs that they've started to use. Now, Um,
35:16
Speaker 1: I had some oral surgery and you mean picked me up,
35:18
Speaker 1: and I can't remember any of the stories or whatever,
35:21
Speaker 1: but I remember going from being out to just being
35:24
Speaker 1: totally with it. And apparently I've been given a drug
35:27
Speaker 1: that's like a revers sedation drug to wake you up. Yeah,
35:32
Speaker 1: there's one called flu mazanell, another called nax alone, and
35:36
Speaker 1: it's just basically they also used them for overdoses of
35:39
Speaker 1: certain kinds in the e R. But they can use
35:41
Speaker 1: them post sedation to get you going again pretty quickly.
35:46
Speaker 1: They stick it directly into your heart. Yeah, just sit
35:50
Speaker 1: up and inhale deeply. It's not like I had that
35:55
Speaker 1: when I had mine. Yeah, I'm cutting edge. Yeah. Uh,
36:00
Speaker 1: I still couldn't eat ahead of time. Oh really, yeah,
36:04
Speaker 1: but you did anyway, You're like, I read that it
36:07
Speaker 1: was fine, I could have a breed. Um. You might
36:11
Speaker 1: actually get a little morphine too for the pain after
36:14
Speaker 1: your room. Yeah. Um, but you might also have those
36:18
Speaker 1: side effects like we talked about with the vomiting and nausea. Um,
36:22
Speaker 1: and maybe we're pretty out of it, you know, Yeah,
36:25
Speaker 1: you might fall over if you get up to use
36:26
Speaker 1: the bathroom. There is a help. There's a probably the
36:30
Speaker 1: worst potential side effect of anesthesia possible. It's something called
36:35
Speaker 1: anesthesia awareness. And we'll would say death, but we'll talk
36:39
Speaker 1: about both of those, right, we'll get into both after this, So, Chuck,
36:57
Speaker 1: we're gonna talk about anesthesia awareness, but we should probably
37:00
Speaker 1: talk about anesthesiologists first, right, Yeah, there's um many levels
37:05
Speaker 1: of anesthesiology g jobs. You can be an anesthesiologist full blown,
37:14
Speaker 1: which means you've gone to PREMD undergrad, you've gone to
37:17
Speaker 1: med school, you have done your to year residency. Sometimes
37:21
Speaker 1: three in your income goes to malpractice insurance doesn't really
37:26
Speaker 1: I would guess not that much, but a lot um
37:30
Speaker 1: and you can. I didn't see where you had to
37:33
Speaker 1: be certified, but you were eligible to take the A
37:37
Speaker 1: B A exam I think, and that I think if
37:39
Speaker 1: you want to be a physician an stysiologist, you actually
37:43
Speaker 1: have to be certified. All you have to do is
37:46
Speaker 1: be able to say anthologists correct, Actually that's not true.
37:50
Speaker 1: It's physician. Anesthesiologists are certified and most of these physicians
37:56
Speaker 1: an aestusiologists um do a one year of specialty training
38:00
Speaker 1: as well. Um with either there are several different subspecialties
38:04
Speaker 1: like hospice and palliative medicine, critical care medicine, and pain medicine.
38:09
Speaker 1: So basically just it's almost like postgraduate graduate school. Or
38:15
Speaker 1: you can be an assistant, which means you have your
38:18
Speaker 1: four year undergrad in pre med and then you've gone
38:21
Speaker 1: through an accredited program and then take an exam. Or
38:25
Speaker 1: you can be a nurse anesthesia anesthesias anesthetist. Anesthetist, Man,
38:34
Speaker 1: that sounds like such a dope. It's this is some
38:36
Speaker 1: tough words, man. I know. It's a lot of stuff
38:39
Speaker 1: going on in there, a lot of teas and ages.
38:40
Speaker 1: And that means you're a registered nurse who has completed
38:44
Speaker 1: UM a training program which last two to three years.
38:49
Speaker 1: You're gonna have to have your b s. Degree and
38:51
Speaker 1: at the end of one year of practice experience UM
38:55
Speaker 1: is when you go through that training program and take
38:57
Speaker 1: an exam, so again many years. It's like serious, serious stuff.
39:01
Speaker 1: It's not like, oh, I want to you know, I
39:05
Speaker 1: want to be a doctor, but I don't want to
39:06
Speaker 1: go through all the schooling, so I'll just be an anesthesiologist.
39:09
Speaker 1: I want to have access to the finest drugs available
39:11
Speaker 1: on the planet Earth. Right now, it's still serious, like
39:15
Speaker 1: you're a doctor, you know, well, you're not like you're
39:17
Speaker 1: any lesser of a You're a nurse. What do you
39:21
Speaker 1: mean And an estatistic said, was a nurse? I No,
39:23
Speaker 1: I'm just talking about all of those jobs require lots
39:26
Speaker 1: and lots of schooling. It's not like the easy way out,
39:29
Speaker 1: I certainly hope. No, No, it's very serious. Job. Okay,
39:33
Speaker 1: so it is a very serious job. Again, we said
39:37
Speaker 1: you are being brought to the brink of death or
39:40
Speaker 1: stupor unconsciousness or whatever you want to call it, and
39:43
Speaker 1: then brought back without any side effects as few side
39:47
Speaker 1: effects as possible. That's right, and certainly no lasting side effects.
39:51
Speaker 1: But there is something. There's a pernicious UH syndrome that
39:56
Speaker 1: doctors have been aware of, the anesthesiologists have been aware
39:58
Speaker 1: of at least since the six these, which is called
40:01
Speaker 1: anesthesia awareness. And basically, anesthesia awareness is where you are
40:07
Speaker 1: given anesthesia, which includes a paralytic which means you can't
40:11
Speaker 1: move your body at all UH, and your eyes have
40:16
Speaker 1: been taped shut so you can't see, but you are conscious.
40:20
Speaker 1: You are aware during surgery, so you're the pain killers
40:25
Speaker 1: would have probably worked too, but something went wrong and
40:27
Speaker 1: you're not unconscious, so you're able to form memories. You're
40:32
Speaker 1: able to hear the doctors talking about you like you're
40:34
Speaker 1: a piece of meat. You're able to hear the cutting,
40:37
Speaker 1: the squishing, the tearing of your organs being moved around.
40:41
Speaker 1: You can smell the singed hair and claterized flesh. You're
40:45
Speaker 1: able to feel genuine fear in some cases if the
40:49
Speaker 1: pain reliever hasn't worked, you're able to experience this excruciating
40:54
Speaker 1: pain and you're not able as badly as you want
40:58
Speaker 1: to to alert and anybody on the surgical teams like
41:01
Speaker 1: you're locked in that you're, yes, that your experienced. It's yes,
41:05
Speaker 1: you're It's like performing surgery on a locked in person. Yeah,
41:08
Speaker 1: without any kind of pain killer or anything like that. Yeah.
41:11
Speaker 1: I didn't know your eyes were taped shut during surgery either, because, Um,
41:16
Speaker 1: you never see that on TV shows, do you. I've
41:19
Speaker 1: never noticed that. Uh, yeah I don't. I've seen it before,
41:24
Speaker 1: but I'm probably on like one of those like remember
41:26
Speaker 1: they used to have real surgeries on Any Discovery in
41:30
Speaker 1: the early days. Yeah, back when they were doing stuff
41:32
Speaker 1: like that. I looked into that though, and um, that's
41:36
Speaker 1: for a couple of reasons. Obviously, to keep the eyes
41:38
Speaker 1: from drying out, because apparently eyelids do not close in
41:42
Speaker 1: fifty of patients when under general anesthesia. They'll just say
41:47
Speaker 1: it's so as to keep the eyes from drying. And
41:50
Speaker 1: I didn't realize this is to prevent corneal abration. Apparently
41:53
Speaker 1: that had been or can be a real problem. Um,
41:57
Speaker 1: even if your surgery is not on your eyes. There's
41:59
Speaker 1: just a lot of activity around your face like a
42:03
Speaker 1: stethoscope and scratch your eye or yeah, a lot of
42:06
Speaker 1: stuff can happen. So we'll take your eyes shut, so
42:09
Speaker 1: they tape it shut so you can't see. But again
42:12
Speaker 1: you can still here. You can still feel and even
42:14
Speaker 1: if you're not feeling pain, you can still feel the pressure. Remember,
42:17
Speaker 1: even with like a local and aesthetic, you can't feel
42:20
Speaker 1: the pain, but you can feel the pressure of the
42:21
Speaker 1: needle going in your jaw. This is the same thing
42:24
Speaker 1: with like stomach surgery or your heart being taken from
42:28
Speaker 1: your chest or what have you. Um So a lot
42:31
Speaker 1: of people, apparently, studies have found since the sixties that
42:35
Speaker 1: about two out of every thousand patients or centuries will
42:41
Speaker 1: experience anesthesia awareness. Yeah, they said that's super rare. That's
42:44
Speaker 1: not rare enough for now. I was hoping to see
42:47
Speaker 1: like one in a hundred thousand or a hundred million. Yeah, yeah, No,
42:51
Speaker 1: it's like two out of every thousand, and supposedly seventy
42:55
Speaker 1: of people who experience anesthesia awareness suffered from clinical petz TSD,
43:00
Speaker 1: which is five times more than soldiers returning from Iraq
43:04
Speaker 1: and Afghanistan. And we're getting this stuff from an Atlantic
43:07
Speaker 1: article called Awakening by Joshua Lang. Just go read it.
43:11
Speaker 1: It's um it's a really great article. Yeah, they gave
43:14
Speaker 1: this one case. There's a bunch of cases in there,
43:16
Speaker 1: but this one. Um. Sherman Sizemore Jr. Was a Baptist
43:19
Speaker 1: minister and coal miner, former coal miner. He's seventy three,
43:23
Speaker 1: and he had exploratory uh laparotomy that right in two
43:29
Speaker 1: thousand six. And any kind of exploratory surgery is you know,
43:34
Speaker 1: it's not fun because they're basically looking around for stuff, well,
43:39
Speaker 1: moving things around. Yeah, they cut away like the flesh
43:42
Speaker 1: and his belly fat and all that stuff. And we're
43:44
Speaker 1: looking um at the the film that holds your guts
43:47
Speaker 1: in place. Yeah, they're poking around in there and um.
43:51
Speaker 1: He of course had interoperative recall, which is another term
43:55
Speaker 1: for anesthesia awareness, that's right, and he um Basically his
44:01
Speaker 1: family couldn't understand what was going on with them. You
44:04
Speaker 1: know a lot of times you'll have these bad dreams,
44:07
Speaker 1: these nightmares about blood and people coming at you and
44:11
Speaker 1: trapping you, and it's it's severe PTSD. And he eventually
44:16
Speaker 1: uh killed himself even though he had no history of
44:18
Speaker 1: psychiatric illness. Within two weeks of his surgery, yeah, shot
44:21
Speaker 1: himself dead. And his family had settled with a lawsuit
44:25
Speaker 1: because they claim that no one even said that this
44:28
Speaker 1: could happen or you should see counseling or anything like that.
44:32
Speaker 1: So sad. Oh, yeah, it's very sad. Supposedly, people who
44:36
Speaker 1: suffer from PTSD, from anesthesia awareness um almost across the board,
44:41
Speaker 1: can't lay down and sleep. They have to sleep in
44:43
Speaker 1: chairs because laying down with uh memories of you know,
44:47
Speaker 1: being on the O R table. It's uh yeah. And again, anesthesiologists, philosophers,
44:53
Speaker 1: any kind of scientists, they don't know how this is
44:56
Speaker 1: happening because we don't understand consciousness, so we don't understand
44:59
Speaker 1: the mechan aism that produces unconsciousness. And then even further,
45:02
Speaker 1: we don't understand when that mechanism that's supposed to produce
45:06
Speaker 1: unconsciousness fails to produce unconsciousness and someone remains conscious and
45:11
Speaker 1: experiences anesthesia awareness. Yeah, I would think there's got to
45:15
Speaker 1: be some fail safe for this. Untake the eyes midway
45:22
Speaker 1: and say like blink, if you can feel me, feel this,
45:27
Speaker 1: but you're you've been paralyzed. You can't move, you can't
45:30
Speaker 1: even blink. It seems like they should. It's got I mean,
45:34
Speaker 1: I don't know. It seems like there's gotta be something
45:36
Speaker 1: that could do, Like there's a machine that has to
45:37
Speaker 1: breathe for you because your lungs can't even move well.
45:40
Speaker 1: And that's why they take your eyes shut to begin with.
45:42
Speaker 1: I guess because you can't blink. That's creepy that people
45:46
Speaker 1: like their eyes remain open. Yeah, I wonder it's like
45:50
Speaker 1: the mom from Throw Mama from the Train, Like even
45:52
Speaker 1: if you can't blink, I wonder if there's any kind
45:55
Speaker 1: of sign like that you could give. Well. So in
45:57
Speaker 1: this awakening Um article they talk about there was a
46:01
Speaker 1: guy who like came up with this box that was
46:04
Speaker 1: meant to it gave like a number between zero and
46:08
Speaker 1: a hundred that supposedly reflected a level of consciousness to
46:13
Speaker 1: be used in the operating room for anesthesia, so that
46:16
Speaker 1: that anesthesiologist could be confident that somebody wasn't experiencing anesthesia awareness.
46:21
Speaker 1: And they found that it doesn't really work. So there
46:24
Speaker 1: are there are people who have undertaken this quest to
46:28
Speaker 1: two basically show somehow there's some outward sign of whether
46:33
Speaker 1: someone's conscious or not. But we just haven't licked it yet. Yeah.
46:37
Speaker 1: I can't believe there's not some sort of machine that
46:38
Speaker 1: could pick up on that. But they've tried, or maybe
46:41
Speaker 1: they're just like, uh, it's two in every thousand. Yeah.
46:44
Speaker 1: I can live with those numbers and that that's no,
46:47
Speaker 1: that's not that's way too common, man. That scares me
46:51
Speaker 1: to death. Yeah, well you said that's the worst thing
46:53
Speaker 1: that can happen. I vote for death is the worst thing. UM.
46:58
Speaker 1: In the nineteen forties, uh, for every one million patients
47:02
Speaker 1: who had full anesthesia, six hundred and forty of them died.
47:06
Speaker 1: By the eighties, that was down to four for every million,
47:10
Speaker 1: which to me, that's good and rare, four out of
47:12
Speaker 1: every million. Yeah, but that number is actually scarily on
47:16
Speaker 1: the rise since the nineteen eighties. UM a German publication
47:21
Speaker 1: called Deutscheses uh arts ablat it's the German Medical Association's
47:27
Speaker 1: UM science journal, and they said that worldwide death rate
47:31
Speaker 1: is on the rise to about seven now per million,
47:35
Speaker 1: and the number of deaths within one year after general
47:38
Speaker 1: anesthesia is one in twenty or if you're over sixty
47:41
Speaker 1: one and ten what and that's within the year after. Yeah,
47:46
Speaker 1: but even still that's not good. No, and that that
47:49
Speaker 1: doesn't necessarily mean that's due to the anesthesia, because they
47:52
Speaker 1: make the point that it's not like the quality of
47:55
Speaker 1: anesthesiological care is different. It's that older people are having
47:59
Speaker 1: surgery these that's that's so good point. Yeah, that's probably
48:04
Speaker 1: what it's due to. But yeah, I mean they said,
48:08
Speaker 1: for a patient to actually die on the operating table
48:10
Speaker 1: is super super rare from anesthesiology. Um, it's apparently much
48:15
Speaker 1: more common to experience anesthesia awareness two and every thousand.
48:21
Speaker 1: Why don't they say one in five? Yeah, really trying
48:24
Speaker 1: to you know, when every thousand nah, and that's not
48:32
Speaker 1: one in five patients surgeries. There's a lot more surgeries
48:36
Speaker 1: than patients. Yeah. And you know when you go, when
48:38
Speaker 1: you take your pets in, they undergo general anesthesi too
48:43
Speaker 1: for surgery. They always say like your pet could die,
48:46
Speaker 1: like it's rare and it happens this often. But um,
48:50
Speaker 1: it can happen. And you know, you have to sign
48:52
Speaker 1: the waivers and that's always especially if of an older animal.
48:56
Speaker 1: It's a little bit of a quandary you're in, you know,
48:59
Speaker 1: whether or not to get the surgery. Is it worth
49:01
Speaker 1: the risk? All that stuff? That's all I got. I
49:05
Speaker 1: got nothing else to Uh, it's anesthesia. If you are
49:10
Speaker 1: feeling confident about spelling that word correctly, go ahead and
49:12
Speaker 1: type it into the search bar at how stuff works
49:15
Speaker 1: dot com. And I said search for everybody, which means
49:17
Speaker 1: it's time for a listener mail. Uh, this one, I'm
49:22
Speaker 1: gonna call ESP. We heard from a lot of people
49:25
Speaker 1: on this one so far. Yeah, but it wasn't as
49:27
Speaker 1: bad as I thought. No. Um, hey, guys, just listen
49:30
Speaker 1: to ESP. It was great as usual. Your podcast help
49:33
Speaker 1: me get through my work day and make me laugh
49:35
Speaker 1: because I learned new and random things. With regards to
49:38
Speaker 1: ESP or whatever people want to call it. I don't
49:40
Speaker 1: know if I believe in it exactly, but I do
49:42
Speaker 1: strongly believe that some individuals are much more intuitive or
49:44
Speaker 1: connected than others. Uh. And here's an example. When I
49:47
Speaker 1: was eleven, my mother died. We were living in Vancouver
49:50
Speaker 1: at the time, and she had died at home. We
49:52
Speaker 1: had not yet called any of the family to notify
49:54
Speaker 1: them until a few hours later. But about fifteen minutes
49:58
Speaker 1: after she passed away, my paternal grandmother, who was in
50:00
Speaker 1: Hong Kong called and said, is Lana okay. I suddenly
50:04
Speaker 1: got a very strong and bad feeling about her, and
50:06
Speaker 1: I thought I should call uh. And again we hadn't
50:08
Speaker 1: told anyone yet and it had only been fifteen minutes.
50:11
Speaker 1: My grandmother has always been very intuitive. It always felt
50:13
Speaker 1: like no matter where our family was, she always somehow
50:16
Speaker 1: had her eye on us in a comforting way, not creepy. Right.
50:21
Speaker 1: She points out she was devout in practicing Buddhist her
50:25
Speaker 1: whole life, and it is partly her devotion to Buddhism
50:27
Speaker 1: somehow makes me believe that she was a soul deeply
50:30
Speaker 1: connected to the rest of the world. Uh yeah, kind
50:34
Speaker 1: of cool. YEA explain that I think we pointed out
50:37
Speaker 1: in the ESP podcast that probably the likeliest explanations that
50:41
Speaker 1: the Buddha hands it out to his most devout followers.
50:44
Speaker 1: There you have. It looks like granny Uh. I don't
50:47
Speaker 1: have her last name, but that is from Joy and
50:50
Speaker 1: can in Hong Kong. Uh. That's right, even though Joy
50:54
Speaker 1: is in Australia can Canberra, Canberra, Canberra, Australia and Thesia,
51:01
Speaker 1: Hong Kong. Joy. Thanks Joy, Yeah, thanks a lot. Joy.
51:06
Speaker 1: That's a good story. Uh, and we got some like that,
51:09
Speaker 1: Actually didn't We probably more of those than Peter doesn't work.
51:15
Speaker 1: We got very few of those. I was really surprised. Yeah,
51:18
Speaker 1: I thought we did a good job of laying it
51:19
Speaker 1: out there. Uh. Well, if you want to share a
51:23
Speaker 1: good family story like Joy did, you can tweet to
51:26
Speaker 1: us at s Y s K podcast. You can join
51:29
Speaker 1: us on Facebook dot com, slash stuff you Should Know.
51:31
Speaker 1: You can send us an email to Stuff Podcast at
51:34
Speaker 1: how stuff Works dot com, and you can visit our
51:36
Speaker 1: home on the web, Stuff you Should Know dot com
51:43
Speaker 1: for more on this and thousands of other topics. Does
51:46
Speaker 1: it how stuff Works dot com