Comment by lordnacho
5 days ago
For contrast, when I was put under with propofol for surgery, there was nothing.
I thought I would gently fall asleep, but it was actually extremely fast. It went from "tell me about your life" which the anesthetist uses to check your state to "oh so came here for uni..." to "huh the surgery is over" in a single cut.
Nothing in between, nothing like that thing you feel when before you fall asleep at night or wake up in the morning. I felt tired when I woke up, but I didn't think I had dreamed or felt anything at all in between.
I had a procedure recently and the description in the preparation instructions said "you won't be asleep, but you might not remember everything"
I talked to the nurse about this as I was prepping for the procedure, and he said that a recent patient talked throughout the procedure, but when he got back to his room afterwards, he asked "so when will the procedure start?"
So, I think the drugs you get might let experience everything. But the "nothing in between" might actually be memory loss, not loss of consciousness.
all this stuff is spooky and philosophically tricky.
Benzodiazepines = memory loss Propofol = we turned your brain off
Nothing stops us from using both, where strategically appropriate.
That sounds more like fentanyl (which is widely used as anesthesia for minor surgeries). With fentanyl you'll be awake but loopy and not fully there. Propofol feels like time had an entire section removed with before and after spliced directly together.
In my personal experience for a day procedure (gastroscopy) it was fentanyl + midazolam, although on another occasion for the same procedure they added ketamine for some reason.
In the latter case I actually remember more of the procedure - although I was completely detached and thought it lasted about a minute (it was a 10-15 min procedure). In that case I can recall having the tube removed and passing out what seems like instantly.
Anesthetics are very weird though. There's still a lot we don't know about how they work. They seem to act like you experienced, complete shutdown, for most people, which seems different from the states that people go into when unconscious or are near death usually.
And some people have a very different experience while under them - they are fully aware.
I had heard something unsettling about anesthesia that I could use verification or debunking.
The gist was that modern implementations suppress memory formation rather than induce unconsciousness. That you remain in some sense aware of what's happening but don't remember the experience. This is safer than traditional methods, but could potentially subject the patient to complex mental or emotional trauma.
Is that accurate?
It's both. In smaller doses, anesthetics like propofol will leave you groggy but semi-awake and able to respond to commands. But you won't be able to form long term memories so you won't remember afterwards. This is "twilight sedation" and is what you usually get when you get a procedure like an endoscopy or colonscopy. You are somewhat awake so that you can help reposition yourself and stuff if they need you to.
In larger doses, propofol will completely eliminate consciousness. This is "general anesthesia" and what you get when you go in for a major surgical procedure. You are completely unresponsive to any stimuli.
There are levels in between these too. Consciousness is a spectrum.
As far as I know, propofol doesn't make you feel particularly good or block pain. It just kind of makes you go away. So in addition, at all levels of anesthesia, they also typically give you a narcotic like fentanyl so that you aren't suffering. They aren't just letting you scream in pain and then erasing the tape afterwards.
As someone who has had a couple of procedures where they pushed the fentanyl into the IV before the propofol, I can 100% assure that pain was the absolute last thing I was feeling. Hell, I was still high as a kite after the propofol wore off when I got home. I was sitting at the kitchen table with a bunch of metal recently unscrewed from my leg bones thinking about literally nothing in the world beyond, "holy fuck this eggnog is the best beverage I've ever had in my life I wish I could drink it forever".
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No, it's just a creepypasta.
Before surgery, you're given an amnestic to help reduce immediate anxiety and avoid remembering going into the OR and getting prepped - which people don't generally enjoy.
Then you get the anesthesia, which puts you to sleep. They put you on a respirator, which - alongside helping your barely/non-working lungs - delivers a gaseous anesthesic to keep you asleep.
Because some reactions to pain are reflex, they may still work. And when you wake up, they don't want you to be in pain; especially if that's on the surgery table. So next, you get the analgesic opioids. Here you may also (if you didn't already) get paralytics to stop all muscle movement.
Rest assured that they are not YOLO-ing your pain and suffering. You are given a cocktail of drugs to make sure you are comfortable before, during, and after surgery.
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In some cases. My first experience with my wife in an ER (there have been many!), the doc came up to us and said exactly this. They needed to reposition a broken bone so it could be put in a cast before surgery to rebuild the wrist could be scheduled. Since it would only take a few seconds, instead of anesthesia they would use a medication that would let her be aware of the process, but she would forget it almost immediately after.
That was about 20 years ago. To this day, the last thing she remembers is lying on the table and saying "OK, let's git-er-done" and the next 5-10 minutes are missing.
>The gist was that modern implementations suppress memory formation rather than induce unconsciousness. That you remain in some sense aware of what's happening but don't remember the experience.
That's called twilight anesthesia and it's used for some procedures, not others. Usually used for stuff like wisdom teeth extraction and colonoscopies. Anything "major" and you're getting general anesthesia. You can ask what type of anesthesia you will be receiving (twilight or general).
https://wikipedia.org/wiki/Twilight_anesthesia
No. As an aside, when you are younger they may elect to put you into a twilight level of sedation.
And that is how I saw the inside of my own beating heart at 10 while I was tied down and essentially naked in front of like 10+ adults.
Oh, and the contrast dye momentarily made me feel like I was being burnt alive from the inside out.
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Partly correct.
The modern implementation is to use general anesthesia as little as necessary as it has numerous side-effects. Local anesthesia with improved selectivity is used if possible.
I also heard that. It was said by a physician (IIRC, from a Boston hospital), who was sitting in on Marvin Minsky's class at MIT, circa 2000.
> Nothing in between, nothing like that thing you feel when before you fall asleep at night or wake up in the morning.
Same. I was put under twice and both times it was like someone flipping a switch from conscious to unconscious. When I woke up it was like nothing happened save for a slight groggy feeling. It was not like sleep where you feel rested, as if you lost time.
edit: to add when going under the first time I was laying down on the operating table as the anesthesiologist made small talk with a nurse I suddenly felt super high while the room started to spin - POOF out.
My first time I remember the anesthesiologist asking me to count backwards from 100. I assumed the process would take 30 to 60 seconds. I don't think I even hit 97..
Yeah, mine was count down from ten. Made it to eight, then I was in a different room and an hour had passed. Closest thing to time travel.
On (In?) my last surgery they did the "make sure to remember what you dream" spiel on me. I dreamt I was having a surgery. After the surgery no one came to ask me what I've dreamt, it left me feeling quite a bit disappointed.
Yeah, people think they can "fight" it, but you can't. That stuff will knock you out. The counting is just so they know when you're out.
It’s generally very quick, but I suppose not perfect as on one occasion, they had to give me some additional kind of injection because for some reason, I was still awake. The guy doing it seemed confused.
With whatever he did additionally, as he did it he goes:
“Let’s try this again, start counting back from 10”
I might have made it to 9 the second time around.
Does this mean they messed up the dosage or something? I’ve had the same guy since and it’s never happened again.
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I've only been put under once and it was when I was very, very young (3 for hernia surgery, I'm in my mid-40s now) and I had a similar experience, except I came to ~half way through and picked up my head, wondering what the fuck was happening to me, before promptly being put under again. It's my earliest memory but it's also one of the only strong memories I have before 6-7 years old.
Had the same experience, what scared the crap out of me is that feeling of not even knowing you're out is how some people spend their last moment.
Not just in surgery for example but in extreme other situations (nukes, titan sub, piano to the head, etc)... You're just there then you aren't and you don't even know. Shook me (lightly) for a while
For me it gave me some peace about death. Say you are vaporized by a nuke. You're walking around chatting one moment, and there is no next moment.
I'm guessing being properly flattened by a truck is similar, though of course that's adjacent to being severely injured and dying later.
That's basically sleep for me. I know I must dream but I only very rarely even remember the smallest fragment of any dreams. So sleeping is like I've not existed for 7 hours from my conscious perspective.
Same with me, check yourself for sleep apnea and "sugar crash" during sleep if you can...
Interestingly some medications like tadalafil restore my dreams... My smart watch also tells me the phases like remand deep have normal lengths. So I'm not sure why it is so rare for me to dream, but I suspect low glucose or oxygen may have something to do with it.
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Honestly it doesn’t sound too bad to me. Just blinking out of existence. No pain, no regret. So what’s there to be scared of?
It's such a waste. You're there with all your personality and you're gone the next. It is quite bad. That's why I think religions came up with an idea of hell...
One may think, any existence is better than nothing.
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Dying is generally pretty easy. It’s hardest on those left behind.
Missing out.
I got put under as a teen for an appendectomy. Shocking. I was absolutely 100% certain I'd stay awake while counting until I hit at least 2-3. I think I made it to 8, then yeah - just like a scene change in a show. I was simply suddenly somewhere else - the recovery room. Apparently I tried to fight the nurses because I wanted to lay on my side (that had JUST been cut open)? I literally have no memory and apologized profusely. I don't even know how that happened - I'm not a violent man. I've been in one (very minor) fight (middle school), and I'm super easy-going in general. It takes a LOT to get under my skin.
> It takes a LOT to get under my skin.
Ouch. Excessively appropriate choice of words there.
They really got under your skin.
Yes, I experienced the same, it was like what they call in cinema a "jump cut". I remember the doors to the OR opening, then bang i was in a bed in the recovery room. Like the universe glitched.
Pretty much the same experience when I had surgery. Just a complete jump over the time I was out. I remember the mask going on, counting backwards, and then I was waking up. No sense whatsoever that any time had passed.
> I thought I would gently fall asleep , but it was actually extremely fast.
Sometimes people fall asleep that way too, especially when very tired. The expression ‘out like a light’ seems apt.
There was nothing that you remember. That means there probably was nothing, but it's still a distinction that should be noted.
Last time I had a medical intervention with propofol I returned so relaxed that I thought I had died and was in the afterlife.
They usually ask me to "count backwards from 10". I don't think I get down to 0. It's _very_ fast.