What Happens While You're Under Anesthesia?
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Hi, my name is Dr. Patel, and I'm the anesthesiologist. And we're going to go into the operating room now. So the room might be a little cold. There might be a few people here. This is what you'd hear in surgery if Dr. Alopi Patel was your anesthesiologist. When she puts patients under, she tries to explain everything as it happens so patients know what to expect. Okay, so while you're sleeping, we're going to go on vacation.

Where do you want to go? Tahiti. Ooh, I like Tahiti. So we're going to go to Tahiti. We're going to go to Bora Bora in Tahiti and we're sitting on the beach. She'll put on your favorite music and continue this guided vacation imagery meant to put you as the patient into a relaxed state. We're sitting on the beach.

putting our toes in the sand. And do you want a margarita, a mojito? What are we drinking today? Yeah, margarita. Salt or no salt? Margarita on the rocks, salt. Okay, what type of flavor? Elopi then begins a process called induction, using medication to induce a state of unconsciousness. I'm going to put this mask on your face. It's going to be a little tight. Pretend this is fresh oxygen from Tahiti. We just imported it, right? So taking deep breaths in and out.

And I'm going to start giving you some medication in your vein. And as I'm giving that IV, you're going to feel me rubbing on the other hand. And that rubbing is going to make you feel better. And slowly, you'll start feeling warmer and warmer. Pretend you're putting your toes in the sand, sipping those margaritas. And soon, you'll be off to sleep. ♪

Mostly because of the cocktail of anesthetics, delivered through IV or inhaled as gases. But Elopi says there is tremendous power, too, in her words. She calls this part of her job verbal anesthesia. And it's a type of anesthesia you can't really put in an IV. It's being able to comfort a patient and help them anticipate what to expect next. Anesthesia literally means without sensation or feeling.

But different types of anesthesia can do different things. General anesthesia involves losing consciousness. You often have a breathing device during those procedures. Sedation is anesthesia where you can breathe on your own.

And regional anesthesia is when one part of the body gets numb, like a leg or an arm, while local anesthesia is just numbing in one specific area. And all of that can be done with different medications. Elopi describes the operating room as her kitchen. Most recipes, you need the same ingredients if you're making something like banana muffins, right? But the amount you're making depends on how many people you're making it for. Do you want something more salty or sugary? Whatever. But instead of flour or sugar,

Allopi is using different anesthetics, like propofol, lidocaine, and different opioids. Anesthetics like these make all kinds of surgery possible. Brain surgery, back surgery, heart surgery, you would not be able to do any of these surgeries, abdominal surgeries, without having the patient completely asleep and paralyzed or their muscles relaxed for the procedure.

Today on the show, we go into the operating room and under the sway of anesthesia, how this once controversial procedure became a cornerstone of modern medicine. I'm Emily Kwong, and you're listening to ShoreWave, the science podcast from NPR. ♪

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Okay, Alopi, let's talk about anesthesia's history. When did people start using it and what kind of chemicals were most popular back in the day? Yes, the traditional sort of history of anesthesia kind of starts around the mid-1800s. So the most popular

of anesthesia that was studied at that time was chloroform. So ether was another one and nitrous oxide. They're all various sort of inhaled anesthetics that can knock out a patient. The first successful demonstration of anesthesia was in 1846, and this was done by William Morton.

William Morton was actually a dentist who was experimenting with different types of anesthesia, and ether was the one that he successfully demonstrated. The day that he successfully demonstrated anesthesia was October 16th, 1846, in the Ether Dome in Massachusetts General Hospital in Boston. And that is now called World Anesthesia Day.

How was anesthesia used or not used for people giving birth back in the day? And how has that history evolved? So Queen Victoria actually had many children. For almost all of her children, she did not have any anesthesia. There

There was stigma back in the day about women having pain relief during labor and delivery because it was expected for a woman to suffer during childbirth because it was God's intention, right? For the pain to be insufferable, to be able to have a child. And it wasn't until Queen Victoria herself asked to have chloroform for her eighth baby or something. She was like, give me some of that good stuff. I am the queen. Yeah.

And she essentially legitimized it, that you can have childbirth with a pain-relieving substance. And since then, we've come so far in obstetric anesthesia in terms of spinal anesthetic, epidural anesthesia for pain relief. Wow. Okay. So let's accompany you now through this process, starting from when a patient is being induced and the anesthetic starts entering their system. What is anesthesia doing to the body?

So depending on the types of anesthetics, it can affect their heart rate. It can affect their blood pressure. It can affect different types of blood flow, right? So when the blood pressure goes down, it can affect the blood flow to the brain, to the heart.

We care about all the organs, but really the brain and the heart are the two most important organs that we really think about because we don't want too little oxygen to be in the brain or the heart. So once the anesthesia enters the system, it's essentially just going in the bloodstream, traveling all across the body, and then being metabolized. It could be metabolized by the kidneys, the liver, and then inhaled anesthetics are metabolized through the lungs and then you breathe them out.

Okay. What is anesthesia doing to your nervous system? So anesthesia in general creates this very relaxing effect, right? So it creates a slowing down of your nervous system. So you have your parasympathetic nervous system and your sympathetic nervous system. Your sympathetic is your fight or flight, right? So you're go, go, going.

anesthesia essentially relaxes the body. So it can help decrease the heart rate. It can help decrease the blood pressure and create a relaxation in the brain as well. So when you're awake, your brain waves are going fast, right? So they're just kind of go, go, going at a higher speed. It's like a pinball machine over there. Yeah. So the waves are just going super fast.

And then when you get anesthesia, IV or inhaled anesthesia, the brain waves come down and they're slower and they're more relaxed. And it just kind of creates the Zen sort of mode for the brain or like an airplane mode, right? Where things are just kind of low energy and able to be relaxed. And during that, that induced coma or controlled coma phase,

significant surgical incisions or surgical stimulus can be done without the brain and the body feeling it. So the messages, like, are they just not getting through? Is it kind of like your body's like, pain, pain, pain, but then the receptors are like, eh, we're just going to ignore that message. Like, what's happening? Kind of, yeah. It doesn't cut off communication necessarily. That would be something like a local anesthetic, right? So a local anesthetic does cut off communication where it just doesn't allow that pain signaling to go through.

Yeah.

If there's significant enough pain, you can definitely feel it, but you won't recall it. And that's another important aspect of anesthesia, right? So there's anesthesia, which is that not feeling sensation, analgesia, which is not feeling pain, muscle relaxation, and then memory loss, right? So when you have anesthesia, your body is not feeling certain things. When you have the pain medications, you're creating that pain-free state, right?

Muscle relaxation, which is muscle relaxants, and then memory recall. You're not going to recall anything either. I didn't know you can't form memories under anesthesia. Yeah. Most of the time, you won't remember anything. So we call that recall in anesthesia. So if we do that recipe just right in the kitchen of the operating room, basically, if we do everything just right, most patients will not remember anything from their anesthetic. How

How is anesthesia different from sleep? So that's a great question. Sleep has its own sort of neurochemistry and physiology, and there are REM waves associated with it. You can have dreaming associated with sleep. But anesthesia, you can sleep for five minutes and feel like you've got the most restful sleep.

But you didn't actually go into REM sleep. It's more of like this state of unconsciousness and you might feel relaxed. But it is different than true sleep. You're not having the same brainwave changes and you're not necessarily having the same dreams that you would under natural sleep state.

That must feel like at once very powerful, but also a big responsibility that you are like guiding people through something that is so, they're so vulnerable in those moments. Absolutely. And it is such a privilege to be with patients at that time. I think it is

one of the most vulnerable times for most patients, right? To feel like, okay, I am not going to have sensation or power or autonomy over my own body. And you're giving it to the hands of the anesthesiologist at that time. And it's a powerful place to be in, but also a very important position to really be able to empower and identify the concerns that your patient has.

Wow. Can you tell me a story about a time you were monitoring a patient under anesthesia that just like stays with you, that like taught you a lot or stayed with you for whatever reason? Do you have a story like that? Absolutely. I have one story that I can think of that really resonated with me about this is why I wanted to do anesthesiology and be an anesthesiologist. There's this very high risk patient that needs surgery ASAP for hematoma, which is a blood clot.

But she also has a massive blood clot in her lungs. So it's a very tricky situation to be in. The patient was already very nervous. And I was able to connect with the patient. I said, hey, you have a blood clot. We have a couple options. I'm going to talk to the surgeon as soon as they get here. And we're going to see how we can do this.

And I spoke to the patient the entire time. We put on her favorite music. Which was? It was Yanni. I had never heard of him. It was like a Greek musician. I know Yanni. And it was my first time listening. Very spirited. Very, yeah. And, you know, we just listened to music and I held her hand and I sat with her and the surgeon did his stuff as fast as he could to evacuate the hematoma. We stabilized, put on pressure dressing, all of that stuff. And the patient was so grateful.

It is such a big part of the patient experience to be there as a human next to that person and not just a face peering down. Like that human aspect of anesthesiology is why I love this field. What would you say to someone who maybe has an upcoming procedure where anesthesia will be involved? And let's say this person's nervous. What would you say to them? Absolutely. So...

Always be honest with your anesthesiologist is what I would say. Your anesthesiologist and your grandmother have one thing in common, which is we want to know when did you eat last because we want to make sure that, you know, you have a, you can have a safe anesthetic on an empty stomach, as we say, but really be honest with your anesthesiologist is the most important thing. Don't lie. Do not lie. Whether it's, whether you used cocaine or marijuana, we do not judge. We do, we are there to protect you and to help you. And

And also, it's super safe. Anesthesia has evolved so much over the last 30 years, especially since the invention of certain monitors for heart rate and oxygen. Anesthesiologists are trained physicians with thousands of hours of care, and we're here to help you and walk you through the process. ♪

Elopi Patel, thank you so much for talking to me. And I hope if I ever have to go under, you are my anesthesiologist. It would be my honor. We'd go to Hawaii, girl. We'd get away. We'd get away. We'll have a margaritas. This episode was produced by Rachel Carlson and edited by Burleigh McCoy. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer.

Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to Shorewave, the science podcast from NPR.

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