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August, 2017

General Anesthesia

by Larry

One imagines an experienced war veteran so good at his trade, so reliably, quickly, and efficiently dispatching the enemy, before it knows what hit him, that our hero earns the nickname, "General Anesthesia."

When I was seven years old, about 1951, I had my tonsils and adenoids removed and was put under using a cotton mask that covered my nose and mouth, through which liquid ether was dripped. It was not a particularly accurate method for attaining a patient's oblivion. Indeed, there are anecdotes about anesthesiologists and other medical staff of the time also being affected by the fumes, with consequences we can but imagine. At any rate, in my case all apparently went well.

In connection with a procedure to remove a large kidney stone that had gotten stuck blocking a tube needed for other things, last month I had my first general anesthesia since then. Although in ordinary awareness I was OK with this, my dreams in the nights leading up to the fateful date revealed misgivings. In a series of them, I evidenced panic, a beach strewn with mangled body parts, or faces missing key features. A sense of control is not readily given up. Who knows what might happen while we are unconscious?

A brother of mine was for awhile in intensive care, to outward appearances sedated and unconscious, yet afterward he related communicating with other patients in the same area, for instance trying through his out of body self to calm one of them who was especially anxious. Others have told of having had awareness of people around them while clinically they were in unresponsive states. Patients revived after so-called near death experiences have told of levels and kinds of awareness that might seem surprising to friends and relatives who were just observing their apparently comatose status.

In the event, last month things were rather different than in the early 1950s. The medical staff were all friendly, easily gained my trust, and seemed competent. The anesthetizing chemicals were applied via plastic tubes and a small gas mask. Machines helped the professionals monitor the amounts required, what was being administered, and my vital signs. I was told what to expect, and all went according to plan (so far as I know). Beforehand I was asked if I had questions. I mentioned knowing there is a little greater chance of harm from the anesthesia in older people, and the anesthesiologist gave me the option to have a tranquilizing substance that could allay anxiety about my procedure but which also involved a longer time required to recover vs. having only the amount of anesthesia called for to put me under and keep me there till the procedure were completed. I opted for the second, figuring I could deal with short-term nerves better than any long-term deficits from a longer time and depth of being "out."

That lithotripsy surgery failed. My kind of kidney stone is apparently too hard for the multiple ultrasonic blasts (over 3000 in about 45 minutes) to affect it. This means there is also no point attempting the same thing on an even larger stone stuck in another tube. In fact, there are a total of five large stones it would be better to remove if practicable. Late this month, a more complicated, longer procedure is to be done. If that one does not get the job done, a third would be required. Thus there will be more opportunities for good and necessary medical care, but also for things that might go wrong.

I drive almost every day, of course. The risks of this activity in the frequency involved are probably far greater, yet I hardly think about them as I commute here and there. Even walking in Austin can be more hazardous than having general anesthesia. There are numerous stories of pedestrians hit here by distracted drivers. I have had three falls while merely out with the dog in my own neighborhood, where decades' old sidewalk levels are irregular thanks to tree roots, settling during droughts or floods, and so on.

The chances of damage from general anesthesia are not readily obtained. I am sure insurance companies have this kind of actuarial information. Depending on Google, though, all I can quickly determine is that only about one in 200,000 general anesthesia procedures result in death attributable to the anesthesia itself, but that complications from anesthesia occur about 5% of the time. These secondary medical problems can include extremely mild to severe forms of dementia. Though it is difficult separating mishaps due to the anesthesia from those related to the procedures themselves, such potential difficulties do go up as we age.

General anesthesia (the term from ancient Greek, meaning loss of sensation) affects the whole body and usually induces a loss of consciousness.

Each night I fall asleep and then feel dead to the outer world. Oddly enough, though vulnerable in that state as well, I rarely consider the possibility I shall not awaken in the morning just as I always have before. I read news accounts or hear them on the radio about this or that person having "died in his (or her) sleep" and wonder what that really means. Did someone interview the people just shy of expiration and so determine that they were still slumbering? It seems a phrase intended to reassure the living, not to accurately depict what occurred for the deceased. I hope when I die it is significant enough that I do not sleep through the experience. In fact, maybe that is why general anesthesia is a little scary: a person could simply check out, cease to be, and never know it.

Anesthesia has been around for thousands of years. Though most ancient anesthesia was primitive, derivatives from the opium poppy had been used in one or two early civilizations since 4000 to 5000 years ago. Even as recently as the early 19th Century, though, anesthesia could be awfully crude by modern hospital standards. Laudanum, a blend of opium, alcohol, and other ingredients, was often used to simply dull the pain rather than providing general loss of consciousness. Hypnosis was tried but useless for most patients. Large quantities of whiskey also had their benefits. Usually, though, even as innovations were being tried that later would lead to general anesthesia via nitrous oxide (laughing gas), ether, chloroform, and morphine, for the vast majority of patients surgery was contemplated with terror, for there was no effective means to remove the severe pain during and after operations. In wartime, hundreds of thousands endured the removal of bullets, shrapnel, limbs, and portions of their faces with little or no anesthetic. Often as not, they were held or strapped down and told to just bite on a strap, piece of wood, or a bullet while enduring the agonies of surgery, typically passing out from the extreme discomfort and shock. Under such conditions, surgery-related deaths were naturally higher, even apart from the poor sterilization methods of the time.

Why do anesthetics work? This is as yet a matter for research. Evidently they inhibit the transmission of signals between nerve cells, but even today more needs to be learned about how.

In any case, I am glad that general anesthesia is available when invasive procedures are required. It seems much preferable to the proverbial biting of the bullet.

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