Knocked out, going under, sedated,
put to sleep...there are plenty of creative terms used to describe the
experience of being under anesthesia, but how does anesthesia actually put you to
sleep? The crazy thing is, we don’t actually know for sure… but as you’ll see in this
video, sometimes it can go horribly wrong…. Anesthesia is one of the most commonly
performed medical procedures out there - more than 60,000 people undergo
anesthesia every single day in the U.S. alone. Despite its prevalence
we still don’t fully understand exactly how anesthesia works in the human body
to put us to sleep - we just know that it works. The word anesthesia means ‘loss of sensation’, and millions of Americans undergo anesthesia
every year to prevent them from feeling pain and to keep them still and unresponsive so that
doctors can safely perform life saving operations that would be incredibly difficult - not to
mention painful - to do to a conscious patient. We may not fully understand how anesthesia
works, but that doesn’t mean it isn’t a real life medical miracle. Before the late 1800s, the
only “drugs” we had to help patients through painful procedures were things like alcohol,
opium and hemlock - hardly fool-proof methods. For centuries, medical procedures like tooth
extractions and fracture repairs were performed with very little - if any - pain relief for the
patient. But, beginning in the 1840s, scientists discovered that some gases, like sulphuric ether
and chloroform, had sedative effects. Anesthesia was born, and medical treatment became wildly less
painful and traumatic than ever before in history. Modern anesthesia cocktails are much safer
and more reliable than these first gases were, but we’re still at a loss to explain
exactly how they work to put us to sleep. There are 4 categories of anesthesia - local,
regional, sedation and general anesthesia. Local anesthesia involves injecting a small amount of
the drug into a specific area. This is the type of anesthesia you’d get at the doctor’s office before
a filling or at the hospital before they stitch you up. It’s also used after major surgeries to
help with pain as other, strong anesthesia begins to wear off. Local anesthetic numbs only the
targeted area, and wears off relatively quickly. Similar to local anesthesia, regional
anesthesia targets a specific area of the body, though it is stronger than local anesthesia and
can block sensation to an entire section of the body. Epidural injections to the spine that
are used to numb the lower body during labor, and femoral nerve blocks that are injected
into the femoral artery in the upper thigh to freeze the entire leg for orthopedic surgery
are just a few examples of regional anesthesia. Both local and regional anesthesia leave the
patient fully conscious - they don’t “put you under”. We need stronger stuff for that. Regional
anesthesia is often combined with sedation. These “twilight sedation” drugs make the patient
more relaxed and unfocused. They don’t force the patient into unconsciousness, but many people
do fall asleep under sedation due to the drowsy, sleepy feeling it induces. Sedation
doesn’t affect breathing or reflexes, making it less risky than full general
anesthesia, and it also wears off more quickly. When you picture a patient lying unconscious
on the operating table waiting to be cut open, what you’re picturing is someone under general
anesthesia. General anesthetic affects the entire body and works in 4 ways. It immobilizes the
body to stop it from moving during the procedure and acts as an analgesic to prevent
the patient from feeling any pain. It also works on the brain by sedating
the patient in an unconscious state, and even induces amnesia to ensure the
patient will have no memory of the experience. In reality, “put to sleep” is not the best way
to describe what it’s like to be under general anesthesia - it’s actually more like being in
a drug-induced coma. "It's a reversible coma, but it's nevertheless a coma," says Emery Brown,
a professor of anesthesiology at Harvard Medical School. When under general anesthesia, an
electroencephalogram, or EEG test, shows that brain activity decreases down to levels very close
to what we expect to see in cases of brain-stem death. It’s no wonder patients find the euphemism
“put to sleep” to be a less scary description! So, what does it actually feel like to
get “put under” with general anesthesia? Donna Penner’s story provides a glimpse into
the mysterious experience of being under anesthesia - as well as a potent warning about how
sometimes, things can go terribly, terribly wrong. Donna, a 45 year old mother from Manitoba,
Canada, had been experiencing some worrying and unexplainable symptoms, so her doctor
recommended an exploratory abdominal surgery to see if they could find the
cause of her mysterious issues. On the day of her surgery, Donna was
understandably nervous to be “put under”, but she was eager to get to the bottom of her unusual
symptoms. She met with her anesthesiologist, who talked her through the process and assured her he
would be by her side the entire time. Since Donna didn’t have any of the risk factors that could
lead to a complication - she was a nonsmoker, not overweight, with no underlying medical
conditions - he assured her that things should go smoothly, and that she wouldn’t remember
a thing when she woke up after the operation. The only downside was that Donna had to fast
for 6 hours before her surgery to ensure that her stomach was empty and reduce the risk
of vomiting or choking while she was under. Finally, Donna was prepped for surgery
and wheeled into the operating room, where she was greeted by her anesthesiologist.
As the surgeon was busy getting prepared for the operation, the anesthesiologist placed a mask
over Donna’s mouth and administered a cocktail of hypnotic agents, opioids, muscle relaxants,
sedatives and cardiovascular drugs to Donna. He held her hand and comforted her as she drifted
into unconsciousness before inserting a breathing tube down her throat to help her breath and
prevent choking, since the anesthesia relaxes breathing and coughing reflexes. He also placed
3 sticky patches on Donna’s chest connected to an electrocardiogram, or ECG machine, to monitor her
heart rate, secured a blood pressure cuff on her arm, and clipped a pulse oximeter to her finger
to monitor the oxygen level in Donna’s blood. True to his word, Donna’s anesthesiologist
would remain by her side throughout the entire operation, carefully monitoring
her stats and ensuring that she was getting a continual dose of anesthesia
drugs. But, despite his watchful eye, there was one thing her anesthesiologist
couldn’t see - Donna was actually awake. Horrifically, Donna had woken up just before the
surgeon was about to make his very first cut. She was fully conscious but immobilized,
unable to speak or to signal to the room full of doctors and nurses that she was awake
and aware. She remained frozen in place on the table as the surgeon sliced open her abdomen and
explored her insides, poking and prodding at her organs for hours. All the while, Donna could
feel everything - every excruciating slice, every horrible movement. She was in terrible,
agonizing pain, and she was helpless to do anything about it - she couldn’t move or scream,
and she was sure she was going to die. “I thought, ‘This is it,” says Donna. “This is how I’m going
to die, right here on the table, and my family will never know what my last few hours were like
because no one’s even noticing what’s going on.’” Miraculously, Donna survived her ordeal,
though her recovery was long and painful. Even once her body had healed, the experience
left her with lasting psychological scars. She developed severe Post Traumatic Stress
Disorder, or PTSD, as a result of her horrific experience on the operating table, and suffered
from anxiety and panic attacks for years. Donna remembers having a full blown panic attack
one day when out shopping. She had stayed in the car while her daughter quickly ran into the
store, but when Donna realized that the car doors were locked and she was trapped inside,
it triggered an intense flashback to the day, more than a decade prior, when she had been
trapped and helpless on the operating table. To this day, Donna cannot stand to wear any
clothing that is tight around her neck, because it makes her feel like she can’t breath and takes
her back to her ordeal in the operating room. No one knows exactly why Donna woke up during
her surgery, but it’s estimated that as many as 1 in every 1,000 patients are believed to wake
up at some point while under general anesthesia. More recent studies show that this number
may be even higher. It’s yet another of the many mysteries surrounding anesthesia and
exactly how and why it works - or doesn’t. Thankfully, Donna’s terrifying experience
is rare. For most patients who get “put under” with general anesthesia, the process
goes smoothly and their surgeons are able to do their work without the patient having any
awareness of the trauma happening to their body. When they wake up, usually about an hour after the
anesthesiologist stops administering the drugs, they have no memory of the experience. It
can actually feel quite surreal - the last thing they remember is the mask over their
face as they drift off into unconsciousness, and when they come to in the recovery room
it can feel like no time at all has passed. It’s normal to feel a little “out of it” as
the anesthesia wears off - patients can feel emotional or loopy, may lack inhibitions
or behave in an exaggerated manner, and can have slurred speech for a few hours
after anesthesia. If everything went smoothly, it can actually be quite funny - at least for
their loved ones and nurses. The process of coming out of anesthesia is medically quite similar to
the experience of a patient who has woken up from a vegetative state, which makes sense when we
think about the fact that being under anesthesia is essentially being in a medically-induced coma.
The stages of recovery are pretty much the same, though they happen quite a bit
faster when coming out of anesthesia. Side effects are common after undergoing
anesthesia. Most of them are not serious and will go away on their own within a few hours to
a few days. It’s normal to experience vomiting, dizziness, and headaches after waking up from
anesthesia, and a sore throat or even a chest infection can be expected as a result of the
breathing tube that was used during the procedure. Confusion and memory loss are also quite
common, and usually resolve quickly. That said, in very rare circumstances, more
serious side effects can occur, including nerve damage, a severe allergic
reaction to the anesthesia drugs, awareness during surgery - like what Donna
experienced - and even, sometimes, death. Even though we know very little about how
anesthesia actually works, it’s an essential - if imperfect - tool in modern medicine, and it’s not
likely going anywhere anytime soon. Thankfully, scientists are working hard to improve
our understanding of how anesthesia works, and to develop more advanced techniques to make
anesthesia more effective and more targeted. Anthony Hudetz works in the Department of
Anesthesiology at the Medical College of Wisconsin, Milwaukee, and he is just one of the
many researchers working to better understand and improve anesthesia. Hudetz imagines a world
where anesthesia is less of a “hammer to the head, knock-out” experience, and more
of a delicate and specific tool. "We can also develop better anesthetic drugs
that would target consciousness itself, because today's anesthetics affect every cell in
the body," Hudetz says. "They suppress the heart and they affect all the major organs; they affect
the circulation; they suppress blood pressure, heart rate. And this is tolerable but we mostly
operate on injured people and sick people, and in that case these side effects of anesthetics
are undesirable and should be minimized." Anesthesia researchers are learning a lot by
collaborating with coma and sleep researchers to share knowledge and develop more delicate
tools that can help across multiple fields. Hopefully, this will mean fewer harrowing
stories like Donna’s, and one day soon, we might actually know how
anesthesia puts you to sleep. If you thought this video was shocking, you’ll
want to be sure and check out our other videos, like this one called “The Most Painful
Things A Human Can Experience”. Or, maybe this other video is for you.
