We Still Don't Know How Anesthesia Works | Answers With Joe

this video is supported by expressvpn what's the most painful experience you've ever had physical pain not you know that time that Charlotte William stood you up for the middle-school dance even though you spent three weeks of Lotte annoying money just to buy her a corsage and then he find out later that she went to the lake that night with Jimmy sturgeons just because he has a journey t-shirt that she liked and it clearly wasn't even his it was her brothers and this after you gave her your fruit by the foot in band class she's beneath you man you're better off okay no really what's the most painful experience you've ever had in your life just just talk about it down in the comments let's see who's been traumatized the most here I'll wait okay I'm done waiting for me it would probably be the time that I had a kidney stone about seven years ago or so I remember I was in my car and I was getting an attack and I knew that it was bad when I heard this disembodied voice often the distance kind of sounded like it was right outside my car somebody just screaming like a banshee and then I realized it was me not fun but honestly probably better than being a patient in the year 1800 in getting any medical procedure at all because you could have surgery no problem it's just that surgery would probably take place in your living room and the pain management would look like this and this quite a few surgeries recently drifted the doctor back in those days were a literal waking nightmare a dentist was basically just a guy that was good with pliers I said before on this channel that I would not want to go back in time further than the birth of antibiotics I think the same could be said for anesthesia now we've come a long way when it comes to pain management thank God but as far as we've come there's still some stuff we don't fully understand things like you know how it works when you get win for basic surgery there's usually a team of five or six people on there to take care of you guess which one gets paid the most hint if it's not your anesthesiologist something is horribly wrong for the first time in history for the last hundred fifty years or so anyway you can go in and get surgery and not be an excruciating pain anesthesia is one of the best things we have ever invented and the truth is we kind of just fell ass-backwards into it the very first prescription from around 2100 BC was thought to have had opium in it and the Greeks used to ease the pain of surgery using Mandrake now alcohol which I joked about a minute ago turns out isn't a joke that's actually one of the things they use to calm and relax patients back in the day other places around the world use cannabis some use coca leaves and some use acupuncture and these didn't always work most of them had terrible side effects but you didn't really have to worry about the side effects too much because having surgery pretty much guaranteed you were gonna get an infection that would probably kill you anyway if I may just hammer at this point home one more time this is how it was for the vast majority of human history luckily for all of us that started to change in 1846 with in Massachusetts dentist named dr. William Morton he had a colleague that had been using ether as a topical anesthetic but he'd also heard stories about Harvard students that were using ether to kind of huff and get high off of it for reasons that I'm sure we're pure ly scientific he decided to have the ether himself and the next thing he remembered was waking up in the future he realized that he had no memory or recollection of anything that happened during that time that he was out and he realized this might be better than just tying a string to a doorknob so he tried it on a patient a guy named eben H Frost and after he put him on ice and while he was chilling he pulled out a bicuspid and lo and behold when Frost thought out he remembered nothing of it no pain no agony no ice buns soon after dr. Morton demonstrated this ether ization technique in the Massachusetts General Hospital and the age of modern anesthesia was born so yes modern anesthesia began in basically the same way that James Bond takes down a henchman with chloroform luckily anesthesia just come a long way since then and today there's four types of anesthesia you're likely to encounter procedural local regional in general procedural sedation also known as conscious sedation or Twilight anesthesia uses drugs to keep patients in a calm and pain-free state but also awake at the same time so if you've ever had your wisdom teeth taken out the dentist or been under lapping gas for one reason or another you've been under procedural sedation so what's the point of keeping you awake well so that the doctor can ask you questions for one thing that's why it's actually popular with brain surgery believe it or not because they need to be able to be aware of whether or not you can still speak while they're doing that in there and it also prevents you from being nauseous or dizzy now awake doesn't mean fully conscious you're still extremely groggy and usually hilarious if I get some tooth taped out yes I think I feel the holes now the good thing about you doing all the dumb stuff that you do under procedural sedation is that you don't remember any of it the thing is you know everybody around you does and if a video of it winds up on YouTube then the whole world does fun fact for the first part of the 20th century women were encouraged to give birth in a Twilight sleep state the thing is this erases the memory of the pain but it doesn't really prevent the moms from feeling the pain at the time so you'll still be in total agony you just won't remember it so yay and then there's a fact that you know the babies are still attached to the mom when they get this anesthesia so it actually gets into the babies as well and it can calm and relax them so much that they stop breathing which is bad local anesthetics numb the area around the wound or the procedure and it doesn't affect anywhere else on the body if you've ever gotten root canal done or a filling at the dentist that's local anesthesia course anesthetic that most people associate with the dentist is novocaine and basically any drug that has pain at the end of it is some kind of local anesthetic and the reason it has cane on the end of it is because it was named after the first local anesthetic cocaine Sigmund Freud was a big proponent of cocaine which isn't a surprise because he used a lot of it but that's not really weird because as I've covered in a previous video cocaine was literally and everything back then but it was a friend of Freud's named Karl Kohler who was the first to use it as a local anesthetic when he put a cocaine solution in the eye of a patient before he gave him glaucoma surgery and while yes the idea of a doctor sprinkling cocaine in your eye probably sounds terrible I just want to point out again that before this and I I really can't emphasize this enough they were doing eye surgery with no anesthetic now I do want to be fair to dr. Koehler what I just said sounds kind of crazy but he did test this out with a colleague beforehand they took turns numbing each other's eyes and then poking each other in the eye with needles science so doctors don't use a lot of cocaine these days at least not on their patients but the derivatives of cocaine still do a great job for local anesthesia if the pain is more widespread however you might want to go with regional anesthesia regional anesthesia blocks pain for a wider area of the body like an arm or a leg or the whole lower half of the body in the case of an epidural the pain drugs are also used as regional anesthetics and they're also used in combination with others as well injections that go into the spine which is a better way of saying the epidural space or the cerebrospinal fluid is called central anesthesia basically anything's as central is regarding the spine so central anesthesia is a sub-genre of regional anesthesia peripheral regional anesthesia are usually it regards a limb like an arm or a leg and this brings us to the Big Daddy The Sandman himself general anesthesia so when referring to general anesthesia a lot of people say that they get put to sleep but it's not really sleep you know you become a mobile you present as unconscious and you also don't form any memories just like with procedural sedation the drug can be given intravenously and or through inhalation and when I say and/or and not being wishy-washy that's often a combination that's used these drugs act on the central nervous system and they impact the entire body and the brain so much so that you either have to wear a mask or be intubated to keep your breathing from closing down and anesthesiologist have to watch the patient really carefully to make sure their oxygen levels are out that their breathing is maintained and that their blood pressure stays the same so if monitoring sleepy people and getting paid a boatload of money sounds good to you anesthesiologist might be the career path that you want to take just set aside 7 to 11 years of schooling to get it so yeah a lot of modern anesthetics is just based on happy accidents that occurred along the way doctors didn't really understand how pain works they just knew that this took it away these days we understand pain really well and we totally get how anesthesia works at least two of the four anyway pay me when nerve fibers respond to what is called noxious stimuli and this can be thermal chemical or mechanical in nature and these are picked up by different kinds of nerve cells called nociceptors and there are different kinds of nociceptors that pick up on the different types of stimuli the mechanical the chemical or the thermal I guess you could compare to the cones in your IDE that only respond to certain colors so when a nociceptors in a resting state the interior has a negative electrical charge while the outside of the cell has a slightly positive charge when the nociceptors becomes active it creates what's called an action potential this travels down the cell and incites sodium ions to enter through the sodium channels to reverse the charge and this continues from one side of the cell to the other when it gets to the end of the cell called the axon neurotransmitters fire across the synapse to the neighboring neurons dendrite and that activate the next cell the action potential continues down that Selim's chain reaction all the way up the nerves down the spine and into the brain only when it gets to the brain is it interpreted as pain so the local anesthetics like the cane drugs that I talked about before they stop the pain by interrupting that flow of action potentials before it gets to the brain local anesthetics do it closer to the wound regional anesthetics do it you know further downstream so how does that work well as I just explained the action potential moves across cells thanks to sodium ions entering via sodium channels anesthetics blocked the sodium channels by entering the cell as a neutral molecule or an ionized meaning neither positive or negative once in the cell it picks up the positive charge from the potassium and blocks the sodium channels and while the sodium channels are blocked the sodium can't enter and the action potential can't move forward hence no pain signals now obviously there's a lot more to it than that for example the way the anaesthetic molecules fit into those sodium channels it's kind of like a key in a lock which gets kind of complicated but that's the basics of how you know local and regional anesthetics work this is something we do understand now the procedural set it is in the general anesthetics well those deal with consciousness and the formation of memory and if there's two things we don't fully understand in science yet its consciousness in the formation of memory now there are some theories and I'm gonna do my best to explain them - according to the research that I've done you know in the last week or so anyway but you know how I'm not a doctor I'm just some schmuck on YouTube please keep that in mind here so that whole molecular key thing I just talked about with the the pain neurons well this happens in the brain neurons as well anesthetics interrupt the action potentials these brain neurons and they prevent them from acting normally the difference is as opposed to say nerve fibers in your arms it's sort of like a chain a linear chain that goes from one cell to the other in the brain every single neuron stretches out and connects to multiple other brain cells and a vast web and in that web our thoughts create general pathways that action potentials get used to traveling through because the neurotransmitters kind of get used to going that way and when these anesthetics hit these brain cells and disrupt the action potentials that sort of connect them becomes disrupted but of course it's more complicated than that because there's different types of general anesthesia drugs and they differ wildly in their structure and molecular makeup and yet they all seem to kind of produce a similar effect which doesn't really make any sense some steroids work as general anesthetics the chemical Zenon does as well and these are completely different chemicals and yet somehow they still do the whole lock and key thing and work just fine which shouldn't be true it was a theory in the 80s that this multiple keys approach worked because these anesthetics were dissolvable and lipids or fat molecules because there are fatty membranes around nerve cells it was thought that if anesthetics got dissolved into those membranes that would kind of maybe gum up the works but then they were seeing similar reactions happening in nerve cells that didn't have those fatty membranes so that kind of threw that theory out the window now there's also the question of which areas of the brain are being affected that's shutting down consciousness and shutting down memory formation which sounds like an easy question to answer right just just do a brain scan but yet functional MRI scans have been done and it has not been helpful at all because it turns out different drugs affect different parts of the brain and yet still are somehow producing the same result so yeah there's no silver bullet there's no one region of the brain that seems to be the thing that turns on and off consciousness and memory formation so modern newer theories of consciousness tend to revolve around the network functions of the brain the idea that these things work because it kind of changes the way the brain talks to itself the different regions of the brain talk more slowly to each other or faster or just more varied you know it's sort of a a synchrony that gets created throughout the brain and that's what sort of shuts it all down but of course some drugs work the opposite way like propofol which actually increases neuronal firing to the point that it creates this cacophony of noise so that the message and the signal gets lost so that loss of synchrony theory explains the loss of consciousness but it doesn't really explain the whole memory formation issue but again there seems to be no simple coherent answer Zenon tends to work on the amygdala propofol tends to work on the hippocampus propofol by the way is a milky white substance is often called milk of amnesia and it's what killed Michael Jackson I'm not trying to be morbid here but I did see a documentary awhile back that sort of talked about his his final days and it turns out that he had insomnia so bad that his personal physician dr. Conrad Murray was giving him propofol every single night just to get him to go to sleep every night he was hooked up to an IV he was catheterized so that he wouldn't wet himself and he was put under just like he was going into surgery and this went on for years this was Michael Jackson's life so this had a couple of effects obviously he built up a tolerance to propofol after a while which led Conrad Murray to give him more and more every night just to get him to go under and eventually on June 25th 2009 it eventually got to be too much and that's when he died Conrad Murray was later convicted of involuntary manslaughter but the other effect is he didn't dream so like I said before going under for surgery they say it's like putting you to sleep but it's not like sleep sleep is actually an active state in the brain that's how the brain kind of cleans itself up it's it's sort of defragging it's hard drive if you will and dreaming is an important part of that and he didn't dream for years so from the brain side of things he was completely sleep deprived it's like he hadn't slept for many years so this tends to make a person go a little crazy and then you add on top of that chronic pain from arthritis and multiple other problems Michael Jackson was messed up like it's kind of amazing he survived as long as he did so that's awful so let's talk about something even worse it's something called anesthesia awareness and in about one or two out of every thousand are so surgery people actually wake up in the middle of surgery so the anesthesia are supposed to do three things one is supposed to paralyze you and make you immobile one is take away your consciousness and two is prevent memories from forming I just said two didn't I I can count but all three of these fail in the case of anesthesia awareness now that's terrible on nightmarish but something that happens that I think is even worse in my opinion anyway is when the consciousness comes back on the memory formation comes back on but you're still paralyzed you're laying there fully aware feeling everything that the surgeon is doing to you and you cannot move and you cannot speak and you can't tell them how much agony you're in this actually happens sometimes thankfully it's extremely rare but the people who are unlucky enough for that to happen to them this creates a trauma that they had to deal with for years but seriously it's extremely rare so if you need to have some kind of life-saving surgery my god get it and again consider yourself lucky because that horrifying scenario I just outlined is what most people throughout human history just called surgery so thanks anesthesia so today's video is brought to you by a new sponsor expressvpn and it's kind of the perfect sponsor for this video now that I think about it because you know I'm just talking about how anesthesia takes away your ability to form memories that's kind of exactly what expressvpn does anytime you go online you're being tracked by somebody now hopefully it's just your isp but it might be hackers it might be bus data miners everybody wants to get your information and remember it for various purposes later on well expressvpn is like a digital anesthetic it erases the memory of everything that you do online by using an encrypted connection but also because they use ram to store the information which means there's nothing to save that on it all just disappears you can also set up your location to pretty much anywhere in the world so as far as the Internet is concerned you're thousands of miles away from where you really are so there's content that's blocked in your country if there's services that cost less in other countries you've got a sneaky way around that isn't it cool you get to be the sneaky one for once so I'll be honest I came kind of late to the VPN thing which is stupid because I do a lot of work in Kok shops and stuff which might be why I got a letter from the IRS recently saying that I had to attach some new form to my taxes this year that has nothing to do with me and it turns out it's probably because somebody filed their taxes under my social security number does this have anything to do with that I don't know but I'm not taking any more chances you know setting it up was crazy fast it was simple and I gotta be honest I'm feeling safer already the moral of the story here is don't be an idiot like me protect yourself with a virtual private network and if you'd like to try out expressvpn you can get three months for free when you go to expressvpn calm slash Joe Scott link down the description big thanks to expressvpn for supporting this video and a huge shout out to the answer files on patreon that are supporting this channel keeping our team alive and just being awesome and forming a cool community I got some cool people that have just joined I got a murder the name's real quick we've got Claudette and Mike in Guam Brady in Burton Shay a Steinbeck er Brenna Reed Vieira Phil applause in the lawn dziak plays our Thomas Hawkins Christopher wells Phil Stiller Lonnie Morrison Kamil's cichlid kissa Kinski Thomas Rowan Nora Noah Ortiz Steve Bradshaw and Eric Reata worst one ever thank you guys so much if you'd like to join them get early access to videos join a cool community and all that kind of stuff you can go to patreon.com/scishow please do like to share this video if you liked it and if this is your first time here maybe check this video out Google things you'll like that one because they're tracking you uh-huh and if you liked any of the videos over here on the side that my face on it I do encourage you to subscribe because I comeback of videos every Monday all right I'll leave you with that thanks again for watching you guys now go out there have an eye-opening week stay at home be safe and I'll see you next Monday hope you guys take care

Channel: Joe Scott

Views: 532,732

Rating: 4.9508581 out of 5

Keywords: answers with joe, anesthesia, ether, propofol, michael jackson, conrad murray, anesthesia awareness, local anesthesia, procedural anesthesia, general anesthesia, surgery, novocaine, dentistry

Id: FzK3oWMm4MY

Length: 19min 16sec (1156 seconds)

Published: Tue Apr 07 2020