Can you imagine what surgical pain and physical and mental suffering patients would have to endure without anesthesia? Probably many diseases in the world cannot be treated.
Before "anesthesia" appeared, the surgeon had to complete the procedure as quickly as possible to shorten the patient's "waking nightmare." Cutting a leg in 6 seconds and cutting off a breast in 30 seconds" is not a legend.
Between 1803 and 1815, the amputation had to be performed quickly because of the large number of wounded caused by the war. French surgeon Jean Dominic Larry had amputated 200 patients in 24 hours. But there is no "anesthesia", coupled with the unclean surgical environment, usually after the operation is done, many patients also die.
(Amputation in the 18th century| source: The History of Absurd Medicine)
In the face of the difficult problem of "anesthesia", the people of all ethnic groups in the world have made unremitting efforts from the past to the present.
Ancient poppies, mandrakes, alcohol, hemp boiling powder, and tongxian powder have all been tried for anesthesia[1];
The emergence of ether anesthesia in modern times marks the beginning of the exploration of safe and effective anesthesia methods and anesthetic drugs by medicinal chemists and clinicians.
The world's first case of ether general anesthesia:
On March 30, 1842, the American physician Crawford Williamson Long successfully performed the world's first case of ether general anesthesia, performing a neck mass resection operation for a patient. Unfortunately, it was not until 1848 that he made these results public, missing the title of "the first person in modern medicine to be anesthesia".
On October 16, 1846, Boston dentist Wilian T.G. Morton successfully demonstrated the surgical operation under ether anesthesia at Massachusetts General Hospital in the United States, and people saw the hope of completing the operation "painlessly". The concept of "anesthesia" began to take shape [1].
(Morton demonstrated the application of ether anesthesia at Massachusetts General Hospital in 1846| Source: Wood Library-Museum of Anesthesiology)
It can be said that without anesthesia, there would be no development of surgery, and medical modernization would not be possible. At the same time, the continuous updating of medical knowledge and the rapid development of new technologies have also promoted the rapid development of anesthesiology.
If you've had surgery, you may remember counting down from 10 before the operation, and maybe before you counted to 5, you lost consciousness and woke up at some point to find that the operation was complete.
It looks like you're asleep, but is that really the case?
General anesthesia refers to the passage of anesthetic drugs into the body through respiratory inhalation, intravenous injection, intramuscular injection, etc., thereby producing temporary inhibition of the central nervous system.
It manifests as [3]:
analgesia – you don't perceive pain;
Unconsciousness – you don't realize what's going on;
Memory loss (amnesia) – you don't remember what happened during anesthesia;
Muscle relaxation (akinesia) – you can't move.
Under normal circumstances, the electrical signals in the brain are like an active "chorus", and different parts of the brain are connected to each other and communicate with each other.
And when you are anesthetized, these brain signals become calm, and the connection and interconnection of brain regions is greatly reduced.
This "communication blockage" is not as simple as "getting some sleep".
(Source: giphy)
In the state of general anesthesia, communication between brain regions is blocked to some extent, resulting in a loss of consciousness and memory.
It can be simply understood that the depth of "falling asleep" in general anesthesia is deeper than when sleeping, so surgical procedures and painful stimuli will not let you know or wake up.
Until the end of the operation, the doctor stops the anesthetic drug, the nerve electrical activity in your brain slowly returns to normal, and the chorus in the brain restarts.
From anesthesia to awakening, the process is more like disassembling your consciousness and perception and then piecing it together.[5]
(Source: soogif)
During the course of general anesthesia, the anesthesiologist uses sedatives, analgesics, muscle relaxants and other drugs to maintain the patient's general anesthesia and provide conditions for surgery.
Sedatives make you fall asleep and your consciousness disappear.
Analgesics that alleviate the response to pain during surgery.
Muscle relaxants, which make your muscles relax and unable to move.
An anesthesiologist is not simply a magician who hypnotizes you before surgery and wakes you up after surgery.
They do more work to keep your life safe while you are "sleeping."
The anesthesiologist silently guards you and does these things:
Constantly monitor your basic vital signs (blood pressure, heart rate, pulse oximetry, body temperature, urine output, etc.).
Always pay attention to the surgical progress, observe the impact of surgical stimulation on your body and the resulting changes in vital signs, such as blood pressure fluctuations, arrhythmias, respiratory abnormalities, etc., and give pre-treatment based on experience and pre-judgment before certain key surgical operation stimulation to reduce the adverse effects of surgical operations.
Appropriate treatment must be made in a timely manner, such as adjusting blood pressure, stabilizing heart rate, dealing with arrhythmias, replenishing fluids and electrolytes, etc.
When critical situations such as major bleeding, cardiac arrest, ventricular fibrillation, anaphylactic shock and other critical situations occur during surgery, it is also the anesthesiologist who is responsible for commanding the overall situation, directing rescue, and escorting your life.
Anesthesia works like flying an airplane, and every anesthesia is a voyage.
Before boarding, the doctor will conduct an "anesthesia security check" for you: to understand your health status, previous diseases, medications, assess your organ function, risk of complications, postoperative recovery prediction, etc., and formulate a detailed anesthesia plan accordingly to improve intraoperative safety and accelerate postoperative recovery.
Anesthesia induction and anesthesia awakening are the most thrilling (like airplane take-off and landing) and also test the anesthesiologist's "piloting" level. For example, during the take-off and landing stages of the voyage, the seat belt should be fastened, the small table board should be put away, the seat backrest should be straightened, and the anesthesia will also have a similar fine but important safety operation.
During a smooth voyage, you will also fall into tension due to unstable factors, such as bleeding, allergies, arrhythmias, blood pressure fluctuations, blood oxygen changes, etc.
Someone must pick you up after landing. After the operation, the anesthesiologist will continue to monitor your vital signs after confirming that you have woken up to ensure your safety.
On this "unconscious" anesthesia voyage, your mind is not a black sea of nothingness, it is like a concert hall diving into the depths of consciousness, the conductor is missing, but the orchestra is still playing neatly, and your brain can't hear it.
Yes, but not high.
The overall reported incidence in China is 0.06% to 0.4% [6].
"I was clearly aware of what was happening during the operation, and every knife I cut could feel, but I couldn't shout or move."
Afterwards, they described the psychological feelings of the time as "separation, extreme fear, suffocation, and even a sense of near-death."
The factors of anesthesia arousal are more complex, and are mostly related to individual differences, anesthesia depth, types of anesthetic drugs, and anesthesia equipment.
People who have experienced intraoperative knowledge (awakening under anesthesia) may experience anxiety, neurasthenia, fear and panic, recurrent intraoperative memory, nightmares, and even post-traumatic stress disorder in the near and long term after surgery [1].
At the end of the operation, the anesthesiologist gradually stops the drug, waits for the patient's breathing to recover and the vital signs are stable, and then removes the endotracheal intubation and allows the patient to breathe on his own.
If muscle relaxants have not been fully metabolized and anesthetics have been fully metabolized, a feeling of imminent death occurs when you are conscious and unable to move or feel inadequate respiratory function.
Wait for muscle relaxant metabolism to be complete, and then you can resume normal motor and respiratory function.
In addition, there are also people who worry about "becoming stupid" and "forgetful" after general anesthesia, which is called "postoperative cognitive dysfunction" in medicine.
In a series of studies, it has been found that this is mostly related to the age of patients, pre-existing diseases, surgical effects, psychological factors, etc., and is not much related to general anesthesia [7,8].
The inscription of Dr. Horace Wells, one of the parties involved in the discovery of ether, reads:
"Found ether, pain no longer".
Painless anesthetics not only bring complex and delicate surgical procedures, but also derive medical technologies such as painless delivery, painless endoscopy, and painless puncture.
With the development of modern medicine and anesthesiology, the need for anesthesia has not only "eliminated pain". On the basis of not being painful and not moving, there is also "not knowing", temporarily closing the patient's awareness and allowing them to undergo surgery unconsciously.
Human beings still carry the spirit of exploration to solve pain in the past few thousand years, and explore safer, more effective and reflect the medical humanitarian anesthetic drugs and anesthetic methods.
Contributing Author: Dan Qing
Ph.D., Southern Medical University
Review expert: Liu Xiaoyuan
Chief Physician of the Department of Anesthesiology, Beijing Tiantan Hospital
bibliography
Deng Xiaoming. Modern Anesthesiology. 4th Edition (Part 1).People's Medical Publishing House.2014.
[2]. Michael H. Hart, The 100: A Ranking Of The Most InfluentialPersons In History Paperback, Revised and updated edition, June 1, 2000.
[3]. Xie S, Ma W, Guo Q, Liu J, Li W, McLeod HL, He Y. The pharmacogenetics of medications used in general anesthesia. Pharmacogenomics. 2018 Feb;19(3):285-298.
Liu Xiaoyan. Clinical EEG (2nd Edition).People's Medical Publishing House.2017.
[5].https://www.brainfacts.org/thinking-sensing-and-behaving/thinking-and-awareness/2021/whats-the-difference-between-sleep-and-anesthesia-051121
Zhang Aihua,Zhu Bo,Yu Xuerong,Huang Yuguang. Research progress known during surgery[J].Journal of Clinical Anesthesiology,2020,36(04):410-412.
[7]. Backeljauw B, Holland SK, Altaye M, Loepke AW. Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia. Pediatrics. 2015 Jul;136(1):e1-12.
[8]. Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol. 2003 Jun;17(2):259-72.
Editors: Wei Luo, Zhao Yanan, Zhang Liang
Typesetting: Han Ningning | Proofreader: Wu Yihe
Operations: Li Yongmin | Coordinator: Wu Wei