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    Sizing Up Surgery

    'Going Under'

    Anesthesia is the art and science of relieving pain and keeping patients safe and stable during surgery. But for patients already nervous about their impending surgery, the idea of being unconscious may not be a comforting thought, especially if it's coupled with the fear of not regaining consciousness.

    According to L. Melvin Elting, former Chief of Surgery at Riverdell Hospital in New Jersey, and Seymour Isenberg of the Kansas City College of Osteopathy and Surgery, authors of The Consumer's Guide to Successful Surgery, although many people associate anesthesia with regular sleeping, slumber is only a side effect. If you were to go to sleep and surgery began, you'd wake up in a hurry. While sleep involves a dousing of the highest brain recognition centers derived from the senses, it would take only a mild stimulus to peak them to alarm.

    The unconsciousness or "deep sleep" required for surgery is another matter. The deep sleep that is required for loss of sensation of pain occurs in stages, beginning with a gradual dozing off to an eventual drifting into paralysis so that the nerve responses are dampened. Unconsciousness must then be maintained during surgery so that patients are not aware of their surroundings and do not experience pain.

    Problems traditionally associated with anesthesia such as drug hangover, nausea, and awareness have been lessened over the years by better drugs, improved monitoring, and specialized training.

    Waking to a Nightmare

    Although it is rare, some patients have reported "awareness" or experiencing sensations while under anesthesia. Those patients say they recall hearing snatches of conversations, being aware of movement, and feeling pain. But whether this awareness really occurs or is just the subconscious mind playing tricks that come back to haunt the conscious mind has been subject to a lot of debate in the medical community. According to Elting and Isenberg, when the anesthesia is weak, or the depth of unconsciousness is purposely held shallow, the subconscious may provide its own interpretations of what is happening and those interpretations may not necessarily be accurate.

    But whether or not awareness is real, anesthesiologists are always on the lookout for indications of "light" anesthesia, such as sweating or involuntary twitching. In these cases, says Brenda Hayden, R.N., an interdisciplinary scientist with FDA's Center for Devices and Radiological Health, the anesthesiologist would increase the anesthesia to put the patient in a deeper state of unconsciousness.

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