Sizing Up Surgery
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
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
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.