What Happens When You're Under Anesthesia?

It's World Anesthesia Day https://wfsahq.org/news/world-anaesthesia-day-2025-anaesthesiology-in-health-emergencies/ tomorrow! So, we invite you to take a deep breathe. Picture a relaxing scene. Maybe a beach in Tahiti, your toes in the sand, a cold drink in hand. Now imagine your favorite music playing in the background. If Dr. Alopi Patel https://rwjms.rutgers.edu/people/alopi-patel were your anesthesiologist, that's exactly what she'd have you do while you waited for surgery. Before she puts patients under the sway of anesthesia, she likes to explain everything that will happen after they lose consciousness and lead them in guided imagery to help them relax before their procedure. She calls this "verbal anesthesia," and says "it's a type of anesthesia you can't really put in an I. V." Anesthesia is a cornerstone of modern medicine makes tons of surgeries possible today. But Dr. Patel says it wasn't always this way — and shares the history and mechanisms behind this once-controversial procedure. (encore)Curious about other breakthroughs in the history of science? Let us know by emailing [email protected]! Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:16Emily Kwong?

  You're listening to Short Wave from NPR.

• 0:21Speaker 02

  Hi, my name is Dr. Patel, and I'm the anesthesiologist. And we're going to go into the operating room now. So the room might be a little cold. There might be a few people here, and I also have a few people.

• 0:31Emily Kwong?

  This is what you'd hear in surgery if Dr. Alopi Patel was your anesthesiologist. When she puts patients under, she tries to explain everything as it happens, so patients know what to expect.

• 0:44Speaker 02

  OK, so while you're sleeping, we're going to go on vacation.

• 0:48Speaker 02

  Where do you want to go?

• 0:48Emily Kwong?

  Tahiti.

• 0:49Speaker 02

  Ooh, I like Tahiti. So we're going to go to Tahiti. We're going to go to Bora Bora in Tahiti, and we're sitting on the beach.

• 0:57Emily Kwong?

  She'll put on your favorite music and continue this guided vacation imagery, meant to put you, as the patient, into a relaxed state.

• 1:07Speaker 02

  We're sitting on the beach, putting our toes in the sand. And are we, do you want a margarita, a mojito? What are we drinking today?

• 1:15Emily Kwong?

  Yeah, margarita.

• 1:16Speaker 02

  Salt or no salt?

• 1:16Emily Kwong?

  Margarita on the rocks, salt, yeah.

• 1:18Speaker 02

  What type of flavor?

• 1:20Emily Kwong?

  Alopi then begins a process called induction, using medication to induce a state of unconsciousness.

• 1:28Speaker 02

  I'm going to put this mask on your face. It's going to be a little tight. Pretend this is fresh oxygen from Tahiti. We just imported it, right? So take in deep breaths in and out. And I'm going to start giving you some medication in your vein. And as I'm giving that IV, you're going to feel me rubbing on the other hand. And that rubbing is going to make you feel better, and slowly you'll start feeling warmer and warmer. Pretend you're putting your toes in the sand, sipping those margaritas, and soon you'll be off to sleep.

• 2:00Emily Kwong?

  Mostly because of the Cocktail of anesthetics, delivered through IV or inhaled as gases. But Alopi says there is tremendous power, too, in her words. She calls this part of her job verbal anesthesia.

• 2:13Speaker 02

  And it's the type of anesthesia you can't really put in an IV. It's being able to comfort a patient and help them anticipate what to expect next.

• 2:20Emily Kwong?

  Anesthesia literally means without sensation or feeling. But different types of anesthesia can do different things. General anesthesia involves losing consciousness. You often have a breathing device during those procedures. Sedation is anesthesia where you can breathe on your own. And regional anesthesia is when one part of the body gets numb, like a leg or an arm, while local anesthesia is just numbing in one specific area. And all of that can be done with different medications. Alopi describes the operating room as her kitchen.

• 2:50Speaker 02

  Most recipes, you need the same ingredients if you're making something like banana muffins, right? But the amount you're making depends on how many people you're making it for. Do you want something more salty or sugary, whatever?

• 3:01Emily Kwong?

  But instead of flour or sugar, Alopi is using different anesthetics, like propofol, lidocaine, and different opioids. Anesthetics like these make all kinds of surgery possible.

• 3:12Speaker 02

  Brain surgery, back surgery, heart surgery. You would not be able to do any of these surgeries, abdominal surgeries, without having the patient completely asleep and paralyzed or their muscles relaxed for the procedure.

• 3:26Emily Kwong?

  Today on the show, we go into the operating room and under the sway of anesthesia, how this once controversial procedure became a cornerstone of modern medicine. I'm Emily Kwong, and you're listening to Short Wave, the science podcast from NPR.

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• 5:11Emily Kwong?

  Okay, Alopi, let's talk about anesthesia's history. When did people start using it? And what kind of chemicals were most popular back in the day?

• 5:23Speaker 02

  Yes, the traditional sort of history of anesthesia kind of starts around the mid 1800s. So the most popular form of anesthesia that was studied at that time was chloroform. So ether was another one and nitrous oxide. They're all various sort of inhaled anesthetics that can knock out a patient. The first successful demonstration of anesthesia was in 1846, and this was done by William Morton. William Morton was actually a dentist who was experimenting with different types of anesthesia. And ether was the one that he successfully demonstrated. The day that he successfully demonstrated anesthesia was October 16th, 1846,

• 6:04Speaker 02

  in the Ether Dome in Massachusetts General Hospital in Boston. And that is now called World Anesthesia Day.

• 6:14Emily Kwong?

  How was anesthesia used or not used for people giving birth back in the day? And how has that history evolved?

• 6:21Speaker 02

  So Queen Victoria actually had many children. For almost all of her children, she did not have any anesthesia. There was stigma back in the day about women having pain relief during labor and delivery because it was expected for a woman to suffer during childbirth because it was God's intention, right? For the pain to be unsufferable, to be able to have a child. And it wasn't until Queen Victoria herself asked to have chloroform for her eighth baby or something.

• 6:51Emily Kwong?

  She was like, "Give me some of that good stuff. I am the queen."

• 6:56Speaker 02

  And she essentially legitimized it, that you can have childbirth with a pain-relieving substance.

• 7:02Emily Kwong?

  Yeah.

• 7:03Speaker 02

  And since then, we've come so far in obstetric anesthesia in terms of spinal anesthetic, epidural anesthesia for pain relief.

• 7:12Emily Kwong?

  Wow, okay. So let's accompany you now through this process, starting from when a patient is being induced and the anesthetic starts entering their system. What is anesthesia doing to the body?

• 7:25Speaker 02

  So depending on the types of anesthetics, it can affect their heart rate, it can affect their blood pressure, it can affect different types of blood flow, right? So when the blood pressure goes down, it can affect the blood flow to the brain, to the heart.

• 7:41Speaker 02

  We care about all the organs, but really the brain and the heart are the two most important organs that we really think about because we don't want, you know, too little oxygen to be in the brain or the heart.

• 7:51Emily Kwong?

  Yeah.

• 7:51Speaker 02

  So once anesthesia enters the system, it's essentially just going in the bloodstream, traveling all across the body, and then being metabolized.

• 8:01Speaker 02

  It can be metabolized by the kidneys, the liver, and then inhaled anesthetics are metabolized through the lungs and then you breathe them out.

• 8:12Emily Kwong?

  Okay. What is anesthesia doing to your nervous system?

• 8:19Speaker 02

  So anesthesia in general creates this very relaxing effect, right? So it creates a slowing down of your nervous system. So you have your parasympathetic nervous system and your sympathetic nervous system. Your sympathetic is your fight or flight, right? So you're go, go, going. Anesthesia essentially relaxes the body. So it can help decrease the heart rate. It can help decrease the blood pressure and create a relaxation in the brain as well. So when you're awake, your, your brainwaves are going fast, right? So they're just kind of go, go, going at a higher speed.

• 8:51Emily Kwong?

  It's like a pinball machine up there.

• 8:54Speaker 02

  Yeah, so the waves are just going super fast. And then when you get anesthesia, IV or inhaled anesthesia, the brainwaves come down. They're slower and they're more relaxed. And it just kind of creates the zen sort of mode for the brain or like an airplane mode, right? Where things are just kind of low energy and able to be relaxed. And during that, that induced coma or controlled coma, significant surgical incisions or surgical stimulus can be done without the brain and the body feeling it.

• 9:26Emily Kwong?

  So the messages, like, are they just not getting through? Is it kind of like your, your body's like, pain, pain, pain? But then the receptors are like, eh, we're just gonna ignore that message. Like, what's happening?

• 9:39Speaker 02

  Kind of, yeah. It doesn't cut off communication necessarily. That would be something like a local anesthetic, right? So a local anesthetic does cut off communication. We're just doesn't allow that pain signaling to go through. But a anesthetic, like an IV anesthetic or an inhaled anesthetic, just kind of relaxes it so you, you don't really have that stimulation as much. And it creates this low energy mode, essentially that airplane mode where you just don't feel it as much. If there's significant enough pain, you can definitely feel it, but you won't recall it. And that's another important aspect of anesthesia, right? So there's anesthesia, which is that not feeling sensation, and agesia, which is not feeling pain, muscle. Relaxation and then memory loss, right?

• 10:24Speaker 02

  So when you have anesthesia, your body is not feeling certain things. When you have the pain medications, you're creating that pain-free state. Muscle relaxation, which is muscle relaxants, and then memory recall. You're not going to recall anything either.

• 10:39Emily Kwong?

  I didn't know you can't form memories under anesthesia.

• 10:43Speaker 02

  Yeah, most of the time you won't remember anything. So we call that recall in anesthesia. So if we, if we do that recipe just right in the kitchen of the, of the operating room, basically, if we do everything just right, most patients will not remember anything from their anesthetic.

• 10:59Emily Kwong?

  Yeah. How is anesthesia different from sleep?

• 11:02Speaker 02

  So that's a great question. Sleep has its own sort of neurochemistry and physiology. And there are REM waves associated with it. You can have dreaming associated with sleep. But anesthesia, you can sleep for five minutes and feel like you got the most restful sleep.

• 11:19Speaker 02

  But you didn't actually go into REM sleep. It's more of like this state of unconsciousness and you might feel relaxed. But it is different than true sleep. You're not having the same brainwave changes and you're not necessarily having the same dreams that you would under natural sleep state.

• 11:36Emily Kwong?

  That must feel like at once very powerful, but also a big responsibility that you are like guiding people through something that is so, they're so vulnerable in those moments.

• 11:47Speaker 02

  Absolutely, and it is such a privilege to be with patients at that time. I think it is one of the most vulnerable times for, for most patients, right? To feel like, okay, I am not going to have sensation or power or autonomy over my own body. And you're giving it to the hands of the anesthesiologist at that time. And it's a, it's a powerful place to be in, but also a very important position to really be able to empower and identify the, the concerns that your patient has.

• 12:19Emily Kwong?

  Wow. Can you tell me a story about a time you were monitoring a patient under anesthesia? That just like stays with you, that like taught you a lot or? Stayed with you for whatever reason. Do you have a story like that?

• 12:32Speaker 02

  Absolutely. I have one story that I can think of that really resonated with me about this is why I wanted to do anesthesiology and be an anesthesiologist. There's this very high-risk patient that needs surgery ASAP for hematoma, which is a blood clot. But she also has a massive blood clot in her lungs.

• 12:54Speaker 02

  So it's a very tricky situation to be in. The patient was already very nervous and I was able to connect with the patient. I said, hey, you have a blood clot. We have a couple of options. I'm going to talk to the surgeon as soon as they get here and we're going to see how we can do this. And I spoke to the patient the entire time. We put on her favorite music.

• 13:14Emily Kwong?

  Which was?

• 13:15Speaker 02

  It was Yanni. I had never heard of him. It was like a Greek musician.

• 13:19Emily Kwong?

  I know Yanni.

• 13:20Speaker 02

  Oh, do you?

• 13:22Speaker 02

  And it was my first time listening, but-

• 13:23Emily Kwong?

  Very spirited.

• 13:24Speaker 02

  Very, yeah. And, you know, we just listened to music and I held her hand and I sat with her and the surgeon did his stuff as fast as he could to evacuate the hematoma. We stabilized, put on pressure dressing, all of that stuff. And the patient was so grateful. It is such a big part of the patient experience to be there as a human next to that person and not just a face peering down. Like that human aspect of anesthesiology is why I love this field.

• 13:54Emily Kwong?

  What would you say to someone who's maybe has an upcoming procedure where anesthesia will be involved and, and let's say this person's nervous? What would you say to them?

• 14:01Speaker 02

  Absolutely. So always be honest with your anesthesiologist is what I would say. Your anesthesiologist and your grandmother have one thing in common, which is we want to know, when did you eat last? Because we want to make sure that, you know, you have a, you can have a safe anesthetic on an empty stomach, as we say, but really be honest with your anesthesiologist is the most important thing.

• 14:21Emily Kwong?

  Don't lie.

• 14:22Speaker 02

  Do not lie. Whether it's whether you used cocaine or marijuana, we do not judge. We do, we are there to protect you and to help you. And also it's super safe. Anesthesia has evolved so much over the last 30 years especially, since the, uh, since the invention of certain monitors for like heart rate and oxygen. Anesthesiologists are trained physicians with thousands of hours of care and we're here to help you and walk you through the process.

• 14:54Emily Kwong?

  Alopi Patel, thank you so much for talking to me. And I hope if I ever have to go under, you are my scienceologist.

• 15:00Speaker 02

  It would be my honor.

• 15:04Emily Kwong?

  We go to Hawaii, girl. We would get away.

• 15:06Speaker 02

  Hawaii margaritas.

• 15:12Emily Kwong?

  This episode was produced by Rachel Carlson and edited by Burley McCoy. Tyler Jones checked the facts. Jimmy Keely was the audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from NPR.

• 15:41Speaker 03

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