What Happens While You're Under Anesthesia?

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 on an operating table for surgery. Today, she takes us on a journey through the history and science of this cornerstone of modern medicine. Curious about other breakthroughs in the history of science? Let us know by emailing [email protected] mailto:[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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• 0:00Emily Kwong?

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• 0:22Speaker 01

  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.

• 0:32Emily 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.

• 0:45Speaker 01

  Okay, so while you're sleeping, we're going to go on vacation. Where do you want to go?

• 0:49Emily Kwong?

  Tahiti.

• 0:50Speaker 01

  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.

• 0:58Emily 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 01

  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 01

  Salt or no salt?

• 1:17Emily Kwong?

  Margarita on the rocks. Salt, yeah.

• 1:19Speaker 01

  What type of flavor?

• 1:21Emily Kwong?

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

• 1:29Speaker 01

  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.

• 2:01Emily 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.

• 2:14Speaker 01

  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.

• 2:21Emily 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.

• 2:51Speaker 01

  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.

• 3:13Speaker 01

  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.

• 3:27Emily 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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• 5:05Emily Kwong?

  OK, 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?

• 5:16Speaker 01

  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 16, 1846,

• 5:58Speaker 01

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

• 6:08Emily Kwong?

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

• 6:15Speaker 01

  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.

• 6:45Emily Kwong?

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

• 6:50Speaker 01

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

• 6:56Emily Kwong?

  Yeah.

• 6:56Speaker 01

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

• 7:06Emily 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?

• 7:19Speaker 01

  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.

• 7:35Speaker 01

  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. So once anesthesia enters the system, it's essentially just going in the bloodstream, traveling all across the body, and then being metabolized. It can be metabolized by the kidneys, the liver, and then inhaled anesthetics are metabolized through the lungs and then you breathe them out.

• 8:05Emily Kwong?

  Okay. What is anesthesia doing to your nervous system?

• 8:13Speaker 01

  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, are going fast, right? So they're just kind of go, go, going at a higher speed.

• 8:45Emily Kwong?

  It's like a pinball machine over there.

• 8:47Speaker 01

  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.

• 9:20Emily 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 going to ignore that message. Like what's happening?

• 9:32Speaker 01

  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, analgesia, which is not feeling pain.

• 10:14Speaker 01

  Muscle relaxation and then memory loss. Right? 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. Uh, muscle relaxation, which is muscle relaxants. And then, uh, memory recall, you're not going to recall anything either.

• 10:33Emily Kwong?

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

• 10:36Speaker 01

  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.

• 10:53Emily Kwong?

  Yeah. How is anesthesia different from sleep?

• 10:56Speaker 01

  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. 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.

• 11:30Emily 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.

• 11:40Speaker 01

  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, um, place to be in, but also a very, uh, important position to really be able to empower and, and identify the, the concerns that your patient has.

• 12:13Emily Kwong?

  Wow. Can you tell me a story about a time you were, um, 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?

• 12:26Speaker 01

  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.

• 12:48Speaker 01

  So that's a very tricky situation to be in.

• 12:50Emily Kwong?

  Yeah.

• 12:50Speaker 01

  And 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.

• 13:08Emily Kwong?

  Which was?

• 13:08Speaker 01

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

• 13:13Emily Kwong?

  I know Yanni.

• 13:13Speaker 01

  What, do you?

• 13:14Emily Kwong?

  Yeah.

• 13:15Speaker 01

  And it was my first time listening, but I-

• 13:17Emily Kwong?

  Very spirited.

• 13:18Speaker 01

  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.

• 13:47Emily 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?

• 13:55Speaker 01

  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.

• 14:15Emily Kwong?

  Don't lie.

• 14:16Speaker 01

  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.

• 14:47Emily Kwong?

  Alopi Patel, thank you so much for talking to me. And I hope if I ever have to go under your... It would be my honor.

• 14:57Emily Kwong?

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

• 15:05Emily Kwong?

  This episode was produced by Rachel Carlson and edited by Burleigh 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.