Feel pain under general anesthesia

Can you feel the pain during an operation? The main thing is that you don't know anything about it afterwards

They put us under anesthesia, guard it and see that we return to life. Conversations with those you can hardly hear: the anesthetists.

"Are you in a nice place where you feel good?" Asks senior physician Elvira Allensbach the woman on the Schragen. This is covered up to the chin, cables run away from her head and arm. You can tell from her gaze that she is setting off for something unknown. "Think about the holidays, about your children," the doctor repeats. Then the patient's eyes close. The value on the monitor, which shows the awake state, decreases steadily. If it was just over 90, it is now falling around 30. The chest is no longer moving. The woman has stopped breathing on her own, she is losing consciousness, in other words: the anesthesia works.

Every time one is anesthetized, one takes a journey towards death and back to life. We give this life to the anesthetists so that other doctors can treat our body. This is often forgotten because our thanks go to those in the foreground. The anesthetist weighs up which anesthetic is best for a patient, how high the dose should be so that the sleep is deep enough and the procedure is painless; but also so that the anesthesia does not have too strong an effect.

Anesthesia is a combination of sleeping pills, pain relievers and a drug that relaxes the muscles so that the patient lies still.

This is especially true for interventions in which the patient would be endangered because of the drop in blood pressure: for a caesarean section, where one must also think of the child, for seriously injured or elderly people. Anesthesia always consists of three components: sleeping pills, pain relievers and a drug that relaxes the muscles so that the patient lies still. Anesthesia affects the central nervous system, but how and where exactly is still unknown today. That is why it is said of anesthesia that it remains an art, or rather: a mysterious science.

45-year-old Noemi Widmer (name changed), who had her uterus removed that morning in the Olten Cantonal Hospital, is being anesthetized with anesthetic gas. Because she is being operated on on the abdomen, her arms must be tight against the body to give the surgeon better access. Otherwise, they would have chosen propofol, a narcotic that is injected into the veins. "So only the head belongs to us," says Italo Castelli, long-time chief anesthetist. While the anesthetic is being administered intravenously, the patient is given pure oxygen with a mask to aid breathing. In the operating room, the anesthetic is then maintained with the anesthetic gas.

"Michael Jackson Milk" Propofol

“Frau Widmer!” Calls out senior physician Allensbach repeatedly to make sure that the patient is sleeping soundly before pushing the tube between the slack vocal cords into the windpipe. Noemi Widmer no longer reacts, not even to the touch of the eyelids, under which the eyes show pupils the size of a pinhead. True, her blood pressure rises slightly when she is intubated, which indicates stress. The physical reaction does not mean that the patient feels pain. And yet she feels something. What exactly? One does not know. As long as she forgets what might have been uncomfortable, it doesn't matter.

"We are service providers who enable others to do their work." Italo Gastelli

Because sinking into this intermediate world is also frightening, anesthetists speak to the patient a few days before the procedure and explain the procedure to them. Noemi Widmer asked for a sedative before the anesthetic. “I don't want to be brave,” says the mother and teacher of three. She should also be reassured by the invitation to think of something beautiful. Studies have shown that patients go into anesthesia more positively as a result. The more nervous someone is, the slower the anesthetic effect occurs. Perhaps one last, conciliatory thought could also lead to good dreams, says head physician Castelli.

Italo Castelli is a tall, second-generation Italian who looks similar to Bill Murray and exudes that serene calm that anesthesiologists are said to be: they stand for hours in the operating room like a watchful ghost at the head end, guarding our survival. Although he doesn't like the word, anesthetists are "service providers who enable others to do their work, in whose shadow we are," says Castelli: "But you don't care."

An anesthetist's devotion is to numbing, not to the riddles of consciousness, which leaves many questions unanswered. For example, it cannot be said why the anesthetic gas can initially create the sensation of falling into a hole. This is different with the intravenous method with propofol, which is more common today: Here it is more like gently switching it on and off. And, as they say: awakening is often accompanied by erotic dreams.

In fact, if you hear people raving about who has been given propofol, you have to imagine painful interventions on the body. They tell of the all-round comforting feeling that this narcotic triggers, both before and after. "It is nice! »says every anesthetist. The milky-white emulsion is also called Michael Jackson milk in the jargon, as the singer died of an overdose of propofol, which he had injected every night and called "milk". Nowadays, people continue to anesthetize - less often - with laughing gas or ketamine, which can trigger hallucinations and is both sleeping and pain reliever. It is mainly used in war and disaster areas and in rescue medicine. All of these narcotics are popular in the party scene too. In the past, patients were allowed to inhale plant extracts and drink schnapps in order to make the surgical pain more bearable, but ether anesthesia prevailed from the middle of the 19th century. The American natural philosopher Henry David Thoreau wrote in 1851 when he had to have his teeth pulled: When you are unconscious you are separated from everything you call "this world". He recommended, “If you have an inclination to travel, take ether; it carries you away to the most distant stars. "

Or to hell? If you are about to have an operation, it is better not to stay in the relevant forums, where people can exchange ideas about what they experienced under too light anesthesia. Kate Cole-Adams also describes in her new book "Anesthesia: The Gift of Oblivion and the Mystery of Consciousness" a caesarean section in which the mother-to-be remained fully conscious. Since the muscle relaxant works in a similar way to the poison dart used by Indians, she was unable to give a signal when she realized she had been cut open while she was awake. She compared the pain to a truck rolling over her and suffered from post-traumatic stress disorder for years. According to studies, one to two patients in 1000 are conscious under the operation. It doesn't always have to be traumatic. Sometimes patients only remember voices or the bright light.

The horror of wakefulness

Both Italo Castelli and Donat R. Spahn, professor of anesthesia and head of the institute at Zurich University Hospital, question the number and assume one case per 20,000 to 30,000 anesthetics. Spahn only saw a heart patient once in his career who heard the doctors talking during the operation. Because her life hung by a thread, she was carefully anesthetized. It's about the art of balance - Spahn also reminds us: "Every anesthetic is fundamentally fatal." It shouldn't happen, but as long as you're not suffering, wakefulness isn't dramatic. This is the case with any local anesthetic. For this reason, in the case of general anesthesia, an anesthetist should not just rely on the numerical values ​​that show the depth of anesthesia, but should not let the patient out of sight. Is he sweating? Does he have tears? If there is an “awareness experience” anyway, an anesthetist should not deny anything, but rather listen to the impressions, says Spahn. "If the patient is told that he is telling something that cannot be, it can be very stressful for him."

"Falling asleep and waking up are among the most delicate phases of anesthesia, like taking off and landing the plane." Italo Castelli

In the Olten Cantonal Hospital, Noemi Widmer is now lying under a green sheet in the operating room. She won't remember anything later: Not how her stomach with CO2 is inflated so that the gynecological surgeon Peter Scott can push his surgical instruments with a camera through the abdominal wall through three small punctures. Not how the so-called buttonhole technique is used to separate the uterus from the tissue and pull it out through the vagina. The uterus was infected with benign tumors. She weighs 350 instead of the normal 80 grams, says the surgeon.

"Frau Widmer, the operation is finished!" Calls senior physician Elvira Allensbach when the patient is lying in the anteroom to the operating room again and does not move: "Breathe yourself!" Falling asleep and waking up were among the most delicate phases of anesthesia, says Castelli, “like taking off and landing an airplane”. During the test with fine electrical surges, her arm twitches, and the brain waveform also shows that she is conscious again, even if she is not yet responsive. Minutes after the anesthetic was turned off, the patient reports back to life, coughing. The ventilation tube is removed from the windpipe. Only now does she come to the recovery room.

How did it feel now, falling into deep sleep? "I tried to think of something nice," says Noemi Widmer an hour later: "But I just couldn't think of anything."