I’m going under general for the first time in two weeks for a brain biopsy.
Explain it and how it’s safe.
I’m not scared of the biopsy, just the general.
Is that normal?
In: 90
Copy/paste from a long response I made in another ELI5 about anesthesia.
It gives you something to do while allowing the doc to watch the medications take effect.
Induction for surgery differs a bit from what we do in the field but the concept is similar.
We start with an induction agent. This is designed to put you to sleep. It often has amnesia inducing effects which makes you stop making memories.
Then once you’re asleep, we give a paralytic. This paralyzes your muscles so that we aren’t fighting against you. It gives us more control. It also prevents your digestive muscles from relaxing and spilling gastric contents into your airway. This is also why they tell you not to eat or drink after midnight. You can’t spill what’s not there.
You’re intubated, which involves using a curved tongue depressor looking object with a handle (and often a camera) to manipulate the tongue / airway structure and putting a tube into your trachea. This gives us a tube that we can use to breathe for you while your muscles are paralyzed (this means the muscles you use for breathing are also paralyzed, which means you’re not breathing during this).
We take over your breathing with a machine. This is a ventilator, but can often be referred to as “life support.”
We give you additional medications to keep you asleep. Depending on what medication we gave for induction, it may be the same, or it may be different. Similar but different.
Now in the surgical world, they also worry about waking you up and all that. We don’t in the field. If we put you to sleep, weren’t not the ones waking you up.
Back to your original question. The easiest way to see how your induction medication is working is to just talk to the patient. Have them count out loud and you know they’re asleep when they stop counting. This isn’t always feasible for us.
If we are intubating in the field, they’re usually really sick / hurt and they may not be able to talk. As such, I’ll poke the forehead and brush the eyelashes to determine whether our meds have kicked in. Each of those will elicit a response that will disappear with paralysis. Once your paralyzed, we intubate quickly and start breathing for the patient before they physiologically realize they aren’t breathing and start to respond accordingly.
Edit: Really long winded way of saying no, it doesn’t matter what order you count in. Once meds are pushed, everyone is just waiting for you to fall asleep. You can count forwards, backwards, sideways, list colors, or name the states in alphabetical order. No matter, once meds are pushed, you’ve got 10-20 seconds before you get sent to the best nap you’ve ever taken.
Edit 2: getting a lot of repeat questions.
Why doesn’t the paralytic stop the heart?
The paralytics we use target a specific receptor pathway / system that isn’t present in heart cells. Imagine of the medicine paralyzes everything in the body colored blue, but the heart is red.
Did I have this with X procedure?
Depends. Maybe. Maybe not. But probably. If you woke up with a cough or a sore throat, there’s a good chance you had something there.
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