I understand they want to know when we pass out, but why count backwards from 10? Why not count forward from 1?
In: 2183
Because counting forward starting from 1 is a skill we practiced a lot during our life and most of us can do it on auto pilot. You don’t need many cognitive faculties to count forward, but to count backward you typically need to be more concentrated and think a bit more about it. So it’s a better indication of how the anesthetic affect you.
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.
[removed]
Does anyone still do this? In the past the drug used to induce general anesthesia, go to sleep for surgery, was sodium thiopental or STP. STP took a relatively long time to make people go to sleep. So anesthesia providers used the ‘count backwards’ thing to distract patients.
Now days, the drug of choice is propofol. Propofol works in one arm-brain circulation. Basically you are asleep as fast as it takes to push the drug into your veins. Distractions aren’t needed as much.
As an anesthesia provider, I tell my patients “pick out a nice dream; vacation on the beach or skiing in the snow…” and there asleep. YMMV.
I remember having to count down years ago, but more recently I was asked what my favorite place to be was while they knocked me out.
Honestly, there’s no definitive purpose. It’s sort of like a learned thing for the anesthesiologist to say. Yes, it can help determine consciousness but there are other ways to do those.
Backwards is because counting forwards can be done very fast so you might count upto 10 in 1.5 seconds whereas counting back from 10 usually takes 5 secs or so.
It’s similar to doctor/ nurse saying take a deep breath while giving an injection
[removed]
ER nurse here I use it when similarly sedating patients for procedures (despite the rolling eyes of my co workers.)
Often when you’re trying to sedate someone it’s hard to tell when it’s working, especially if it’s a “conscious” sedation where they’ll be awake but not remember the procedure.
The counting backwards method works great because the person being sedated will usually stop once it starts working. Also provides some mild comfort in the process, some people will get paradoxically anxious as they start fading and it gives them something to do.
I had surgery earlier this month. They didn’t count down. They asked me questions. They asked me where I worked, then they asked what I do. I saw my vision getting fuzzy, so I said, “Why? You guys don’t care. Goodbye.” and went out.
When they masked me, they said, “We’re just gunna give you some oxygen.” I knew what was up, but I had told them I was anxious, so I guess that was a slick move.
I was “put under” to have my impacted wisdom teeth surgically removed back in 1978. I remember being told to count backwards from 100 and getting as far as 96. I never had another surgery until last November when I underwent a lumpectomy. I was administered anesthesia and don’t recall being asked to count…in fact, the last thing I remember was being rolled on my bed/gurney through the operating room doors feet first and I commented “Just like *Ben Casey*!” Next thing I knew I was in recovery, and a nurse was concerned because my nose was bleeding slightly.
(I used to watch the reruns of Ben Casey with my Mom when I was a wee little kid….[This is the scene I was reminded of.](https://youtu.be/juN1mgR3VBQ)…._ )
Latest Answers