How Does Anesthesia Work? We Still Don’t Know
When patients ask anesthesiologists what we charge for putting them to sleep, we often say we do it for free. We only bill them for the waking up part.
This isn’t just a way of deflecting a question, it also serves as a gentle reminder to both parties regarding the importance of “coming to.” If we couldn’t regain consciousness, what would be the point in having the surgery in the first place? Nobody wants to experience pain and fear if it can be avoided. If the only way to avoid the pain of an operation is to temporarily be rendered unconscious, most people will readily and willingly consent to that, as long as we can return to our natural state of being alert and interactive with the world around us. We are awake and aware and that–rather than any particular conception of health–is our most precious gift.
How does Anesthesia work ?
From an Anesthesiologist’s point of view, we really shouldn’t charge for putting someone to sleep. It’s too easy. With today’s medications, putting someone to sleep, or in more correct terms, inducing general anesthesia, is straightforward. Two hundred milligrams of this and fifty milligrams of that and voilà: you have a completely unconscious patient who is incapable of even breathing independently. The medications we administer at induction are similar to the lethal injections executioners use. Unlike executioners, we then intervene to reestablish their breathing and compensate for any large changes in blood pressure and the patient thereby survives until consciousness miraculously returns sometime later.
In addition, those in my field have to contend with the reality that we really don’t know what we are doing. More precisely, we have very little if any understanding of how anesthetic gases render a person unconscious. After 17 years of practicing Anesthesiology, I still find the whole process nothing short of pure magic. You see, the exact mechanism of how these agents work is, at present, unknown. Once you understand how a trick works, the magic disappears. With regard to inhaled anesthetic agents, magic abounds.
Take ether, for example. In 1846 a dentist named William T.G. Morton used ether to allow Dr. Henry J. Bigelow to partially remove a tumor from the neck of a 24-year-old patient safely with no outward signs of pain. The surgery took place at Massachusetts General Hospital in front of dozens of physicians. When the patient regained consciousness with no recollection of the event it is said that many of the surgeons in attendance, their careers spent hardening themselves to the agonizing screams of their patients while operating without modern anesthesia, wept openly after witnessing this feat. At the time, no one knew how ether worked. We still don’t. Over the last 173 years, dozens of different anesthetic gases have been developed and they all have three basic things in common: they are inhaled, they are all very, very tiny molecules by biological standards, and we don’t know how any of them work.
Why we still don’t know…
If you have never closely considered how our bodies do what they do (move, breathe, grow, pee, reproduce, etc.), the answers may be astounding. It is obvious that the energy required to power biological systems comes from food and air. But how do they use them to do everything? How does it all get coordinated?
These are the fundamental questions that have been asked for millennia, by ancient shamans and modern pharmaceutical companies alike. It turns out that the answers are different depending on what sort of perspective and tools we begin with. In the West, our predecessors in medicine were anatomists. Armed with scalpels, the human form was first subdivided into organ systems. Our knives and eyes improved with the development of microtomes and microscopes giving rise to the field of Histology (the study of tissue). Our path of relentless deconstruction eventually gave rise to Molecular Biology and Biochemistry. This is where Western medicine stands today. We define “understanding” as a complete description of how the very molecules that comprise our bodies interact with one another. This method and model has served us well. We have designed powerful antibiotics, identified neurotransmitters, and mapped
Article from LewRockwell
