I used to work in this field decades ago. It was relatively straightforward. You could see it with your plain eyes in the EEG, but also you could calculate metrics from it. One really fun way was to listen to the sped up EEG signal when a person is put into anesthesia. It sounded like you went underwater.
The key thing is that when people are given muscle relaxants, you need an independent method to measure consciousness directly.
I haven't followed this in decades so it's a total surprise to me if it isn't mainstream yet.
You could buy a module for your anesthesia monitor for this, no need to use a separate device.
Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why start with kids rather than adults?
We do it regularly in both kids and adults, and this is nothing new. It's just that a study confirms it's useful using statistics instead of common sense. We were already using EEG in both kids and adults 15 years ago.
I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased.
But has that statement been debunked for sedentary people or people with kidney disease?
'A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.'
— Max Planck
An example is that thin people cannot possibly have sleep apnea, it only affects overweight people. Overly-confident Dunning-Kruger doctors adamantly declared this as "truth" to me enough times that it stalled me getting properly treated at least a decade.
My wife is a doctor and provided me (layperson) the following context. Apparently EEG is now used in most adult surgeries and has been increasing over time. It is used as a marker of how 'asleep' you are to guide how much medication you get. However, this is relatively recent and the use of EEG in kids (where the brainwaves are different) was not studied/used as much. It seems like this study pushes towards a future where EEGs are routine in most if not all surgeries to make them safer - especially as the next generation of anaesthetists are trained in it.
MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament).
So with this kind of practice, you create any patient's worst nightmare: being cut open, feeling everything, knowing everything, but unable to stop it. And you are unknowing, uncaring or too cheap to prevent that e.g. via EEG monitoring.
Edit: Parent removed his comment. Roughly, from memory, there was some claim by him about being a professional anesthetist, having very rarely encountered EEG and only bi-spectral index monitoring (an EEG-derived computed measurement) in some IV cases, some claims about the unreliability of both and about the preference for MAC (minimum alveolar concentration) to monitor depth of anesthesia.
MAC is the alveolar concentration (so strictly speaking defined only for anesthetic gases) at which half of people show no motor reaction on surgical incision. I understand your interpretation about paralysis, but we know the measurement endpoint is not paralysis in practice. Gases are hypnotics, and although they do cause some amount of muscle relaxation they do not induce paralysis. Hence the need for other drugs when we need paralysis. BTW, there is evidence that EEG prevents awareness under anesthesia, but it's not a guarantee either. Fortunately, awareness is extremely rare even in the select cases where it occurs more often (emergency C-section and cardiac surgery, especially in seniors).
........................................
>Single-trial classification of awareness state during anesthesia by measuring critical dynamics of global brain activity (2019)
> The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients.
So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis.
Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)
"MAC being the primary indication of anesthetic depth being the textbook definition"
I am an attending anesthesiologist and this is true. MAC cannot be interpreted at face value, though. You've got other drugs on board (not accounted for in MAC), the patient might be frail or very old, etc. etc. All things changing MAC interpretation, which is why there are still anesthesia providers instead of robots ;-) We currently have no way of faithfully measuring the depth of anesthesia, and our understanding of consciousness/awareness is incomplete. Anesthesiologists have to rely mostly on know-how, even in 2025.
It obviously varies on place of practice and the way you were taught. My understanding is the evidence is pretty clear that it helps but happy to defer to your lived experience.
If the reporting is accurate, which is really not a given with MIT, this is great news. For all its upsides, general anesthesia is still dangerous and very rough on you, and all these effects are always amplified for young patients.
> children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness, and non-purposeful movements
In general, a very simple mental model for general anesthesia is that it's an unnatural state for your body and your body will do its best to get rid of it, similar to say alcohol or drugs. This means systemic inflammation, stress on your cardiovascular system, liver and kidneys, brain, and so forth. Most all of these issues scale with how much anesthetic you receive, similar to a hangover being worse the more you drink.
In other words, general anesthesia is rough on you just like getting black out drunk is, it's just more controlled and we do our best to try and limit the downsides because it's invaluable for surgery where applicable.
> In other words, general anesthesia is rough on you
Can confirm having watched our kids recover from general anesthesia multiple times.
Full disclosure: have three kids, eldest child at lifetime total of 4x general anesthesia so far (1x for endoscopy, 3x for surgery), youngest child lifetime total of two (1x endoscopy, 1x dental work). Middle child seems to have escaped so far... he asked recently what it was like, siblings answered unanimously - "terrible".
I had a general anesthesia at 21 for dental surgery. The come back was a nightmare: nausea, shaking, cold and hot alternating, terrible headache, cramps, exhausted and mentally depressed during ~2 days. I couldn't eat, I couldn't drink (but brute force myself to do it), I couldn't think or concentrate on anything but the pain. The only close experience I can remember is the wake up after a blackout hangover but it really wasn't that bad compare to the anesthesia.
6 years later a car crash required artificial coma during 3 days. They drug me along the week following my come back. The dreams during the last day of coma and that week took me through fascinating and terrifying experiences half real (intubation, interactions with family and medics...) and imaginary (ever-repeting-same-day, interns having a fireplace in the ICU floor with guitars, mind-controlled bed to move around the room...). They finally gradually stop the drug and I was only a bit angry and physically suffering from my injuries but not that bad.
Big up to the amazing Royal Perth Hospital team for that amazing care. They saved my life and made the process a confortable trip.
I always wonder what was that drug that produce so weird half-wake dreams with not much side effects. And why they don't always use that for dental surgery and everything else. I heard hypnosis can work instead of a classical general anesthesia and am keen to try if the funny Australian drug isn't an option. Everything but not the general anesthesia.
edit: wonder if both experiences could have been the same sedative drug but the second had a hypnotic wake-up parachute drug during the comeback.
I’ve had one for an operation on a broken jaw, just didn’t think it was particularly rough. Of course it takes time to come round and be clear headed, but the OP kinda implied serious physical problems with “dangerous and very rough on you”. Maybe I just misunderstood what they were saying, but I thought they meant rough as in long lasting damage (which I didn’t think was the case), not temporary discomfort.
Your situation obviously isn’t ideal, but doesn’t have the same implication.
> I always wonder what was that drug that produce so weird half-wake dreams
The sibling comment here mentions Ketamine, which is possible, but if they’re giving that to you intravenously then all perception of time and space will be warped. It’s extreme. So wild dreams is one thing, questioning what is even real is more like ketamine.
It is after effect free though and doesn’t last long, so once stopped you can be over it within the hour. It also has antidepressant effects afterwards.
Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized?
Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning.
The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.
You are correct. But there is also the aspect that in current opinion, children below the age of 2 to 3 years do not form episodic memory. Which can reinforce the misconception about the necessity of anesthetics in children, because they are unable to recall and tell about the pain.
Anesthesia is mostly know-how. When you've put several hundred kids under, you (usually) become equipped with a good sense of what's going on, even without kids telling you.
"Kids don't need anesthetics. If they are young enough, they won't remember the pain, so you can just operate without anesthetics. They are also easier to restrain than adults."
This was state of the art in medicine for quite some time. I fear the general trend of "medication bad" will get us back to those dark times.
This right here. Medicine is not bad in general. Mother Nature is a wicked mistress. Pain and suffering are her defaults, and glimmers of happiness fleeting.
Modern technology and medicine in particular have made our lives better and longer in ways our near ancestors could not have dreamed of or hoped for.
It's not hard to find counterexamples of course: opioid addiction, climate change, etc. But on balance we're a hellava lot better off now than 50 or 500 years ago.
Nice to use a bit less anesthesia for faster/better recovery and money savings. But for goodness sake - let's not go TOO far down that path.
Do notice that the comments about 'pain and suffering are mother nature's defaults' have very little to do with anything else you said, or with the discussion more broadly. I think these sorts of things are bad internet hygiene and promote an actively depressive state of mind. They can be memetic concepts, and should be treated with care. If you do actually feel this way about your own life, I'd encourage you to seek some kind of help. And besides, there's nothing natural about surgery...
I think the rest of what you're saying is fairly accurate, though.
> I fear the general trend of "medication bad" will get us back to those dark times.
I think this won't ever happen. Modern docs would absolutely not accept working under such conditions. Anesthesia is not only comfort for the patient, but also for care providers. As you can often see when surgeons advise patients on refusing local anesthesia or nurses demanding benzos for the screaming demented patient at 2 a.m.
My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralysed but not given general anaesthesia due to risk of immediate death. This led to a position statement from the paediatric society at the time that nobody should be operated on without pain relief / general anaesthetic.
Note that this does not mean that general anaesthesia was not given at all to kids before 1987, but that there was a belief in the USA (and elsewhere) that newborns did not need pain relief during anaesthesia. Your use of 'kids' versus 'newborns' is a bit misleading in that respect.
> textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants.
Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced.
> infant surgery routinely conducted with no or minimal anesthesia well into the 1980s
"Routinely" isn't a few isolated cases, that's the word for "this is the usual thing to do".
> The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years.
"Vast majority" and "dominated" also doesn't sound like just "some cases".
> surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals.
We can discuss the definition of "kid" and "newborn", but I would no longer call them "newborn" when they start walking. Also "most American hospitals" means the practice was very widespread even in 1986.
I think the whole situation is one of the medical community failing to recognize and admit their own mistakes. Instead, the obvious barbarism of the whole situation is played down, diminished and belittled. Thereby protecting their own feelings and standing at the cost of the victims' right to the truth. And thereby paving the way for a repetition of such gruesome mistakes. At which point I would argue, it might even be a little callousness or even intent...
While the theory about pain in kids was certainly wrong, you are lacking some context about what 'safe' used to mean, and what it means nowadays. In the 80's, kids were under halothane and long-acting paralysis drugs which, especially in cardiac patients, are really dangerous. Halothane is now discontinued, as are many other common drugs from this time. Theories do not spring out in isolation. The evolution of technology, biological understanding and new pharmacology have all contributed to allow new opinions as incremental changes made old theories more and more evidently obsolete. Doctors 50 years from now will also wonder how we could be so stupid in 2025.
I don’t know where the truth lies, but even if everything you wrote is true (and it does sound reasonable to me), not giving anesthesia might still be a safer choice considering the side effects. Not saying it is, only saying that we need to take a look at the side effects and risks, and all other (at a time) available information before we call them barbarians.
At some point in adult medicine, it was recognized that using an analgesic during surgery, in addition to the then normal combination of paralytic and hypnotic, significantly increased survival rates. This fact was independent of the patients capacity to remember the pain and wasn't any kind of psychological response like PTSD. It was the basal reaction to injury and pain by stress that killed those patients.
The exact same reaction kills non-adults. The proof took longer, but it is there now. That doctors even needed proof instead of, without further experimental knowledge, assuming the null hypothesis of children being small adults in this case already is proof of a kind of chauvinistic barbarism. Infants were some kind of lesser human to them, thus couldn't react in the same way as adults.
Remember, the norm was _no_ analgesia, _no_ pain relief. For the majority of infants. Its not that they decided on a case by case basis on the right balance of analgesia vs. risk. They decided as a matter of course that analgesia was superfluous for infants.
I think there is a definitional problem with "kids" vs "infants" vs "newborns" which are all difficult to define, the type of anaesthesia that was administered and we are also talking about 40 years ago. Our understanding of anaesthetics and heart surgery in newborns was much different than today. America definitely has a checkered and sordid past here and in psychiatry. But we also have a duty to be definitionally exact here which is why I tried to get a bit more context when the GP used the term "kids". I had thought before investigating that meant all the way up to teenagers.
I admit that "kids" is a bit imprecise and can lead to misunderstandings. But that is just not important to this discussion.
And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else.
If you feel adventurous, have your family doctor give you a paralytic and then push a sterile needle under your fingernail. Then tell me the exact definition of sufficient anesthesia in that case ;)
Compare that with the whole “twilight sleep” way of delivering babies and you can see a whole misogynistic thread of not respecting natural systems and of trying to minimize or eliminate the behavioral symptoms of pain while doing little to actually ease the patient.
This research is aimed precisely at making it safe enough to administer general anesthesia in these populations for that to become standard of care.
Let me preempt one possible line here: I do not love the circumstances under which I would have been circumcised as a neonate in Mississippi in the very early 1980s, and I do not resent the result. Living that far tied up in the past is for men who can't figure out how to do anything else. I am not one of those and despite an essential sympathy with the theoretical basis of their position that no putative benefit remotely
justifies the the risk of the intervention, I have a short way with "intactivists."
But if it had been possible safely to administer more than EMLA (perhaps!) for pain relief, not even in that place and time would anyone be so barbaric as to refuse it. Of course. And that, making possible that precise measure of mercy in the case where the intervention is not merely cosmetic, is exactly that at which this research is directed. So, to anyone looking to make a cause of the ghosts of a billion foreskins or whatever, I would say please do not attempt even by implication to recruit my argument in support of your position.
I didn't say anything about a foreskin anywhere. And my point is, they did not just do minor stuff like a circumcision (which I think is a barbaric, pointless and immoral practice to inflict on non-consenting minors in any case except to maybe cure phimosis).
They did major surgery. Like opening the cranium or abdomen. Like removing limbs. Like removing burnt skin by brushing it off and applying skin grafts. And no, they didn't even apply Lidocain, because children don't feel pain. At best, they gave muscle relaxants as chemical restraints and to make the tissue easier to cut.
Yes, any, male or female, genital mutilation is life-changing.
What I meant is, it is "minor" as far as surgery goes, as opposed to "major". The distinction is about the risk to the life of the patient, the kind of anesthesia you need (local vs knockout), the setting you do it in (walk-in vs stay at the hospital) and the amount of aftercare required (change the bandage vs. medication+monitoring+hospital).
And those studies are BS, done to prove a preexisting point. Any properly done study by independent researchers without an agenda doesn't show any kind of effect from circumcision beyond the resulting sensory problems, deformation, nerve damage, erectile dysfunction, scarring and adhesion.
I really do not understand why did you felt the need to push for circumcisions here. Like, no one asked or discussed them one way or the other. Like ok, it is religious for Jews and Arabs, but no one else have to care.
Jesus, I tried as hard as I knew how not to start a fight, knowing this place plays host to a few foreskin mourners. Better just to avoid entirely, it appears, and duly noted.
What a shame the eyeroll emoji is filtered here. That, apparently, is the level people are on. A paragraph is too much! Or is everyone still rationing since Cerebral, or whatever that telemedicine pill mill was called, shut down a few years back? Is that why no one is reading today?
I never thought I'd say this, but for God's sake and as a favor to us both, pipe my shit through ChatGPT and ask for a reframing on a sixth-grade reading level. You pay for access to the damned robot, let it wipe your nose through the remedial work. I've got embroidery to do and movies to watch.
What? How are you making that leap? I'm not insulted; we've never met. I am confused, though, and you are a licensed professional facing specific ethical requirements and constraints on your issuance of medical advice. Perhaps you'll explain what you know that I don't.
Circumcision induces keratinization of the glans (one of the reasons this makes us more resistant to many STDs). I noticed a huge difference in touch perception before vs. after and I strongly resent that this was brought onto me. I'm not trying to insult anyone. It's personal.
What is the level of unconsciousness during anesthesia? Is it "sleep-like" unconsciousness or "neurons do basically nothing" level? Whenever I read about anesthesia I am wondering if we are not accidentally killing people (and creating new ones) like in teletransportation paradox. https://en.wikipedia.org/wiki/Teletransportation_paradox
Depends on the "kind" of anesthesia, on the medication used and on the specific reaction of the patient to that medication.
For example there is stuff like Ketamine, which in some cases can live up to its other use as a recreational drug and give the patient very colorful dreams. There are sedatives that just take away the capacity to form memories, but leave you awake and aware, just calmer. In cases like some knee surgeries, it is possible to leave the patient fully awake, just paralyze and numb the legs.
Just anecdata, but I was under a few times as kid. It was like teleporting into the future. Last memory was being told to count backwards, next memory was waking up in the recovery room.
Apparently I had a small anesthetic overdose in the hospital as a kid and woke up a day or two later than expected, but from my perspective, nothing happened and I just went to sleep then woke up.
I used to work in this field decades ago. It was relatively straightforward. You could see it with your plain eyes in the EEG, but also you could calculate metrics from it. One really fun way was to listen to the sped up EEG signal when a person is put into anesthesia. It sounded like you went underwater.
The key thing is that when people are given muscle relaxants, you need an independent method to measure consciousness directly.
I haven't followed this in decades so it's a total surprise to me if it isn't mainstream yet.
You could buy a module for your anesthesia monitor for this, no need to use a separate device.
It is mainstream. We have modules. It's useful, but unfortunately not a magic wand either.
Why is this about kids?
Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why start with kids rather than adults?
This article provides shockingly little context.
We do it regularly in both kids and adults, and this is nothing new. It's just that a study confirms it's useful using statistics instead of common sense. We were already using EEG in both kids and adults 15 years ago.
Doctors not too long ago would tell you that infants don't experience pain.
There are a lot of not backed by science beliefs in the medical field that won't die until the doctors that believe them do.
https://pubmed.ncbi.nlm.nih.gov/23548489/
Too much protein is bad for your kidneys!!!
PS: this has been debunked, still docs keep saying it.
I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased.
But has that statement been debunked for sedentary people or people with kidney disease?
'A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.' — Max Planck
An example is that thin people cannot possibly have sleep apnea, it only affects overweight people. Overly-confident Dunning-Kruger doctors adamantly declared this as "truth" to me enough times that it stalled me getting properly treated at least a decade.
My wife is a doctor and provided me (layperson) the following context. Apparently EEG is now used in most adult surgeries and has been increasing over time. It is used as a marker of how 'asleep' you are to guide how much medication you get. However, this is relatively recent and the use of EEG in kids (where the brainwaves are different) was not studied/used as much. It seems like this study pushes towards a future where EEGs are routine in most if not all surgeries to make them safer - especially as the next generation of anaesthetists are trained in it.
I’m good here. Thanks.
MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament).
So with this kind of practice, you create any patient's worst nightmare: being cut open, feeling everything, knowing everything, but unable to stop it. And you are unknowing, uncaring or too cheap to prevent that e.g. via EEG monitoring.
Edit: Parent removed his comment. Roughly, from memory, there was some claim by him about being a professional anesthetist, having very rarely encountered EEG and only bi-spectral index monitoring (an EEG-derived computed measurement) in some IV cases, some claims about the unreliability of both and about the preference for MAC (minimum alveolar concentration) to monitor depth of anesthesia.
MAC is the alveolar concentration (so strictly speaking defined only for anesthetic gases) at which half of people show no motor reaction on surgical incision. I understand your interpretation about paralysis, but we know the measurement endpoint is not paralysis in practice. Gases are hypnotics, and although they do cause some amount of muscle relaxation they do not induce paralysis. Hence the need for other drugs when we need paralysis. BTW, there is evidence that EEG prevents awareness under anesthesia, but it's not a guarantee either. Fortunately, awareness is extremely rare even in the select cases where it occurs more often (emergency C-section and cardiac surgery, especially in seniors).
>Anesthesia Awareness and the Bispectral Index (2008)
https://www.nejm.org/doi/full/10.1056/NEJMoa0707361
........................................
>Awareness during anesthesia: how sure can we be that the patient is sleeping indeed? (2009)
https://pmc.ncbi.nlm.nih.gov/articles/PMC2683150/
........................................
>Awake Under Anesthesia (2018)
https://www.newyorker.com/books/page-turner/are-we-all-awake...
https://archive.ph/t9T7o
........................................ >Single-trial classification of awareness state during anesthesia by measuring critical dynamics of global brain activity (2019)
https://www.nature.com/articles/s41598-019-41345-4
........................................
>Intraoperative and Anesthesia Awareness (2023)
https://www.ncbi.nlm.nih.gov/books/NBK582138/
Good day to you.
Well... My textbook[0] says:
> The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients.
So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis.
Please tell me you are not really a doctor.
[0] https://www.sciencedirect.com/topics/medicine-and-dentistry/...
Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)
"MAC being the primary indication of anesthetic depth being the textbook definition"
I am an attending anesthesiologist and this is true. MAC cannot be interpreted at face value, though. You've got other drugs on board (not accounted for in MAC), the patient might be frail or very old, etc. etc. All things changing MAC interpretation, which is why there are still anesthesia providers instead of robots ;-) We currently have no way of faithfully measuring the depth of anesthesia, and our understanding of consciousness/awareness is incomplete. Anesthesiologists have to rely mostly on know-how, even in 2025.
It obviously varies on place of practice and the way you were taught. My understanding is the evidence is pretty clear that it helps but happy to defer to your lived experience.
What about people who routinely use drugs in heavier concentrations or who have higher tolerance from genetics? How is that detected?
You just crank it up until those people don't react. With experience, you can anticipate those pretty well.
[flagged]
If the reporting is accurate, which is really not a given with MIT, this is great news. For all its upsides, general anesthesia is still dangerous and very rough on you, and all these effects are always amplified for young patients.
> very rough on you
How so?
To start, the article gives a few good examples:
> children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness, and non-purposeful movements
In general, a very simple mental model for general anesthesia is that it's an unnatural state for your body and your body will do its best to get rid of it, similar to say alcohol or drugs. This means systemic inflammation, stress on your cardiovascular system, liver and kidneys, brain, and so forth. Most all of these issues scale with how much anesthetic you receive, similar to a hangover being worse the more you drink.
In other words, general anesthesia is rough on you just like getting black out drunk is, it's just more controlled and we do our best to try and limit the downsides because it's invaluable for surgery where applicable.
> In other words, general anesthesia is rough on you
Can confirm having watched our kids recover from general anesthesia multiple times.
Full disclosure: have three kids, eldest child at lifetime total of 4x general anesthesia so far (1x for endoscopy, 3x for surgery), youngest child lifetime total of two (1x endoscopy, 1x dental work). Middle child seems to have escaped so far... he asked recently what it was like, siblings answered unanimously - "terrible".
Rough like the roughest hangover you can have.
I had a general anesthesia at 21 for dental surgery. The come back was a nightmare: nausea, shaking, cold and hot alternating, terrible headache, cramps, exhausted and mentally depressed during ~2 days. I couldn't eat, I couldn't drink (but brute force myself to do it), I couldn't think or concentrate on anything but the pain. The only close experience I can remember is the wake up after a blackout hangover but it really wasn't that bad compare to the anesthesia.
6 years later a car crash required artificial coma during 3 days. They drug me along the week following my come back. The dreams during the last day of coma and that week took me through fascinating and terrifying experiences half real (intubation, interactions with family and medics...) and imaginary (ever-repeting-same-day, interns having a fireplace in the ICU floor with guitars, mind-controlled bed to move around the room...). They finally gradually stop the drug and I was only a bit angry and physically suffering from my injuries but not that bad.
Big up to the amazing Royal Perth Hospital team for that amazing care. They saved my life and made the process a confortable trip.
I always wonder what was that drug that produce so weird half-wake dreams with not much side effects. And why they don't always use that for dental surgery and everything else. I heard hypnosis can work instead of a classical general anesthesia and am keen to try if the funny Australian drug isn't an option. Everything but not the general anesthesia.
edit: wonder if both experiences could have been the same sedative drug but the second had a hypnotic wake-up parachute drug during the comeback.
> Rough like the roughest hangover you can have
I’ve had one for an operation on a broken jaw, just didn’t think it was particularly rough. Of course it takes time to come round and be clear headed, but the OP kinda implied serious physical problems with “dangerous and very rough on you”. Maybe I just misunderstood what they were saying, but I thought they meant rough as in long lasting damage (which I didn’t think was the case), not temporary discomfort.
Your situation obviously isn’t ideal, but doesn’t have the same implication.
> I always wonder what was that drug that produce so weird half-wake dreams
The sibling comment here mentions Ketamine, which is possible, but if they’re giving that to you intravenously then all perception of time and space will be warped. It’s extreme. So wild dreams is one thing, questioning what is even real is more like ketamine.
It is after effect free though and doesn’t last long, so once stopped you can be over it within the hour. It also has antidepressant effects afterwards.
Probably Ketamine.
I had anesthesia for a surgery at age 15 and I was depressed for a year afterward.
I’m sure everyone’s experience is different, but it made me feel groggy in a way that was difficult to bounce back from.
Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized?
Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning.
Or a thirst for revenge.
The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.
You are correct. But there is also the aspect that in current opinion, children below the age of 2 to 3 years do not form episodic memory. Which can reinforce the misconception about the necessity of anesthetics in children, because they are unable to recall and tell about the pain.
Anesthesia is mostly know-how. When you've put several hundred kids under, you (usually) become equipped with a good sense of what's going on, even without kids telling you.
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"Kids don't need anesthetics. If they are young enough, they won't remember the pain, so you can just operate without anesthetics. They are also easier to restrain than adults."
This was state of the art in medicine for quite some time. I fear the general trend of "medication bad" will get us back to those dark times.
Btw, those dark times ended only as recently as 1987! https://www.newsweek.com/when-doctors-start-using-anesthesia...
Another medical horror story that only ended way more recently than it should have (mid 1950's probably): https://www.straightdope.com/21341781/in-medicine-what-s-the...
This right here. Medicine is not bad in general. Mother Nature is a wicked mistress. Pain and suffering are her defaults, and glimmers of happiness fleeting.
Modern technology and medicine in particular have made our lives better and longer in ways our near ancestors could not have dreamed of or hoped for.
It's not hard to find counterexamples of course: opioid addiction, climate change, etc. But on balance we're a hellava lot better off now than 50 or 500 years ago.
Nice to use a bit less anesthesia for faster/better recovery and money savings. But for goodness sake - let's not go TOO far down that path.
Do notice that the comments about 'pain and suffering are mother nature's defaults' have very little to do with anything else you said, or with the discussion more broadly. I think these sorts of things are bad internet hygiene and promote an actively depressive state of mind. They can be memetic concepts, and should be treated with care. If you do actually feel this way about your own life, I'd encourage you to seek some kind of help. And besides, there's nothing natural about surgery...
I think the rest of what you're saying is fairly accurate, though.
> I fear the general trend of "medication bad" will get us back to those dark times.
I think this won't ever happen. Modern docs would absolutely not accept working under such conditions. Anesthesia is not only comfort for the patient, but also for care providers. As you can often see when surgeons advise patients on refusing local anesthesia or nurses demanding benzos for the screaming demented patient at 2 a.m.
My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralysed but not given general anaesthesia due to risk of immediate death. This led to a position statement from the paediatric society at the time that nobody should be operated on without pain relief / general anaesthetic.
Note that this does not mean that general anaesthesia was not given at all to kids before 1987, but that there was a belief in the USA (and elsewhere) that newborns did not need pain relief during anaesthesia. Your use of 'kids' versus 'newborns' is a bit misleading in that respect.
https://www.sciencedirect.com/science/article/pii/S152659001...
> textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants.
Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced.
> infant surgery routinely conducted with no or minimal anesthesia well into the 1980s
"Routinely" isn't a few isolated cases, that's the word for "this is the usual thing to do".
https://pubmed.ncbi.nlm.nih.gov/20608214/
> The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years.
"Vast majority" and "dominated" also doesn't sound like just "some cases".
https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surg...
> surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals.
We can discuss the definition of "kid" and "newborn", but I would no longer call them "newborn" when they start walking. Also "most American hospitals" means the practice was very widespread even in 1986.
I think the whole situation is one of the medical community failing to recognize and admit their own mistakes. Instead, the obvious barbarism of the whole situation is played down, diminished and belittled. Thereby protecting their own feelings and standing at the cost of the victims' right to the truth. And thereby paving the way for a repetition of such gruesome mistakes. At which point I would argue, it might even be a little callousness or even intent...
While the theory about pain in kids was certainly wrong, you are lacking some context about what 'safe' used to mean, and what it means nowadays. In the 80's, kids were under halothane and long-acting paralysis drugs which, especially in cardiac patients, are really dangerous. Halothane is now discontinued, as are many other common drugs from this time. Theories do not spring out in isolation. The evolution of technology, biological understanding and new pharmacology have all contributed to allow new opinions as incremental changes made old theories more and more evidently obsolete. Doctors 50 years from now will also wonder how we could be so stupid in 2025.
I don’t know where the truth lies, but even if everything you wrote is true (and it does sound reasonable to me), not giving anesthesia might still be a safer choice considering the side effects. Not saying it is, only saying that we need to take a look at the side effects and risks, and all other (at a time) available information before we call them barbarians.
At some point in adult medicine, it was recognized that using an analgesic during surgery, in addition to the then normal combination of paralytic and hypnotic, significantly increased survival rates. This fact was independent of the patients capacity to remember the pain and wasn't any kind of psychological response like PTSD. It was the basal reaction to injury and pain by stress that killed those patients.
The exact same reaction kills non-adults. The proof took longer, but it is there now. That doctors even needed proof instead of, without further experimental knowledge, assuming the null hypothesis of children being small adults in this case already is proof of a kind of chauvinistic barbarism. Infants were some kind of lesser human to them, thus couldn't react in the same way as adults.
Remember, the norm was _no_ analgesia, _no_ pain relief. For the majority of infants. Its not that they decided on a case by case basis on the right balance of analgesia vs. risk. They decided as a matter of course that analgesia was superfluous for infants.
I think there is a definitional problem with "kids" vs "infants" vs "newborns" which are all difficult to define, the type of anaesthesia that was administered and we are also talking about 40 years ago. Our understanding of anaesthetics and heart surgery in newborns was much different than today. America definitely has a checkered and sordid past here and in psychiatry. But we also have a duty to be definitionally exact here which is why I tried to get a bit more context when the GP used the term "kids". I had thought before investigating that meant all the way up to teenagers.
I admit that "kids" is a bit imprecise and can lead to misunderstandings. But that is just not important to this discussion.
And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else.
If you feel adventurous, have your family doctor give you a paralytic and then push a sterile needle under your fingernail. Then tell me the exact definition of sufficient anesthesia in that case ;)
> And the exact definition of the anesthesia given to most infants before 1987: A paralytic. Nothing else.
To my knowledge, this was only true for newborns. Infants and up usually got some sort of hypnotic.
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Compare that with the whole “twilight sleep” way of delivering babies and you can see a whole misogynistic thread of not respecting natural systems and of trying to minimize or eliminate the behavioral symptoms of pain while doing little to actually ease the patient.
This research is aimed precisely at making it safe enough to administer general anesthesia in these populations for that to become standard of care.
Let me preempt one possible line here: I do not love the circumstances under which I would have been circumcised as a neonate in Mississippi in the very early 1980s, and I do not resent the result. Living that far tied up in the past is for men who can't figure out how to do anything else. I am not one of those and despite an essential sympathy with the theoretical basis of their position that no putative benefit remotely justifies the the risk of the intervention, I have a short way with "intactivists."
But if it had been possible safely to administer more than EMLA (perhaps!) for pain relief, not even in that place and time would anyone be so barbaric as to refuse it. Of course. And that, making possible that precise measure of mercy in the case where the intervention is not merely cosmetic, is exactly that at which this research is directed. So, to anyone looking to make a cause of the ghosts of a billion foreskins or whatever, I would say please do not attempt even by implication to recruit my argument in support of your position.
I didn't say anything about a foreskin anywhere. And my point is, they did not just do minor stuff like a circumcision (which I think is a barbaric, pointless and immoral practice to inflict on non-consenting minors in any case except to maybe cure phimosis).
They did major surgery. Like opening the cranium or abdomen. Like removing limbs. Like removing burnt skin by brushing it off and applying skin grafts. And no, they didn't even apply Lidocain, because children don't feel pain. At best, they gave muscle relaxants as chemical restraints and to make the tissue easier to cut.
According to a social media influencer.
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Yes, any, male or female, genital mutilation is life-changing.
What I meant is, it is "minor" as far as surgery goes, as opposed to "major". The distinction is about the risk to the life of the patient, the kind of anesthesia you need (local vs knockout), the setting you do it in (walk-in vs stay at the hospital) and the amount of aftercare required (change the bandage vs. medication+monitoring+hospital).
And those studies are BS, done to prove a preexisting point. Any properly done study by independent researchers without an agenda doesn't show any kind of effect from circumcision beyond the resulting sensory problems, deformation, nerve damage, erectile dysfunction, scarring and adhesion.
I really do not understand why did you felt the need to push for circumcisions here. Like, no one asked or discussed them one way or the other. Like ok, it is religious for Jews and Arabs, but no one else have to care.
Who pushed?
Jesus, I tried as hard as I knew how not to start a fight, knowing this place plays host to a few foreskin mourners. Better just to avoid entirely, it appears, and duly noted.
What a shame the eyeroll emoji is filtered here. That, apparently, is the level people are on. A paragraph is too much! Or is everyone still rationing since Cerebral, or whatever that telemedicine pill mill was called, shut down a few years back? Is that why no one is reading today?
I never thought I'd say this, but for God's sake and as a favor to us both, pipe my shit through ChatGPT and ask for a reframing on a sixth-grade reading level. You pay for access to the damned robot, let it wipe your nose through the remedial work. I've got embroidery to do and movies to watch.
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What? How are you making that leap? I'm not insulted; we've never met. I am confused, though, and you are a licensed professional facing specific ethical requirements and constraints on your issuance of medical advice. Perhaps you'll explain what you know that I don't.
Circumcision induces keratinization of the glans (one of the reasons this makes us more resistant to many STDs). I noticed a huge difference in touch perception before vs. after and I strongly resent that this was brought onto me. I'm not trying to insult anyone. It's personal.
Any relation to integrated information theory (IIT, Koch et al)?
What is the level of unconsciousness during anesthesia? Is it "sleep-like" unconsciousness or "neurons do basically nothing" level? Whenever I read about anesthesia I am wondering if we are not accidentally killing people (and creating new ones) like in teletransportation paradox. https://en.wikipedia.org/wiki/Teletransportation_paradox
Depends on the "kind" of anesthesia, on the medication used and on the specific reaction of the patient to that medication.
For example there is stuff like Ketamine, which in some cases can live up to its other use as a recreational drug and give the patient very colorful dreams. There are sedatives that just take away the capacity to form memories, but leave you awake and aware, just calmer. In cases like some knee surgeries, it is possible to leave the patient fully awake, just paralyze and numb the legs.
Just anecdata, but I was under a few times as kid. It was like teleporting into the future. Last memory was being told to count backwards, next memory was waking up in the recovery room.
Apparently I had a small anesthetic overdose in the hospital as a kid and woke up a day or two later than expected, but from my perspective, nothing happened and I just went to sleep then woke up.
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