We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old.
Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing with surgical stimulation. The commonly used doses of sevoflurane are used because they are supposed to inhibit movement in response to noxious stimulus. So presumably these patients are all being paralysed or given a lot of opioid to stop them moving?
Using sevoflurane instead of propofol for maintenance if you are trying to reduce PAED is not really standard of care and makes me suspicious they are trying to overstate the effectiveness of their device.
I was surprised when my 7 year old son received a minor eye surgery (he had a random fleck of metal on the sclera) and they gave him a large dose of ketamine.
He remained conscious but was immobilized. I asked him what it was like afterwards and he said “dad, everything turned into legos!!”
I was given ketamine as a 15 year old for a broken ankle that needed to be re-set. The nurse didn't tell what it was but I could read the label when she was filling up the syringe. It definitely didn't put me to sleep.
My family has a history of malignant hyperthermia, so I was recently put under without inhaled anesthetics and they put an EEG on me. It was wild, zero delerium, nausea, or grogginess. I just snapped back into full consciousness.
Propofol is great isn’t it! I worked with some old guys who did some of the original studies demonstrating safety of propofol anaesthesia in MH. The world is much better for people with MH than it was 30 years ago, as long as they have a way to inform their doctors of the condition.
Was put under for minor surgery using propofol some 20 years ago. Doc started injecting the milky white goo into my IV, without so mucy as a hello, there was a clock in the room which seemed to slow down, I couldn't breathe or move or cry out and was sure I was dying.
Then I woke up in a recovery room, with zero awareness of anything that happened in between.
Always nice to see another anesthesiologist on hackernews, we're quite a few it seems. I have done research in this area and also worked a bit with Emery. Which/what brand EEG monitor do you use?
Hi :) Yes I think the combination of quite a bit of phone time during the work day and also being frustrated tech people makes HN good for us.
I use SedLine but have used entropy and BIS in the past.
Interestingly the study uses 1mg/kg roc in 40% of the patients and a lot of sugammadex, as well as a pretty decent dose 0.5mcg/kg/min remifent infusion.
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.
'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
I think it's an omnipresent concern in people with 10-20% kidney function left, and outside that cohort, it's a concern if you're getting a supermajority of your calories from protein for a prolonged period of time (which is quite rare/expensive for most of us)
Most people who eat "high protein diets" are not actually eating all that much protein, because their food is laced with lots of fat and some carbs. The guy eating burgers and sausage all day long is actually on a high-fat diet. This fools people because fat is so nutritionally dense, and because lean protein is basically always chock-full of bulky water. The soy "protein" I'm eating still has fat and carbs.
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?
> As long as you have don’t have pre-existing kidney issues, you don’t need to worry about high-protein intakes killing your kidneys, and it’s time to put this myth to bed.
Unfortunately most of the research cited there was in "resistance-trained" individuals (and one in nurses, who are far from sedentary). The meta analysis also included at least some research on active individuals. And the author is a bodybuilder and fitness coach.
The one study of overweight individuals mentioned found no adverse side effects but only lasted six months, which may not be long enough for clinical effects to become obvious.
Also, the author overlooked gout entirely.
Based on all that, I'm not convinced it is safe for sedentary individuals.
I think the author should have written:
> As long as you are highly active and have don’t have pre-existing kidney issues...
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.
Anesthesia gasses aren't paralytics. MAC is not about chemically preventing muscles from activating but depressing consciousness to the point that muscles don't move in reaction to painful stimulus. Chemically blocking muscle movement (neuromuscular blockade) takes an actual paralytic like succinylcholine. Pain control is yet another, separate factor. Even with depressed consciousness from a gas/propofol infusion and neuromuscular blockade, blood pressure (which is part of standard monitoring!) still will spike in response to painful stimuli. So usually, anesthesiologists will give an opioid in addition to gas/propofol to control pain, even if the patient isn't conscious and wouldn't be consciously aware of the pain of surgery.
The nightmare scenario you describe is when a patient has neuromuscular blockade, is not being given sufficient gas/propofol to depress consciousness, and has inadequate pain control that isn't being picked up in the blood pressure either because the anesthesia provider isn't paying attention or is controlling blood pressure through drugs to the point they can't see anything. If, for some reason, that kind of anesthetic is medically necessary, benzodiazepines can (if tolerated) prevent memories from forming lessening the chances of psychological trauma.
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".
Interesting. My adventurous child (soon 10) has been under thrice and generally remembers nothing unpleasant, despite it being a bit worrying for the parents. She has been a bit confused and weird upon waking up, but whatever they have given her to ease her transition into waking life appears to have made her forget it. She tends to remember talking to me (or watching Bluey) in the OR and then she is talking to some doctor in another room, wondering why they are not putting her to sleep. The experience has been quite smooth despite one of the times taking place in more of an emergency setting after an accident.
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.
First off, glad it worked out nicely for you and there were no complications.
I'm gonna stretch the alcohol analogy a bit here, because that's most likely to be relatable to everyone, but of course the situation is a bit more nuanced with anesthesia. If you're a healthy adult, you could probably down a bottle of vodka. You might not enjoy it nor have a good time, but you'd most likely make it out the other end with a wicked hangover and some questions about life choices. If you're a small child, you might leave with permanent brain damage. If you have an underlying condition, you might have a kidney fail. Etc. Anesthesia is the same way. The fact that you, I'm assuming a healthy adult, walked away with few issues, doesn't make it any less risky.
Most healthy adults walk away from general anesthesia without longlasting effects. But for everyone else, you can already find a number of unfortunate experiences in this comment section alone. A large portion of people who go under do so because they're already in some dire state and need emergency help. Adding general anesthesia on top of that is a large source of risk.
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.
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.
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 ;)
> 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.
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
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.
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.
To add to the examples others have given there is also some that makes you not feel pain but you do remain semi-conscious and when so can still form permanent memories. This is called conscious sedation. They can adjust your level of consciousness as they go, so they can make you more aware if they have to ask questions or need to you do something like move a body part for them and make you less aware when they don't need any interaction.
It combines a sedative from the benzodiazepine family with a synthetic opioid painkiller. This is the most common sedation for colonoscopies. I had a colonoscopy using this, with fentanyl as the opioid and probably midazolam for the benzodiazepine (if not that probably diazepam).
I was aware of the doctor starting the procedure and felt something cold. I could feel pushing sometimes. But nothing hurt or was even annoying (except that cold right at the start). I remember being asked how I was doing and answering. I remember the doctor talking about the quality of my prep--the laxatives had not been as effective as they could have been--and noting that it was still good enough to allow them to continue.
There are some gaps so I think at some points I was more out of it.
I had an earlier colonoscopy with deep sedation using propofol. Here's the experience with that: (1) they start it and I have maybe 10 seconds of memories after that point. At this point I wasn't even in the procedure room. I was in a bed in a waiting area. (2) My next memory is waking up, in the same waiting area, with a nurse telling me they are done, putting the basket with my pants and glasses and phone on the bed, and telling me I could put my pants on.
I've got no memory of being wheeled into the procedure area, or of anything that happened there, or being wheeled back.
That doesn't necessarily mean I didn't feel anything during the procedure. When we were going over the sedation options when arranging for that colonoscopy I asked if deep sedation means you don't feel anything at all, and all the doctor would say is that I would not have any memories of anything.
That isn't exactly reassuring.
If someone offered to pay me a large amount of money to undergo a couple of hours or horrible torture with a guarantee that they would give me a drug to prevent forming long term memories of that torture I would not accept. I would be too worried that there could be other negative persistent effects of such mental trauma than just the formation of long term recallable memories and that the memory preventing drug would not stop those other effect.
We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old.
Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing with surgical stimulation. The commonly used doses of sevoflurane are used because they are supposed to inhibit movement in response to noxious stimulus. So presumably these patients are all being paralysed or given a lot of opioid to stop them moving?
Using sevoflurane instead of propofol for maintenance if you are trying to reduce PAED is not really standard of care and makes me suspicious they are trying to overstate the effectiveness of their device.
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