8 ms·

In kids, EEG monitoring of consciousness safely reduces anesthetic use

139 points by LorenDB 2y ago

dgekfeg 2y ago
[flagged]
Etheryte 2y ago
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.
- louthy 2y ago
  > very rough on you How so?
  - Etheryte 2y ago
    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.
    - logifail 2y ago
      > 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".
      - halper 2y ago
        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.
  - aziaziazi 2y ago
    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.
    - holowoodman 2y ago
      Probably Ketamine.
      - deleted 2y ago
        [deleted]
    - louthy 2y ago
      > 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.
  - nchase 2y ago
    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.
    - aziaziazi 1y ago
      That’s a shame. I hope you’re better known.
holowoodman 2y ago
"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-babies-medics-thought-they-couldnt-feel-pain-1625350 https://www.newsweek.com/when-doctors-start-using-anesthesia...
- throwanem 2y ago
  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.
  - holowoodman 2y ago
    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.
crazygringo 2y ago
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.
- quantumwoke 2y ago
  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.
  - cyanydeez 2y ago
    [flagged]
  - bts327 2y ago
    I’m good here. Thanks.
    - quantumwoke 2y ago
      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.
    - holowoodman 2y ago
      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.
Nezghul 2y ago
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 https://en.wikipedia.org/wiki/Teletransportation_paradox
- accrual 2y ago
  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.
  - codr7 2y ago
    Agreed, super weird. Did it once for a back injury as an adult, also only remember the countdown. But my system was flushed with opiates when I woke up, so I was in a pretty good mood at least.
- holowoodman 2y ago
  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.
- deleted 2y ago
  [deleted]
- tzs 2y ago
  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.
siavosh 2y ago
Any relation to integrated information theory (IIT, Koch et al)?
HocusLocus 2y ago
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.
- rscho 2y ago
  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.
  - holowoodman 2y ago
    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.
    - rscho 2y ago
      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.
- riskassessment 2y ago
  Anaesthetics are far from harmless. Using the minimal amount necessary is a good thing, actually.
Gravityloss 2y ago
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.
- rscho 2y ago
  It is mainstream. We have modules. It's useful, but unfortunately not a magic wand either.
kilimounjaro 2y ago
Paediatric anaesthesiologist here. 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.
- robbiep 2y ago
  Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8qBnLG/view?usp=sharing https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...
  - kilimounjaro 2y ago
    Many thanks!!
- tapoxi 2y ago
  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.
  - kilimounjaro 2y ago
    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.

139 points by LorenDB 2y ago

[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.

louthy 2y ago
> very rough on you How so?
- Etheryte 2y ago
  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.
  - logifail 2y ago
    > 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".
    - halper 2y ago
      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.
- aziaziazi 2y ago
  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.
  - holowoodman 2y ago
    Probably Ketamine.
    - deleted 2y ago
      [deleted]
  - louthy 2y ago
    > 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.
- nchase 2y ago
  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.
  - aziaziazi 1y ago
    That’s a shame. I hope you’re better known.

holowoodman 2y ago

"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-babies-medics-thought-they-couldnt-feel-pain-1625350 https://www.newsweek.com/when-doctors-start-using-anesthesia...

throwanem 2y ago
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.
- holowoodman 2y ago
  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.

crazygringo 2y ago

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.

quantumwoke 2y ago
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.
- cyanydeez 2y ago
  [flagged]
- bts327 2y ago
  I’m good here. Thanks.
  - quantumwoke 2y ago
    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.
  - holowoodman 2y ago
    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.

Nezghul 2y ago

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 https://en.wikipedia.org/wiki/Teletransportation_paradox

accrual 2y ago
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.
- codr7 2y ago
  Agreed, super weird. Did it once for a back injury as an adult, also only remember the countdown. But my system was flushed with opiates when I woke up, so I was in a pretty good mood at least.
holowoodman 2y ago
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.
deleted 2y ago
[deleted]
tzs 2y ago
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.

siavosh 2y ago

Any relation to integrated information theory (IIT, Koch et al)?

HocusLocus 2y ago

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.

rscho 2y ago
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.
- holowoodman 2y ago
  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.
  - rscho 2y ago
    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.
riskassessment 2y ago
Anaesthetics are far from harmless. Using the minimal amount necessary is a good thing, actually.

Gravityloss 2y ago

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.

rscho 2y ago
It is mainstream. We have modules. It's useful, but unfortunately not a magic wand either.

kilimounjaro 2y ago

Paediatric anaesthesiologist here. 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.

robbiep 2y ago
Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8qBnLG/view?usp=sharing https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...
- kilimounjaro 2y ago
  Many thanks!!
tapoxi 2y ago
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.
- kilimounjaro 2y ago
  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.