Re: More is Better (anesthetic)

From: Pete Carlton <pmcarlton.domain.name.hidden>
Date: Sat, 2 Jul 2005 14:49:19 -0700

The discussion about whether it would be okay to use anesthetic that
worked only by removing memories is missing one important piece:
that the effects of pain are not just floating "experiences"
perceived by the "mind", but have very real effects on the body -
high stress levels, release of stress hormones, behavioral trauma,
etc. Before stating whether you'd be willing to undergo torture
followed by memory loss, it also has to be specified what the long
term effects of repeated stress would be. If it's stipulated in the
thought experiment that there would be -no- lasting effects at all;
i.e., no way in principle that you or someone else could tell after
the torture that you'd been tortured as opposed to merely sedated,
then it doesn't look like such a bad deal.


On Jul 1, 2005, at 10:52 PM, Stathis Papaioannou wrote:

> I have not undergone conscious sedation myself, but I have
> administered the anaesthetic (midazolam, diazepam, propofol,
> fentanyl) for hundreds of gastroscopies and colonoscopies.
> Sometimes the patients are more or less fast asleep for the whole
> experience. Other times, they seem to be fully awake, talking to
> you with only a slight slurring of their voice, as if they have had
> a few beers. In fact, benzodiazepines are not that dissimilar to
> alcohol pharmacologically, and patients who go into delirium
> tremens from alcohol withdrawl are treated with large doses of
> diazepam. (It is ironic that any adult can buy as much alcoholic
> beverages as he wants, but for diazepam, which basically has all
> the effects of alcohol but is much safer, a prescription is
> needed.) The dose of the anaesthetic agent in conscious sedation is
> titrated according to how the patient responds: if he is very
> anxious the anaesthetist might give more midazolam, which is
> primarily given for its anxiolytic effect rather to induce amnesia,
> while if he is complaining of pain more fentanyl is given. Not
> everyone has complete amnesia for the procedure afterwards, but
> even if amnesia were guaranteed, certainly no doctor would
> deliberately allow a patient to suffer just because he won't
> remember it. The only situation I can think of where midazolam
> might be used primarily for its amnestic effect is with young
> children (you squirt it up their nose!) who need to have a series
> of unpleasant treatments, and would become very distressed each
> time if they could remember the details of their last experience.
>
> --Stathis Papaioannou
Received on Sat Jul 02 2005 - 17:57:12 PDT