RE: More is Better (anesthetic)

From: Lee Corbin <lcorbin.domain.name.hidden>
Date: Mon, 4 Jul 2005 08:20:25 -0700

Stathis writes

> [Lee wrote]
> > I'm glad that even the appearance of pain in an unconscious patient
> > is disturbing to physicians. That's very good. For the body to be
> > experiencing pain---and presumably sending pain signals to the brain
> > ---too closely resembles pain being experienced but with no memory
> > trace being left.
>
> The main reason for giving opiods when the vital signs are affected as if
> the patient is in pain is not because we believe the anaesthetised patient
> is actually in pain, but because it imposes a physiological stress which
> could cause the patient physical harm.

I see. I'm a little disappointed because I'm still scared of
this idea that just preventing memory formation may sometimes
be used in place of anasthetics.

> It may also reassure you that in the worst possible case - the patient is
> actually awake, but paralysed - the pain experienced is nowhere near what
> you would imagine a fully awake person with no drugs on board would
> experience. I once met a young girl, about 10, who had apparently been awake
> during the first part of a cardiac operation, when her chest was being cut
> open with an electric saw. What does it feel like when your chest is being
> cut open with an electric saw? It is "an itchy, scratchy sort of feeling."
> Thank God for fentanyl!

Ditto!

Thanks for the clinical explanations.

The "physiological stress" you mention above: it happens when
grave surgery is inflicted on tissue? Is it the body's violent
reaction to take emergency action in some way when it senses
something really bad is happening? How does fentanyl (in this
case) work? By locally suppressing the body's reaction, or
what?

Lee
Received on Mon Jul 04 2005 - 11:20:12 PDT