[HN Gopher] In kids, EEG monitoring of consciousness safely redu...
       ___________________________________________________________________
        
       In kids, EEG monitoring of consciousness safely reduces anesthetic
       use
        
       Author : LorenDB
       Score  : 105 points
       Date   : 2025-04-30 13:46 UTC (4 days ago)
        
 (HTM) web link (news.mit.edu)
 (TXT) w3m dump (news.mit.edu)
        
       | Etheryte wrote:
       | 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 wrote:
         | > very rough on you
         | 
         | How so?
        
           | Etheryte wrote:
           | 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 wrote:
             | > 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".
        
           | aziaziazi wrote:
           | 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 wrote:
             | Probably Ketamine.
        
             | louthy wrote:
             | > 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 wrote:
           | 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.
        
       | holowoodman wrote:
       | "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...
        
         | throwanem wrote:
         | 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 wrote:
           | 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.
        
             | throwanem wrote:
             | According to a social media influencer.
        
           | watwut wrote:
           | 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.
        
             | throwanem wrote:
             | 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.
        
         | quantumwoke wrote:
         | 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.
        
           | holowoodman wrote:
           | 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...
        
             | quantumwoke wrote:
             | 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.
        
               | holowoodman wrote:
               | 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 ;)
        
               | rscho wrote:
               | > 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.
        
             | serial_dev wrote:
             | 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.
        
               | holowoodman wrote:
               | 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.
        
             | rscho wrote:
             | 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.
        
         | Nifty3929 wrote:
         | 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.
        
           | thelaxiankey2 wrote:
           | 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.
        
         | throwaway173738 wrote:
         | 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.
        
         | rscho wrote:
         | > 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.
        
         | tzs wrote:
         | 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...
        
       | crazygringo wrote:
       | 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 wrote:
         | 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.
        
           | bts327 wrote:
           | I'm good here. Thanks.
        
             | quantumwoke wrote:
             | 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 wrote:
             | 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.
        
               | bts327 wrote:
               | Good day to you.
        
               | holowoodman wrote:
               | 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 ;)
        
               | rscho wrote:
               | "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.
        
               | bookofjoe wrote:
               | >Robotic Anesthesia: A Vision for 2050
               | 
               | https://journals.lww.com/anesthesia-
               | analgesia/fulltext/2024/...
        
               | bookofjoe wrote:
               | >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/
        
               | rscho wrote:
               | 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).
        
             | mschuster91 wrote:
             | What about people who routinely use drugs in heavier
             | concentrations or who have higher tolerance from genetics?
             | How is that detected?
        
               | rscho wrote:
               | You just crank it up until those people don't react. With
               | experience, you can anticipate those pretty well.
        
         | bagels wrote:
         | 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/
        
           | Hydraulix989 wrote:
           | 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.
        
           | bookofjoe wrote:
           | '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
        
           | baxtr wrote:
           | Too much protein is bad for your kidneys!!!
           | 
           | PS: this has been debunked, still docs keep saying it.
        
             | leereeves wrote:
             | 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?
        
               | baxtr wrote:
               | https://physiqonomics.com/are-high-protein-diets-bad-for-
               | you...
               | 
               | Had a great overview.
               | 
               |  _> 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._
        
         | rscho wrote:
         | 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.
        
       | Nezghul wrote:
       | 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
        
         | accrual wrote:
         | 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.
        
         | holowoodman wrote:
         | 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.
        
         | tzs wrote:
         | 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 wrote:
       | Any relation to integrated information theory (IIT, Koch et al)?
        
       | HocusLocus wrote:
       | 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 wrote:
         | 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 wrote:
           | 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 wrote:
             | 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.
        
       | Gravityloss wrote:
       | 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 wrote:
         | It is mainstream. We have modules. It's useful, but
         | unfortunately not a magic wand either.
        
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