Ever been Knocked Unconscious?

When I was in middle school, I had minor eye surgery. The doctor started to make polite conversation with me about my summer plans before the procedure started, and that's all I remember. This baffled me, as you can imagine, until I later learned that this absence of memory was caused by something called anesthesia. 

There are 4 types of anesthesia, those being General anesthesia, Local anesthesia, Regional anesthesia, and IV/Monitored sedation. General anesthesia is the most common type of anesthesia administered during procedures such as mine as a way to temporarily put someone into an unconscious state to prevent them from feeling pain or discomfort. Anesthesia consists of three major components: analgesia (pain reduction or elimination), amnesia (temporary), and muscle relaxation.

Anesthesia being breathed in as a gas through a mask, one form of anesthetic distribution.

 Now, off to how it works. Different anesthetics works in different ways but they all incorporate some little friends that we learned about constantly this year: Proteins! Local anesthetics work by targeting different proteins in the membranes that surround nerve cells. These anesthetics block nerve transmission to pain centers in the nervous system by binding to and inhibiting the function of an ion channel in the cell membrane of nerve cells known as a sodium channel. This causes an obstruction of the movement of nerve impulses near the site where the anesthesia was injected. General anesthetics put a patient into a different anesthetic state than that of local anesthetics and they function differently as well. A 2018 study was conducted where researchers studied the mechanisms of general anesthetics by examining propofol, a medicine most commonly used for general anesthesia. The results indicated that Propofol restricts movement of a kind of protein in such a way that inhibits communication between neurons. There isn't really a concrete explanation as to how all kinds of anesthesia work since different kinds are needed for different procedures, but research is ongoing. General anesthesia affects the entire body while other anesthetics affect only certain regions. The three main stages of General anesthesia are going under (induction), staying under (maintenance), and recovery (emergence). A common misconception of anesthesia is that it feels like a nap. In reality, being under anesthesia makes a person lose all awareness of their surroundings and pain, as well as of memory. All I could remember of my surgery was being prepped by the doctors and then waking up after the procedure as if a giant chunk of my memory was chopped off. 

Did you know that there is an actual job for administering this kind of medicine?  An anesthesiologist (a pretty self explanatory title) trains to administer anesthesia to a patient. As simple as this job sounds, it is actually a pretty terrifying process. If an anesthesiologist were to give a patient too high of a dosage of anesthesia, they could enter a state of respiratory distress mid-surgery, experiencing nausea or vomiting, hallucination, or hypothermia. Not giving enough anesthesia could be just as harmful and could lead to the patient coming to mid-surgery, which would be quite confusing for them, wouldn't it? An anesthesiologist's job also includes monitoring the patient's heart rate, breathing, temperature, fluid levels, blood oxygen levels, and blood pressure. (Fun Fact: Anesthesiologists get paid an average of 200-300k a year. Wow.) 

Now, there's a mildly scary side to anesthesia. There's a rare case about once in every 1,000 to 2,000 surgeries where a patient could gain awareness that they are under anesthesia during a surgery. They may be able to feel the pain but not be able to vocalize it. This is called "anesthesia awareness" and can lead to post-traumatic stress disorder. Scientist have researched ways to avoid anesthesia awareness by exploring the use of brain monitors. 

  Anesthesia being directly administered into the blood stream 

So, now you're up to date on the process of being knocked unconscious by drugs! If you are interested in medicine like I am, this knowledge is probably quite fascinating for you. Even if you aren't a big medicine person, I still think that everyone should be privy to the inner workings of the medical world and how complex the human body is. I just wish I'd known that in middle school, it probably would have saved me a whole lot of confusion :)