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Comment by winrid | Hacker News Reader

I recently had a foot injury. In the ER they put me under and the (fantastic) surgeon "twisted" the foot back into place.

I don't remember anything, however other people said I was moaning in pain while under anesthesia. Pretty weird.

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Ever since I’ve been a little kid this one thing has stuck with me; if you can’t remember it, is it like it never happened? I used to wonder that about nightmares, but I tended to go with the view that a version of you did suffer, and on some level the impact is there. Like a person with anteretrograde amnesia who can’t remember learning to work a specific maze, but still realizes the gains of the previous attempts.

I still don’t know if it’s even a realistic question, but I still wonder.

There’s a lot of study going on about that very issue right now. A lot of surgery is done with the patient conscious or semi-conscious, but on an amnesiac medication that’s supposed to suppress memories. It’s not clear whether memories retained at a deeper sub-conscious level can trigger PTSD.

As recently as the 1980s, they would do heart surgery on newborns because the surgeons felt that the babies wouldn’t remember anything about it. It sounds monstrous to me, however.

That's not why they did it. They did it because anesthesia wasn't as good then, and there were significant risks to the infants.

When the risk of pain outweighed the risk of anesthesia the practice stopped.

It's realistic, I vaguely remember one story from someone who dislocated his shoulder in his teens and had to have a doctor pop it back into place. Apparently they didn't have regular pain killers, so they gave him something that induced amnesia and just had clinic staff hold him down. He doesn't remember any of it at all.

Granted this happened ~50 years ago so I don't know how embellished the story became over the years, or how pain science changed since then.

I'm pretty sure using these amnesia type drugs is the standard for endoscopies and colonoscopies (versed aka midazolam). You can find horror stories about them online. You can have those procedures done with just propofol or without any sedation but I'm pretty sure they give you versed by default.

I'm sure you can find horror stories for propofol and other drugs, but I'm vastly more uncomfortable with the idea behind intentionally inducing amnesia.

Apparently patients do experience pain under certain anaesthesics, but that they do not remember upon awaking. Pretty disturbing to me.

https://www.theatlantic.com/health/archive/2017/12/surgical-...

When I got my wisdom teeth removed, I regained conscience in the middle of sobbing. I remember feeling a strange disassociation because I didn't feel any pain or know why I was intensely crying.

During the procedure they split the roof of my mouth from stem to stern and had to stitch it back together.

When I got home I looked at myself in the mirror and realized I had a bad black eye.

I wish I could have reviewed footage of whatever cage match I was involved in!

As disturbing as it is, when you consider how surgeries used to be performed before anesthetics we're still pretty lucky to have them. Even if it just paralyzed you it would still probably be an improvement just because the surgeon would be able to work without you moving.

It could well have been that you got a dissociative agent. This is not uncommon in the ED. I remember using etomidate when I was a resident to deal with a kid who lacerated their tongue. After the shot a screaming kid who wouldn't let anyone near his bleeding mouth was totally compliant and willingly stuck out his tongue so I could throw a couple stitches in it.

Anesthesia and analgesia are two different things. There are also different types of anesthetics. For "procedural sedation" (the sort of thing you would do in the ER), it's common to simply use a dissociative agent (like Ketamine), so you aren't really "out", you just aren't "in" either.

Wow! Fascinating, thanks.

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