And some people have a very different experience while under them - they are fully aware.
The gist was that modern implementations suppress memory formation rather than induce unconsciousness. That you remain in some sense aware of what's happening but don't remember the experience. This is safer than traditional methods, but could potentially subject the patient to complex mental or emotional trauma.
Is that accurate?
Before surgery, you're given an amnestic to help reduce immediate anxiety and avoid remembering going into the OR and getting prepped - which people don't generally enjoy.
Then you get the anesthesia, which puts you to sleep. They put you on a respirator, which - alongside helping your barely/non-working lungs - delivers a gaseous anesthesic to keep you asleep.
Because some reactions to pain are reflex, they may still work. And when you wake up, they don't want you to be in pain; especially if that's on the surgery table. So next, you get the analgesic opioids. Here you may also (if you didn't already) get paralytics to stop all muscle movement.
Rest assured that they are not YOLO-ing your pain and suffering. You are given a cocktail of drugs to make sure you are comfortable before, during, and after surgery.
Luckily, opioids can be swapped for other medications that are less effective, like high dose NSAIDs. There's also local anesthetics for some stuff.
In that case, they don’t seem to work that well for me. Or maybe they do it differently here.
I always remember going into the OR and being prepped.
My anxiety for my last surgery was huge up until the moment I passed up. The best I got was the anaesthesist telling me it was normal for someone in my circumstances (I’d not had anxiety the last few times, so was very confused as to why I had so much this time, I was freaking for some reason)
You may also require either a higher baseline dose than expected, and an onset of acute anxiety can actually affect dosing too. Both totally normal!
Either way, it's best to speak with your doctor leading up to surgery if that experience was upsetting. There's lots that can be done for dosage, supplemental medication, etc. Your comfort is important!
And that is how I saw the inside of my own beating heart at 10 while I was tied down and essentially naked in front of like 10+ adults.
Oh, and the contrast dye momentarily made me feel like I was being burnt alive from the inside out.
She now insists on full sedation.
The modern implementation is to use general anesthesia as little as necessary as it has numerous side-effects. Local anesthesia with improved selectivity is used if possible.
That's called twilight anesthesia and it's used for some procedures, not others. Usually used for stuff like wisdom teeth extraction and colonoscopies. Anything "major" and you're getting general anesthesia. You can ask what type of anesthesia you will be receiving (twilight or general).
That was about 20 years ago. To this day, the last thing she remembers is lying on the table and saying "OK, let's git-er-done" and the next 5-10 minutes are missing.
In larger doses, propofol will completely eliminate consciousness. This is "general anesthesia" and what you get when you go in for a major surgical procedure. You are completely unresponsive to any stimuli.
There are levels in between these too. Consciousness is a spectrum.
As far as I know, propofol doesn't make you feel particularly good or block pain. It just kind of makes you go away. So in addition, at all levels of anesthesia, they also typically give you a narcotic like fentanyl so that you aren't suffering. They aren't just letting you scream in pain and then erasing the tape afterwards.
As someone who has had a couple of procedures where they pushed the fentanyl into the IV before the propofol, I can 100% assure that pain was the absolute last thing I was feeling. Hell, I was still high as a kite after the propofol wore off when I got home. I was sitting at the kitchen table with a bunch of metal recently unscrewed from my leg bones thinking about literally nothing in the world beyond, "holy fuck this eggnog is the best beverage I've ever had in my life I wish I could drink it forever".
The only thing I got for my endoscopy a couple of years ago was some numbing spray for my nose and a decongestant.
All in all, I really appreciate the loss of memory formation, since the most annoying part of these procedures for me is the boredom. Just splice all that out, thanks.