Enigmatic

During a recent discourse on end-of-life care I realized that anesthesia is a very misunderstood specialty. Basically a topic about drug-induced comatosed patients turned to various items related to anesthesia - like paralyzing medications, propofol induced comas, and the need for pain control these situtations.

What I found interesting was that the physician, with many years of experience dealing with dying patients and ICUs, didn't really know a great deal about an anesthestic state produced when one creates a drug coma. He didn't remember what drugs were used to cause muscular paralysis either. A couple students trying to be helpful shouted out succinylcholine.

"Well, yes, that does cause paralysis", I thought, "but for a very limited time (2-10 minutes)". More likely he was referring to the longer acting non-depolarizing muscular antagonist - like vecuronium or even pancuronium (since we're talking about dying ICU patients here). But no one brought these up. Multiple suggestions of a depolarizing blocker, but nothing else. A lot of places don't even use sux anymore because of the side effects, but I'm going off on a tangent here.

He then went on to discuss whether pain meds were needed in these types of comatose patients. What amazed me was that he wasn't sure if they needed them or not. Some of my peers suggested that propofol was useful to prevent pain. Hm, news to me. I thought that opiates and other painkillers were used for this, but maybe, again, they were thinking back on their surgery sub-I and remembered the anesthesiologist giving some propofol when a patient was "awake" and moving - thus the belief that it affects pain. I wanted to talk about the fact that people do respond to pain even when in drug comas, and often anesthesiologists titrate opiates and other pain relievers in based on physiological parameters, but decided it wasn't worth it.

Ultimately I found it interesting that the nature of anesthesia is so misunderstood by many people. "Give some white stuff. Pass some gas. What's so hard about that?" Apparently a helluva lot more than you'd think - since most people involved in care that mimicks anesthesia's induction and maintenance have false notions on what's going on. I don't want to know what a surgeon thinks - I'm sure it's even more basic than that.