Propofol-induced deep sedation reduces emotional episodic memory reconsolidation
advances.sciencemag.org
advances.sciencemag.org
You fall out of consciousness insanely fast. One moment you're talking to the anaesthetist about your name, what you're there for. You feel a cool sensation where the needle is. Before it's grown to your whole arm, you've vanished. I mean you're not dreaming, you're gone.
The only way you know you were gone is that there's no sensation of time. When you sleep, you feel like there's time. Under propofol I felt like my arm was cold, then I was groggy and waking up. In one action.
Maybe it's like dying, I don't know. But there's definitely this "system was rebooted" sensation as you come back to consciousness.
> Before it's grown to your whole arm, you've vanished
I wonder about this bit though - I wasn't sure if I really had gone out that quickly, or if I talked for more time but just don't remember it.
After my operation I apparently woke in the recovery room and said some things (I heard the nurses talking about it afterwards) - but I have no recollection of it at all.
Also, you're spot on about the passage of time - when I finally woke and was actually lucid (well, fairly!), it really felt like no time had passed.
Something about the sensation of returning felt like it was on the waking side of the experience, rather than the falling asleep side.
And because I did it twice I did see that the doctor had practiced it, it wasn't just smalltalk. He got me to do a biographical spiel because you tend to have one (grew up there, moved for uni, blah blah) ready. So when it came time to give it, I sort of vanished while talking about myself. No slurred speech like I was drunk, just sort of "oh shit I'm falling asleep" after maybe a couple of sentences, and then gone.
I can see why Michael Jackson might have liked it. It really does KO you super fast.
By the way, this hasn't led to me drawing any particular conclusions about the nature of reality or consciousness. I didn't find it useful to hold a particular set of beliefs about these things before the event, and that didn't change afterwards. If anything, it just presents more questions.
The OBE itself had some dream-like qualities, though one thing I did notice was that the "resolution" was superb, unlike my normal dreams. We're talking next-gen graphics. The closest thing I can compare it to is as if the entire field of vision was center of focus.
Clear enough to afterwards, even years later, be able to recall the exact color and texture of the floor tile glazing, just how a doorway arched, and precisely how a distinctly non human entity looked and acted.
Curiously, at least to me, it's primarily a profoundly visual experience. Sound, touch, and smell is rarely, if ever, prominent in those dreams. Maybe the clarity of vision somehow drowns them out, or maybe I simply don't dream much in sound, but it only becomes apparent when the visual experience is almost jarringly clear.
Lucid dreaming resources will teach you about all that. You'll probably enjoy it.
The amnesia was considered a benefit because it's not the case that you want to remember everything that happens immediately before surgery...
My ex, waking up from anesthesia, heard the surgeon chat to others about $chain (local supermarket), to which she yelled out of the blue, to their surprise and amusement, just "$chain sucks!". She had no recollection of that and only knows about it because they told her later. [The place is ridiculously expensive, worse than Whole Foods was before the Amazon acquisition.]
Hearing is the last sense that goes he said. The idea was to keep calm and not talk about how something was hopeless.
I'm not qualified to say if this is true but I keep getting reminded about it in different other settings.
After everything was prepped, my surgeon and I were chatting about something and the last thing I recall was the anesthesiologist putting the mask on me and saying "nemasu" (Japanese for "sleep").
There was no countdown, no drowsiness, no sleepiness -- I was just gone and then waking up post surgery. It felt as though no time had passed, but it had been hours. Completely and utterly trippy.
The point being, you’re still arousable. A vigorous rub of the sternum will likely wake you up. Not so much on propofol.
I will address some of the other details of your comment though. First, the statement that someone on seroquel is "arousable": Compared to propofol, sure. But a vigorous rub of the sternum will absolutely not do it for many people, myself included. My wife can attest to the difficulty. And if aroused before time, the state can be likened to severe drunkenness in terms of ability to function.
Also, your are right, there are arguably better sleep aid options. But it's arguable because individuals react so differently to different medications. Seroquel was not a first choice for the task, or the third. A doctor likely would be negligent in prescribing it for that sole purpose on a first consultation without exploration of other options.
As for it being a shit or "dirty" drug, there aren't particularly good options within this class of drugs. We can argue about whether these are over-prescribed, but for people who truly do need them, it is something of a devil's bargain where the benefits can be suspect relative to the costs. For the fortunate that response to them, newer medicines like latuda offer a much lower side-effect profile for similar benefits. Absent very good insurance though, that is financial hit of roughly $15,000 per year that few can afford out of pocket. This leaves the "dirty" drugs.
I won't put words into your mouth with this next part, but there are some that would then argue that these sorts of drugs are universally unsuited for any use, and that people suffering from their targeted disorders might better control their symptoms with diet, exercise, and supplements. Having seen many people attempt such and fail, I regard this point of view as a sort of survivors bias. The people that argue this point of view tend to be the very rare people for whom it works, but just as with any particular medication, the efficacy of any treatment regime varies greatly with the individual.
While “shit” was a bit tongue in cheeky the term “dirty” is used among practitioners because of the wide range of metabolic side effects that the atypical psychotics have. Seroquel is a metabolically “dirty” drug. Taken in therapeutic doses long term a high percentage of people will end up with metabolic syndrome derangements.
Likewise, in the US and Canada, is not indicated for sleep disorder/insomnia use either. In Lexicomp it’s not even listed for off-label use. That’s just a fact, I don’t know what you’re trying to convince me of. In the US there is also a storied history with Astra-Zeneca and a lawsuit due to their practices of pushing off-label use resulting in a $.5 billion settlement.
Another fact is that Seroquel was one of the most heavily marketed drugs ever to primary care providers. As my 100s of dollars of Seroquel branded swag my office accumulated 15 or so years ago will attest to (I am not a psychiatrist).
My own personal experience has been that most psychiatrists I’ve spoken to at a large academic center, are appalled at the idea of using seroquel for insomnia long term due to serious side effects and the consensus is that it’s MOA is mostly due to its antihistamine property. That’s really all I was saying.
Also most atypicals are not highly sedating, lurasidone especially so. I have not heard of it seriously being mentioned likely for primary insomnia.
Otherwise I wasn't referencing lurasidone for it's sedative properties (it can have the opposite effect) but in comparison with Seroquel for it's use on-label as an antpsychotic. Sorry if there was confusion there. It's a much better option than Seroquel, if it happens to work for you. It doesn't always.
So I resolved to have a colonoscopy without any anesthesia or painkillers. It wasn’t a big deal for me, it felt like having bad gas when the tube would go around a corner in the intestines, but the nurses acted like I was insane. The doctor had to come out and tell them it was fine. He said doctors have to experience a colonoscopy awake at least once so they know what it feels like, which I found interesting. Seeing what was in there was pretty interesting too. The American medical system acts like the smallest bit of discomfort warrants being knocked out. The anesthesiologist seemed a little put out about it too, as I refused to even let them give me an IV. Maybe he didn’t get paid if I wasn’t out.
It was funny afterward because someone had the job of escorting me to my ride, so we walked together to my car. Made the whole thing far less unpleasant in my estimation.
There is a tremendous variation in both pain tolerance and anxiety. You sound like you’re in the minority.
The anesthetist still gets paid. His concern is if you freak out (this happens more often then you may think), he may at minimum have paperwork to do and worse you may sue him for malpractice (“well he didn’t clearly explain it would be that bad during the consent process).. again this problem happens more than you may think. Ie the negative ev for them if you do not do the typical protocol is considerable.
I have to go for a colonoscopy in another two and a half years, and I’ll insist on no sedation that time as well. You seem familiar with the process, is there a way to avoid feeling like I’m having a fight with the staff next time?
He/she must have been really, really pissed by your IV refusal.
The only way I have a sense of time from sleeping is if I can recall a dream when I wake up. Otherwise the experience is identical: I remember going to sleep, and I remember waking up, but the space in between is empty -- no sense of time or anything.
It's identical to being put under general anesthesia via propofol or other amnesia-inducing substances.
Other clues may be sounds you hear around you -- like other people going about their business (making breakfast, talking, etc), or cars driving past. These clues might be registered by your subconscious, even when you're not consciously aware of them.
Another clue is how rested you feel. If you wake up feeling incredibly tired, you probably haven't gotten much sleep.
Yet another clue is temperature, as it tends to get colder at night and warmer during the day.
The smell of breakfast or coffee could give you a clue. How hungry or full you feel could be a clue, as could needing to go to the bathroom.
There are probably plenty of other clues as well. In the absence of such clues, I'm not sure how well one would be able to guesstimate time after being asleep.
Weird thing, I always start to talk English (German native speaker) while drifting away. Since I was a little ashamed of that, I once told the technician beforehand and he replied it's quite common and a known observation.
I hypothesize a foreign language might require some mental effort and isn't accessed the same as the native language. The fading consciousness might lose a native language sooner, maybe.
When I finally switched to Norwegian they seemed pleased and left me alone.
There's a theory about this phenomenon in this paper: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044....
I went under a second time for the removal of the stent and used this second experience to confirm that it was indeed the anesthetic that confers this happy feeling post op.
I wouldn’t wish kidney stones for my worst enemies though. That pain is horrible.
Of course it's more complex than that since most of those also make it easier to keep you under.
Sometimes, anesthesiologists will give opiates so that you don’t wake up abruptly in pain, or give benzodiazepines so you feel less anxious afterwards. Depends on what they did - if you had a dislocated shoulder, the pain is much less once it has been ‘reduced’ (Put back), so you probably wouldn’t have (too) much pain, relatively speaking, once you wake up. But if someone just cut open your abdomen, you will have lots of pain on waking, so makes more sense to give some opiate beforehand, to make your wake-up ‘nicer’.
Propofol also tends to lower your blood pressure a lot, so some docs feel you can get the same level of sedation with less low blood pressure by giving a bit of benzodiazepines + propofol
My moment was not propofol but another medicine for nausea/vomit - it worked in seconds just when I had resigned myself to throw up. I was shocked. How?
https://en.wikipedia.org/wiki/Ondansetron
Usually nausea is caused by the perception that your body "doesn't feel right." Serotonin is responsible for the feeling of wellbeing. Just so happens that subreceptor 3 is more about well being feeling of the body :-)
This stuff is true. She tells me people often experience discomfort and pain, and even complain during the examination (they don't go completely unconscious), but after they've woken up, they don't remember it! They may have some lingering pain, but they don't feel bad about the examination. The doctors say it went well, and they believe it.
Wasn't this the plot of the podcast turned TV series Homecoming?
activate a memory, take medicine, suppress memory
rinse and repeat and having cured your PTSD the army can send you back to the war.
Propofol sedation is a pretty big proposal for something like this so they'd need a comparative effectiveness trial I think.
This is a truly magnificent achievement for all mankind.
A study on 50 people doesn't sound like it has the statistical power to predict anything in the general population.
Scores (percentage) for each story per group:
group A (n = 25 participants) reactivated mean (SEM) = 53.49 (2.29);
nonreactivated mean = 59.20 (2.60);
group B (n = 24 participants) reactivated mean = 59.52 (1.97);
nonreactivated mean = 61.19 (2.11).
What's the predictive power of this? What's the explanatory power? What did we learn? That 25 people reacted a little differently than 25 other people on a test after the same drug was administered and some more time elapsed between the times when the two groups took the tests.
There's nothing to see here.
Edit: Btw, both groups received endoscopy and midazolam or phenylpiperidine derivatives- so not only the effect measured was small it was also not possible to clearly attribute it to propofol, rather than the endoscopy or the additional drugs administered.