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Comment by lr4444lr | Hacker News Reader

Just an anecdote: I once had a procedure that required I be under a "light" general anesthesia (don't recall which). I was generally paranoid at the time though about everything, and strapped an audio recorder to my leg secretly. Turns out I did wake up mid procedure (the audio suggests doctor and nurse rushed to stop me from touching the area of operation of my face, and that I was distressed) but as the doctor promised, the sedative would have a strong effect on my short term memory and I remember not being able to recall any of what I had heard on the recording. I don't consider this at all traumatic: my memory was selectively wiped of that time period by virtue of the drug. Life just went on. It may not be popular to say, but I do feel from my experience that pain with no memory is pretty much as good as no pain, in the grand scheme of things.

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I wonder if the journalist is asking the wrong people.

Instead of interviewing patients supposed to be under drug-induced amnesia, and finding the few who remembered, ask the doctors and nurses who are being asked to restrain patients in distress. A specialist in a procedure that requires light general anesthesia would, if this was true, have done surgery on thousands of people in various degrees of distress.

To me, that would be a pretty heavy secret to carry, and a 'conspiracy' that large would be impossible to conceal. I do agree, though, that pain without memory is pretty much as good as no pain. When you're conscious but unable to remember being conscious, are you still capable of suffering?

My initial intuition to your last question was, “No, suffering usually entails some sort of looking-back process that places the pain in that context.”

I then realized that animals can suffer, and either I’m confounding Buddhist and Western psychological definitions of suffering, or suffering doesn’t require consciousness of it occurring for it to be suffering.

I hope that makes sense!

The difference is that when an animal suffers, they retain memories. One only need to consider something like this story I heard about a dog on Reddit, who was scared of obese people and men. Turns out, the dog was severely abused by a 500-lb man who was its former owner.

I recall hearing about this phenomenon about a decade ago, and at the time someone theorized that the specific memory may be lost but the effects were still present, and that these effects could cause general anxiety and distress without the person understanding the reasoning. I think it is perhaps more philosophical than rational, but it did give me pause to consider that perhaps not everyone forgets enough of a surgery to escape its effects, even in the best of circumstances.

Yeah, they've done experiments with patients with no long-term memory where they do things like shock them when they shake hands. People develop an aversion to it but can't explain why.

There are entire fields of study dedicated to studying the long-term effects of various trauma. Unfortunately it gets mixed in with the "repressed memories" and other pseudoscience ideas, so the pop-science news articles are not good sources of information.

That said, memory repression isn't the only type of anesthesia involved in these procedures. Patients are given multiple medications, which do everything from dampen the pain signals to relax the patient.

It's not equivalent to just forgetting the pain stimulus. The pain stimulus is massively reduced, even if it were to break through to the patient's awareness.

Apparently upper GI endoscopy procedures are conducted under very very mild sedation, I believe typically using propofol.

The most recent one I got, I had disturbing hazy dreams the next two nights where I was conscious of the scope down my esophagus. I would not be surprised if it was less dream and more of a memory fragment.

>pain with no memory

reverse situation - all the memory and no pain. I had a surgery on my nose done under local, and it was kind of unreal experience when the surgeon stopped cutting and took what looked like a typical woodworking chisel and a small hammer and started to chisel away the bone in my nose - all without any pain, my head is just like a piece of wood - the force would transfer and the back of my head would feel the pressure every time the hammer would fall and the scraping vibrations of the chiseling would just reverberate through the scull. ... More than 20 years later ENT here was genuinely curious where did i get such a nice job done. USSR military surgeon :) And back in the USSR my mother had her appendix removed under local too, and the surgeon was communicating to her various stages of the surgery, like what he is going to do and how that may be felt/perceived.

I wonder about the merits of those different approaches. (very handwavy as IANAD) With the local the pain doesn't seem to reach the central nervous system. With the sedation or general it reaches i suppose, yet the central nervous system has no reaction. If one supposes that the strong pain may be a kind of neuron pathway/connection altering signal ("EEPROM burning"), it would be plausible to expect that that unfelt or felt-and-forgotten at the time pain under sedation or general may still have some effects down the road.

I heard that in USSR the policy for apendectomy was that adults got only local anesthesia and kids would get general. No idea if that was the official policy or rumors only. I had appendectomy when I was 12 (that was USSR times) and got general anesthesia.

most probably it was some kind of officially established policy/practice. My mother got the appendectomy when she was an adult, and i got the nose job when i was almost 16, while the hernia surgery that i had at 5 was naturally under general.

My wife has actually had both, on separate occasions. About 15 years ago, she smashed her wrist, breaking it into multiple pieces. In the ER, they explained that the wouldn't give her an anesthetic to push things into place for a splint (to hold it together until surgery could be scheduled), but they'd give her meds so she would forget the pain. I was absolutely amazed that it worked. She vaguely remembers telling them "let's git 'er done" and then nothing for about an hour after that.

Fast forward about 5 years or so, she's on the operating table to have titanium plates inserted to hold her ankle together and she apparently wakes up in the middle of the procedure and started trying to rip her IV out while the surgeon and nurses struggle to hold her down (she's pretty strong) while the anesthesiologist puts her back under. She has no memory of this: the only reason we even know about it is that one of the nurses mentioned later that "you caused quite a stir in there."

Training horses is not for the faint of heart :-)

> Training horses is not for the faint of heart :-)

I was going to guess a motorbike, but I'm pretty sure horses are even worse!

Probably. Motorcycles can't think for themselves.

> It may not be popular to say, but I do feel from my experience that pain with no memory is pretty much as good as no pain, in the grand scheme of things.

If given the choice, I'd choose this over over deeper sedation.

Sedation and Anesthesia are not entirely risk-free. Even routine Anesthesia has been correlated with various subtle cognitive differences in the days and weeks after a procedure in some (though not all) studies.

I'd rather be given the minimum dose necessary to get the job done than have a provider go overboard with medications to avoid the small chance of someone breaking through the sedation.

> pain with no memory is pretty much as good as no pain

I can't speak to your specific case, but in general that's not true.

Even if you have no conscious memory of trauma, it can manifest itself in ongoing stress, fear, and general PTSD-like symptoms.

You may have been lucky in waking up but perhaps without pain, but that's not the case with everyone.

Sedation without going into general anesthesia is not an easy thing at all, and even experienced anesthesia providers will sometimes struggle. However, patients moving or being otherwise disoriented is quite frequent and in itself is a non-event except when trying to reach for the surgical site, as you describe. As for distress, it's often not from pain but rather confusion, which can somtimes devolve into agitation and necessity to deepen the anesthesia. In my experience, true awareness is exceptionally rare. It's true that some procedures, such as cardiac or emergency C-section have an increased risk of event due to the particular context, though.

There is no such thing as ‘light’ general anaesthesia. It’s a terrible term used only by non-anaesthetists. Did you have sedation? Movement with sedation is extremely common and not a concern. With sedation, we aim to provide comfort and relief from the anxiety-inducing parts of the experience, not unresponsiveness to noxious stimuli and lack of recall.

Sorry, but there is nothing else to say except that you are extremely wrong. This kind of belief is exactly why male circumcision is not seen for the evil that it is. Please try to consider the possibility that trauma without conscious memory can have disastrous results - as other commenters are trying to get you to understand...

Circumcision (as commonly practiced) is generally seen as "evil" because infants lack the power of consent to refuse. I'll gladly consider pain without memory to be "disastrous" if you can marshall enough evidence for that.

Lieber Einziger, bitte sende mir eine E-Mail an christian.bahls@mogis-verein.de wenn Du Dich zu diesem Thema mit weiteren Engagierten austauschen möchtest.

> you are extremely wrong

Can you point to evidence suggesting this? Not trying to be adversarial, just genuinely curious since almost everyone in this thread is just exchanging anecdata.

I remember waking up from general anesthesia during removal of my wisdom teeth. The oral surgeon seemed kind of surprised, cursed and asked the assistant to give me more anesthesia. I didn't find it all that traumatic either at the time, but I was only awake for a minute or so.

Was it true general (full intubation, paralysis, etc.) or "conscious sedation" (falling asleep with no memory and an oxygen tube next to your nose)?

Waking up and trying to move would make sense under conscious sedation. Seems very unlikely under general, given my (non professional) understanding.

I don't believe "light general" is a thing.

Please don’t bring a recorder. It puts you at risk because when we ask if you have any devices, we expect an honest answer. If it is discovered you will lose the trust of your treating team. You can get electrical burns if certain equipment is used. You could have recorded conversations about other patients, which you are not entitled to do.

Yeah, not that'd I'd do it today because mental health is better, but it was pretty low risk. The surgery was on my nose, and the recorder was a cheap alkaline battery one (4.5 volts) strapped to my leg below the knee.

By this argument, living an entire life of suffering and then not remembering it when you’re dead would mean that it doesn’t matter and all suffering can be ignored. I hope that’s not the ethical code we settle on.

No need to be concerned. Exactly zero people are concluding that suffering can be ignored because someone is ok with not remembering pain during a medically necessary surgery.

The sedation prevents the memories from forming, and also prevents the person from processing what's going on. The actual pain signals are also significantly dampened.

It's not equivalent to a lifetime of suffering in any way.

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