Long-term risks of surgery: ‘It gives people’s brains a hard time’

Having the patient awake is a liability. It's understandable that doctors don't want to take the risk.

Not OP, but I have convinced a surgeon not to use a general for shoulder surgery. I was fortunate to have had a previous surgery with a doctor that avoided general when he could, so I knew it could be done and that it worked well for me. To bolster my case, I found research papers showing that recovery from the surgery I was having was faster and better with a local nerve block + sedative instead of a general. The nurses tried to convince me I was wrong and making a bad choice, and the doctor would not do the surgery unless I agreed that he could use general if he felt he had to in the middle of the surgery. But then he did the surgery, did not have to use the general, and thanked me, because he said he was going to start doing more surgeries without general.

I don't think it's common to do general anesthesia for colonoscopy (or gastroscopy). Doctors do a minor anesthesia (intoxication) so you sleep while the operation in performedbut that's not a general anesthesia.

In a general anesthesia you can't breath on your own so they stick a tube in your mouth. And it needs a special doctor (anesthesiologist) to perform the general anesthesia.

Colonoscopies are no big deal. Do not let them put you under for them. They are odd/uncomfortable but not painful.

As an added bonus the doctor can show you anything they find on the screen and answer questions.

I had no problem getting my colonoscopy without drugs, and I recommend considering this route. It's very cool to see what's going on—how often do you get to see your appendix? Discomfort was minimal; I get more pain from my abdominal workout at the gym. (Although I suspect my doctor was unusually good.) For the most part, it was kind of like watching a procedure on TV, with occasional reminders that I was the subject: "You're watching in Cramp-O-Vision!" It was nice to have zero recovery time and drive home.

I have actually refused to do a colonoscopy with a doctor who insisted on general and went to a different doctor who agreed to it. It's definitely a wasteful use of general anaesthesia.

I had a colonoscopy a few years ago. I didn't need any anaesthesia at all. It was merely intermittently rather uncomfortable. I got the impression that this was perfectly normal and that Norwegian medics are much more reluctant to use anaesthesia of any kind and especially total anaesthesia than in many other countries.

Interesting. In my case they just lubed me up and went in LOL

I agree. It's a bit tricky to study these things because you can't necessarily (ethically) assign people to different trial groups and use different dosages, but just recording data on what type of anesthesia was used and doing a subsequent followup a few months later could already be valuable.

Eh, this doesn't sound good for all the people that were on ECMO because of covid.

No.

That's such a tiny, tiny, tiny percentage of surgeries and the risks being discussed are present without any heart-lung bypass being involved, ever.

That's not to say it's not an issue for people undergoing such a procedure, but it's just not what's being discussed here.

But according to those quotes there was still anesthesia administered in all cases, just not always general anesthesia.

So the possibility of anesthesia being the cause has not been ruled out by the studies you quote.

Don't forget that most surgery also involves antibiotics which can be another cause of trauma, particularly to the microbiome. Changes to the microbiome have been shown to have cognitive effects recently.

damn, noticed the same effect here!

My opinion is that in most cases the side effects are going to be less awful than the thing that you were put under for is.

Further, I'm willing to bet most people have no side effects from anesthesia, since most of the time they are only sedating you enough for you to be unconscious.

I would go do it. You'll do a sleep study, nothing crazy. Sleep apnea can really jack up your heart if left untreated.

Do you wake up with a dry mouth?

What an ENT will likely do is scope your sinuses (costs a chunk of change, but pretty cool and informative), and send you home with a self-administered sleep study that may catch sleep apnea if it exists.

It’s an insidious illness. I was mostly like you: no issues getting to sleep, no issues with teeth, no coffee. I was diagnosed with mild sleep apnea. My symptoms were lethargy and having major trouble studying. It caused me to drop out of university, not knowing the cause. It’s something that can slowly erode your heart health and actually starve your brain of oxygen each night. Get it checked!

From what I’ve read and experienced, it has not been worthwhile, especially in light of these concerns about anaesthesia. Turbinate reduction is temporary and wears off in the order of magnitude of years. I read that the same effects may be achieved by exclusively nose-breathing and never mouth-breathing. At night you can control this by mouth-taping. Pick up James Nestor’s book ‘Breath’, he’s got a good discussion on all of this.

Essentially, get some 3M micropore tape, cut a 3-4cm long strip and place it on the middle of your lips. Half of the tape on the top lip, half on the bottom. If you’re really struggling to get airflow, try to get ‘breath right’ nasal strips and use those for a few weeks. You can re-use those if you’re careful, 2 nights usually. Good luck. Please reply if you have questions.

I'm 41, and you are describing me to a tee. I had surgery about 4 years ago, and was under for less than an hour. The language issues, writing and spelling, etc. Most importantly for me is that writing software has gotten a lot more difficult. I attributed it to aging, but after reading some of this research, I'm questioning that. It feels like the issues have popped up in the last several years.

However...

I feel like this is how we got into the false causal relationship between autism and vaccines. Kids get a lot of vaccines in the first 4 years of life, and are diagnosed with autism then as well. So, you work backwards from a diagnosis and say, "oh the problems started a few weeks after the 3 year check-up, and they got shots, so the shots caused it!!" I would be worried we are doing the same here.

There is likely cognitive decline in men in their late 30s due to stress from work and kids, lack of sleep, reduced activity + weight gain, etc. We also get colonoscopies (or other procedures) around then as well. So, it is easy to say, "well I started having memory problems a few years ago, right around the time I had a hernia repair under general anesthesia, so they MUST be related."

I also want to say that Anesthesiologists don't always "bring you to the brink of death, and then hold you over the abyss by your ankles". That would be silly.

Maybe for open heart surgery or brain surgery or some other extremely dangerous surgery where if you were to wake up the shock could kill you, but that would be overkill for a broken arm that needs pins to heal or for an appendectomy done with endoscopic tools.

Knocking you out and keeping you under would be more than enough for that.

That's a great question, I'm not sure. Could it be because I just had neck surgery and they didn't want to risk infection or damage to the area? I don't have the medical knowledge to know if incompetence factored into the situation at all, but I suspect it did.

I’ve always read that it was the best treatment option. Do you have studies that say otherwise?

The statistics don't actually tell you YOUR risk. They tell if the risk a population has on average collectively.

Your personal risks could be much higher or lower, and quantifying them is basically impossible. It only makes sense to use the "average" risk level for reasoning if the sampled population is particularly representative of you, which is vanishingly unlikely due to the "curse of dimensionality".

It makes a lot of sense to decide public policy of how driving should be managed based on those statistics, but is hilariously inappropriate to base your decision to get in a car and drive based on them.

> but that's just a fact of healthcare and life.

It's a problem of different goals. In the variants of "Maximize net good/minimize net harm" frequentist statistics are appropriate to reason with. From a individual "maximize my personal quality of life" perspective, I am likely member to many intersectional groups and complexities that render that statistical reasoning meaningless. You can only generalize the results of a study to those represented by it's sampling and the cold hard reality is that a nontrivial amount of people are not represented.

Public health reasoning is entirely self consistent and rational given it's goals (minus perversions due to capitalism and rent seeking).

The problem is that it is actively hostile to most people who are disabled, a minority, or dealing with any long-tail health problem.

Yep. I live there too. It led to the above insight.

Some successes (Heart surgery helped with chronic migraine pain). I'm currently turning off large swaths of my immune system in hopes that Celiac, Crohn's and Psoriasis get better.