Yeah, my daughter’s second child was an emergency C-section of that exact type. I asked her about it weeks later and she does not remember much of anything, including pain. It seems she was too busy actually dying to be aware of anything like that. Both hers and the baby’s vital signs suddenly plummeted to about zero.
I haven’t. Crash c-sections involve the rapid induction of general anesthesia (assuming no epidural in place). Mom and baby dying is not a situation that can be solved by cutting into an awake patient. The only exception would be if the mom was already in cardiac arrest.
I once had a fungal growth on my face, between nose and lip. The doctor had to cut out a sample for analysis, and for some reason that I forget, he said anesthesia would not be possible. Hurt like a motherfucker.
Sorry for the multipost. Ketamine is a very potent dissociative analgesic, which should allow a surgical stimulus without the patient screaming; they will be aware of the pain but not disturbed by it. Which is not to say that the story didn’t happen as told, however I have used a ketamine/benzo combination for pretty painful surgeries and the patients have done fine. With the right doses of ketamine one could amputate a leg comfortably.
In this situation, the concern was likely that giving an already intoxicated patient opiates would cause respiratory depression, and make him more likely to vomit and aspirate it along with some of the teeth and blood already in his mouth. If we had to induce general anesthesia for an emergency it would certainly be possible.
Many factors can make anesthesia riskier, but like you said the anesthesia can be tailored to the specific patient to minimize the risk. A patient being intoxicated with opioids, benzos, alcohol, etc. would not be especially concerning compared to the sort of risks anesthesiologists deal with regularly, like patients with severe cardiac or pulmonary disease who require emergency surgery. To clarify, “not being able to wake up” isn’t really a thing. If the patient is so intoxicated that they are still unconscious or unable to breathe properly after all the anesthesia wears off or is reversed, then they would probably have required intubation to protect their airway from aspiration and mechanical ventilation anyway.
Regional anesthesia (nerve blocks) and neuraxial anesthesia (spinal or epidural) can be very useful for patients who would not tolerate general anesthesia, but are usually not very useful for an intoxicated patient, as patients need to be conscious and cooperative to safely do a nerve block or spinal.
Are you sure it was morphine, and not fentanyl? Fentanyl is often used for endoscopy sedation because it’s very potent and has a much faster onset and shorter duration of action compared to morphine.
The answer is a qualified no. There are certainly anesthetic techniques which minimize or eliminate the risk of hypotension. One of the key points here is that patients who are that medically fragile will require much less medication to be adequately anesthetized compared to a healthy patient. Regarding the Black Hawk Down scenario if that patient were brought to a modern trauma center he could certainly be safely anesthetized. It wouldn’t be ideal - for example, studies show that trauma patients are at high risk for intraoperative awareness, probably because they tend to be too hypotensive to tolerate much anesthetic gas. This can be minimized by giving more medications which have less of an effect on blood pressure, such a midazolam which is especially useful for its amnestic properties, certain opoids like fentanyl, dissociative analgesics like ketamine, etc. And of course the surgeon and anesthesiologist are working on raising the blood pressure by controlling bleeding and giving IV fluids, blood transfusions, and medications to raise the pressure.
Dentist here. I have done root canals on three people without anesthetic (they don’t use anesthetic for anything). Most people would consider that a painful procedure. It wasn’t however painful for any of them. People can train themselves in pain perception.
Other than extreme emergency things like tracheotomies or heart massages done on people who are basically unconscious already, I’d say none.
When I had my root canal, I was told that it wouldn’t be necessary because that tooth was utterly and completely dead. I requested it anyway.
This isn’t 100% in the spirit of the OP, but this guy couldn’t have general anesthesia for a good reason.
I can’t recall ever hearing about this in any hospital where I’ve worked, although that doesn’t mean it hasn’t happened. I have heard of women who had some propofol or some similar ultra-fast acting sedative put in her IV, prior to the immediate delivery of the baby, and they went to work.
My dentist thought my tooth was completely dead and went on with the procedure without even asking if I want local anesthesia. He looked fairly apologetic when I ended up almost blacking out from pain in his chair.
And here’s the tale of Vijay Welch-Young who had major surgery without painkillers. Yeah, I know it’s from Cracked.com, but there are other references to the story out there. I just like this one(*)
(*) I say “like”, but it gives me the shuddering fits
Not surgery exactly, but as a child forty-odd years ago I had stitches in my eyebrow with no anesthetic. I think they didn’t want to leave the eyelid area numb for fear my little pokey fingers might hit or damage my eye.
Until recent decades, some people believed that small children didn’t feel pain, or didn’t remember it if they did, and if they did, it would build character, or some similar nonsense.
:mad:
I had exactly the same procedure as Kimstu, also about 45 years ago. Ran full speed into a brick wall (I wasn’t a bright child) and gashed my eyebrow pretty bad. The doctor said they couldn’t use a local because of it being so close to my eye or some such thing, so they held me down and commenced to sewing. My father had to leave the room because he couldn’t take my screaming.
On the children and pain note, it wasn’t long after that I broke my clavicle falling off horse. I was wearing a fairly snug jersey and the ED doc said there was no reason to cut it off. He insisted that they raise my arms high over my head and pull the jersey off. This was incredibly painful and again there was much screaming. The doctor handed the jersey to my mom and said something like, “There, saved you a few dollars on the shirt.”
That is awful. I am so glad they are better informed now! When I was little I got a thick sliver under my thumb nail, and the doctor froze it pretty solid, but it still sucked when he jammed the tweezers in there to grab it - I guess I should be happy for any freezing at all!
My daughter broke her arm near her wrist two years ago, but only broke one bone, so they had to break the other to set it. They gave her propanol, so she was mostly asleep and didn’t remember it later, but she still reacted and booted the doctor (it did take several people to hold her). I was in the room and it did bother me to see my child reacting as if in pain, but she didn’t remember it at all.
Hi there fellow sufferer! That’s almost exactly what I did, except it was a basketball pole instead of a brick wall. Drove my glasses frame (yes, I already wore glasses at age seven) right into my eyebrow, and had to get stitched. Still have the scar running along the center of that eyebrow.
It can be done without anesthesia, but SHOULD it?
I never had children, but I can assure you that nobody would dare go near my vajayjay with a pair of scissors (which is what doctors use to perform them) without numbing me up first. I’ve also had women tell me that they had natural tears sewn up without anesthesia, and said that hurt more than the whole labor. :eek:
[QUOTE=Arrogance Ex Machina]
This isn’t 100% in the spirit of the OP, but this guy couldn’t have general anesthesia for a good reason.
[/QUOTE]
This woman had to perform her own caesarean with only 3 shots of liquor as anesthetic.
Yes, male infants use to be circumcised without any anesthetic.
I broke my wrist when I was 13. The orthopedist who set it decided we need to go trouble of anesthesia (which would mean going from his office to the hospital next door) when he set and told me to be a man. So his nurse held my legs down while my mother took my torso. While he was setting it I was in so much pain that one of my legs got free and the nurse (also mother of a school friend) ended up with a bloody nose. It didn’t occur to anyone to have me take my shoes off. Then he had to set it again while the cast was still wet. That ended with me screaming (more) profanity, threating to kill him, and kicking hard in the crotch. That I vaguely remember.
Apparently the asshole had the nerve to get upset after that, but Mom put the fear of God into him and threatened to sue. As in threatening to call her lawyer uncle & the police from the office phone. A different practice handled the follow up. Also I could barely move for a few days afterward because of all the muscles in my body contracting at the same time.