# Why do anesthesiologists say "count back from..."
**URL:** https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744
**Category:** Factual Questions
**Created:** [July 23, 2006, 9:00pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744 "2006-07-23T21:00:26Z")
**Posts on this page:** 20
**Page:** 2
### Author:  [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)
#### Post date: [July 24, 2006, 3:00am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/21 "2006-07-24T03:00:54Z")
I’d agree with the answers given. I’ve done my share of surgical assisting and emergency anesthesia – maybe one quarter of the anesthesiologists I know ask the patient to count backwards.
If the patient can talk and follow directions, their airway is intact, they are breathing, they have circulation, they are not comatose. Their higher brain functions are still working.
If the patient is concentrating on something, they are less anxious. I have heard that you can check reflexes and whether a given area is numb more accurately if the patient is distracted – maybe it’s true.
Having regular routines and rituals can also be a source of comfort for the anesthesiologist. I’ll bet every doctor has a little talk they give everyone with a given problem; when you’re tired it’s sometimes just easier to say the same thing the same way.
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### Author:  [@Foldup\_Rabbit](https://boards.straightdope.com/u/Foldup_Rabbit)
#### Post date: [July 24, 2006, 6:47am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/22 "2006-07-24T06:47:54Z")
I’ve been under twice, but I have never been asked to do anything other than relax. I suppose it might have helped, since my usual internal monologue while going down goes something like, “Oh, dear. Oh, gosh. Oh, help. Oh, this isn’t working. This isn’t working and they’re going to cut me open and it’s going to hurt. Oh, no. Oh, help. Oh, rats. Oh, f–”… And then I wake up in recovery.
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### Author:  [@ambushed](https://boards.straightdope.com/u/ambushed)
#### Post date: [July 24, 2006, 7:59am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/23 "2006-07-24T07:59:30Z")
> [@Little Plastic Ninja](#):
>
> What’s it feel like when you’re going down?
Immediately after administration, you feel very comfortably warm – the first seconds are quite pleasant. _Then_ you start to feel so incredibly great it’s almost orgasmic. Like **levdrakon** said, you’re filled with a profound sense of love and good will towards everyone everywhere; if you felt coordinated enough, you’d want to get up and warmly embrace everyone in the room and dance.
Unfortunately, you’re asleep within a matter of seconds. If you were still awake when this wonderful feeling went away, you’d cry and cry like a baby for its loss.
Unlike **Musicat** , I experienced _nothing_ like a NDE is supposed to be like. YMMV, of course, but I’ve never heard anyone else describe it that way.
Oh, and **Little Plastic Ninja** , when my sister-in-law was studying to be a nurse-anesthesiologist, she did research and polling among those tiny few who “woke up” or were otherwise conscious during their operation. Most of them still felt no pain and described it as if they were dreaming. Trauma is, according to her, very rare even among the tiny 0.1-0.2% who are either conscious or have an apparent recall of the procedure. But to assuage your obvious (if almost certainly unfounded) fears, why not ask your surgeon/anesthesiologist to use what they call a “BIS monitor”? If your surgical team does not have or use them, why not try to find one that does?
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### Author:  [@Charlie\_Tan](https://boards.straightdope.com/u/Charlie_Tan)
#### Post date: [July 24, 2006, 8:01am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/24 "2006-07-24T08:01:30Z")
> [@Little Plastic Ninja](#):
>
> What’s it feel like when you’re going down?
I think it depends on what kind of surgery you’re gonna have. I had a kidney removed a little over a year ago and sport a 10" scar across the left flank of my stomach.
The ananesthetic was not pleasant. going under wasn’t a problem, but…
1. I wasn’t allowed to drink anything since the night before. Believe me, that morning was hell, just from thirst.
2. It was a big procedure, with tubes going in and out everywhere, one of them down my. It was inserted while I was under, but the days after, I was extremely sore in my throat and around my lips. Not getting enything to drink for two days after didn’t help matter.
3. I took the longest time to wake up, about four hours, and even after I woke up, I was extremely drowsy the rest of the evening. Not a pleaant feeling.
Part of my non too pleasant experience was the nature of the procedure, of course, but the anesthetic was no walk in the park by itself.
YMMV (And probably depending on what type of surgery you’re getting, but I’m sure some of our resident (heh!) MDs can confirm if anesthetics change depending on why they put you under.)
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### Author:  [@Charlie\_Tan](https://boards.straightdope.com/u/Charlie_Tan)
#### Post date: [July 24, 2006, 8:04am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/25 "2006-07-24T08:04:21Z")
Ahem.
> [@Charlie Tan](#):
>
> one of them down my **throat**.
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### Author:  [@gabriela](https://boards.straightdope.com/u/gabriela)
#### Post date: [July 24, 2006, 10:25am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/26 "2006-07-24T10:25:54Z")
> [@Shoshana](#):
>
> A mini-mental status exam (also, “min-mental state exam”) is a quick way to screen for confusion, cognitive problems, and possible gross neurological trouble. It’s used in part to help determine whether more specific inquiry and testing should be performed. If you’re in pretty good shape, it just seems a little weird. If you’re not in good shape, it’s very difficult. Tasks include spelling a word backward, copying a geometric figure, saying where you are, remembering three items for several minutes, and the like. “Serial 7s” wasn’t part of the MMSE per se, but is sometimes tacked on or substituted for a different item. If you can’t do serial 7s, you may be asked to try serial 3s.
>
> In some circumstances, much of information sought by the MMSE can be gleaned in the context of a basic intake interview. If a person’s answers are impoverished or odd in certain ways, they might then be asked formal MMSE questions. If a person’s cognition and memory appear grossly intact, there’s no need for that. The intention is not to trick anybody, but rather to have an easy triage tool for situations where the person may not be able to tell you what’s happened–a person with dementia, for example, or somebody who’s fallen off a ladder.
This was a clear, concise, and enlightening answer. Thanks, **Shoshana** , I didn’t know that.
As a resident I was taught to ask confused patients three orientation questions: 1) Who are you, 2) Where are you, 3) What day is it. If they didn’t pass #1 you didn’t have to ask them #s 2 and 3. If they pass all three of them you get to write in the chart, “A&Oxiii”, which is jargon for “Alert and oriented times three”, which means mentally normal. Not as precise as the exam **Shoshana** described, is it?
The knowledge of your own name is said to be very deep, and a person must be really sick or have something very seriously wrong with the brain to lose it. Where are you can be lost with mild dementia or moderately severe illness. What day is it can be lost by perfectly normal physicians writing to the Straight Dope.
“Normal” in quotes, of course.
When I was a surgical resident (before switching to pathology) I was once sent over to Major Medical Receiving in the ER to consult on a pancreatitis patient. This was in Kings County, the city or charity hospital of Brooklyn. Those of you who have worked in major charity hospitals, you know what I’m talking about. Those of you who haven’t, can never imagine. There was a serious largest cockroach contest once… took a month… some guy won it with a three-incher from the basement. And this was not in Florida. This was in New York.
Poor pancreatitis guy was really deranged from the dehydration and electrolyte disturbances (and may not have been all that clear mentally beforehand, because of the chronic alcoholism). He wasn’t exactly raving, but he wasn’t okay either. He had just answered “Who are you” correctly. The medical resident taking care of him asked him, “Where are you?” The patient looked around at the other patients, the instruments, the linoleum, and the tacky ceiling, and said, "I dunno! I think it’s a hospital, but I’m not sure!’
The medical resident looked at me sourly and said, “He’s oriented. I’m not sure it’s a hospital either.”
Gawd, I loved that remark.
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### Author:  [@rhiannon777](https://boards.straightdope.com/u/rhiannon777)
#### Post date: [July 24, 2006, 2:45pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/27 "2006-07-24T14:45:40Z")
> [@Little Plastic Ninja](#):
>
> Who else has gotten one recently?
>
> What’s it feel like when you’re going down?
I had surgery in May. I was really nervous beforehand as well, but everything turned out fine.
By the way, I have never known of anyone who woke up during a surgery. My mother works with a lot of elderly people, so I’ve heard about a LOT of surgeries.
Here’s how mine went. After I arrived at the hospital, they had me put on the gown (actual cloth, not paper, which was exciting to me). I waited around in my own bed-cubicle and the surgeon and anesthesiologist came to talk to me and make sure everything was good to go. A nurse brought me some pills to swallow (an anti-naseau thing as a preventative measure for later and something else). Another nurse came and hooked up my IV. I think I got a bag of saline for hydration, then ten minutes or so before they wheeled me into the OR, she gave me an injection into the IV line of a tranquilizer. Since it went right into my veins through the IV, I felt instantly relaxed. So relaxed that I giggled a little as they were wheeling me in.
I remember thinking that it was weird being in the OR because everything was cold and metallic and there are a lot of people standing above you in scrubs and masks. They gave me another injection of the actual anasthesia into the IV line. My personal paranoia was about waking up during the surgery. To make myself feel sure that they’d really have to knock me out good, I tried my hardest to stay awake after they administered it. I’d say I was out in two minutes at the most. At least that kept me occupied instead of nervous!
It just felt like going to sleep when you’re REALLY, REALLY tired. It’s not at all unpleasant or scary.
One thing to be aware of so you don’t get scared when it happens…they have to wait for you to wake up to give you painkillers. So, when you first wake up, you will be in some pain (you’re still under the effects of anasthesia, though, so it’s not terrible). As soon as I woke up and told them I was hurting, they gave me an injection into my IV line and it took effect immediately. After that, I felt uncomfortable but not in pain.
One thing I learned the hard way…avoid anything acidic for four or five days afterward. My throat was a little sore from the breathing tube, but I didn’t think much of it…until I had some mustard.
Good luck…it will all turn out fine!
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### Author:  [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)
#### Post date: [July 24, 2006, 5:36pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/28 "2006-07-24T17:36:43Z")
I’ve awakened twice when I was under anesthesia. The first time, I was having a lump removed from my knee. I could feel the doctor tugging at it, but there was no pain. I heard him say that it was bigger than he’d thought, and I asked to see it. Instead of seeing it (I didn’t have my glasses on anyway) I got more anesthesia, and soon back in lala land. The second time, I woke up just as the doctor was stitching up my nipple. Again, I felt no pain, just a tugging sensation. I told the anesthetist that I was awake and that my nose itched horribly. He kindly scratched my nose for me with a gauze sponge. He asked if I was in pain, and I replied no, I could feel sensations but not pain. He said that he didn’t want to put me back under, the surgeon was nearly done. I was fine with this, as I’d had Versed, which makes me very mellow and co-operative.
I did NOT wake up in the middle of my hysterectomy, and I’m glad of it.
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### Author:  [@myrnajean](https://boards.straightdope.com/u/myrnajean)
#### Post date: [July 24, 2006, 7:18pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/29 "2006-07-24T19:18:07Z")
Sounds like everyone is describing different drugs. I’ve had all of these various experiences, depending on which drug the doctor was using.
The 100, 99, 9zzzzzzzz, was always liquid valium (at least that’s what they called it at the dentist )
The one where you feel sooooo comfortable and everything is perfect, that was demerol. (appendix removal) wheeeeee!
And the one where you supposidly relax and have amnesia, well, that one doesn’t work on me. I remember the entire procedure (colonoscopy) and I was talking through the entire thing (“HEY! whats that on that screen?blaha bla blah blah”. I think they just kept giving me more and more of the drug to make me shut up, and afterwards I was puking for hours!
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### Author:  [@Ethilrist](https://boards.straightdope.com/u/Ethilrist)
#### Post date: [July 24, 2006, 7:28pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/30 "2006-07-24T19:28:56Z")
> [@Little Plastic Ninja](#):
>
> What’s it feel like when you’re going down?
I had a Nitrous Oxide general anesthetic when I had my wisdom teeth pulled. They hooked me up and went off to work on other things. As I was lying there, I didn’t feel any different. I lifted my arm, and it left a trail of blackness behind it. I tried to touch the arm of the nurse next to me, and everything I touched turned to blackness. I tried to reach up and grab the light with both hands, but the blackness consumed everything I touched, until there was nothing left.
This remains one of the most terrifying experiences I have ever had.
For those of you facing operations, I’m sure your experiences will be different. 😃
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### Author:  [@FlyingRamenMonster](https://boards.straightdope.com/u/FlyingRamenMonster)
#### Post date: [July 24, 2006, 7:44pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/31 "2006-07-24T19:44:16Z")
> [@Little Plastic Ninja](#):
>
> I’m kind of anxious about this myself. I’m about to go in for a procedure (August 11, I’m counting the days) that requires a general anesthetic.
>
> Who else has gotten one recently? I’m utterly terrified by the prospect. I don’t like being knocked out, I hate and fear those horror stories of people waking up on the table. I once nearly fainted when giving blood and that goes down as one of the more frightening moments of my life.
>
> What’s it feel like when you’re going down?
Well, first, you’re lying on the operating table. Then, suddenly, you’re in the recovery room feeling slightly disoriented, and [del]your kidneys are missing[/del] you might hurt a bit where they cut you. It’s not like falling asleep at all, it’s more like if you imagine your life is a film reel and they cut out part of the film and joined the ends back together. It’s kind of neat, really. Oh, and they give you a tranquiliser, so even if you’re freaked out now you’ll probably be less so once the time comes.
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### Author:  [@dangermom](https://boards.straightdope.com/u/dangermom)
#### Post date: [July 24, 2006, 8:20pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/32 "2006-07-24T20:20:46Z")
When I had my wisdom teeth out, I didn’t realize at all that I’d fallen asleep. I started trying to tell the nurse that I wasn’t asleep yet, don’t do anything! I did this through a mouth full of cotton, and she had to point out that they were done. Then I giggled all the way home; whatever drug they gave me was one where you either laugh or cry while it’s wearing off.
I had surgery a few years back and the anesthesiologist didn’t ask me to count, he just asked how I felt and chatted a bit. I was feeling a bit dizzy by then but couldn’t think of any way to describe it except by saying, “I’m feeling vertiginous! Is that a word?” I knew I’d been out when I woke up after that one, but I don’t remember much.
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### Author:  [@gigi](https://boards.straightdope.com/u/gigi)
#### Post date: [July 24, 2006, 9:07pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/33 "2006-07-24T21:07:27Z")
> [@Shoshana](#):
>
> Tasks include spelling a word backward, copying a geometric figure, saying where you are, _remembering three items for several minutes_, and the like.
**Sun, Saturn, basketball.** I still remember them from nine years ago when I went to the psych clinic with panic attacks. Of course then I couldn’t remember the therapist’s name (I said Mr Friedman because I must have been thinking of M_A_S\*H) but I am terrible with names even on my best day.
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### Author:  [@Charlie\_Tan](https://boards.straightdope.com/u/Charlie_Tan)
#### Post date: [July 24, 2006, 9:17pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/34 "2006-07-24T21:17:07Z")
> [@FlyingRamenMonster](#):
>
> and [del]your kidneys are missing[/del] you might hurt a bit where they cut you.
**HEY** :eek:
:eyes the Pastafarian suspiciously:
see post #24
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### Author:  [@norinew](https://boards.straightdope.com/u/norinew)
#### Post date: [July 24, 2006, 9:37pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/35 "2006-07-24T21:37:18Z")
> [@Little Plastic Ninja](#):
>
> What’s it feel like when you’re going down?
To me, it feels like someone found my off-switch. Versed (the relaxing/amnesia drug) doesn’t work for me, so I always remember everything right up to the last second.
I’ve had general anesthesia more than a dozen times, most recently just last June. My only two complaints are these: once, when the anesthesiologist was “oxygenating” me (his terminology) by feeding me oxygen through the mask, I had a panic attack, and felt like I couldn’t breathe at all; but that was just me. Also, if the IV is in a particularly small vein, the anesthesia can burn (but it only burns for a couple of seconds, then you’re out).
As for the sore throat from the breathing tube, that’s happened to me maybe three times. It’s certainly not an every time thing, at least for me. YM, of course, MV.
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### Author:  [@Dunderman](https://boards.straightdope.com/u/Dunderman)
#### Post date: [July 24, 2006, 9:51pm UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/36 "2006-07-24T21:51:37Z")
> [@FlyingRamenMonster](#):
>
> Well, first, you’re lying on the operating table. Then, suddenly, you’re in the recovery room feeling slightly disoriented, and [del]your kidneys are missing[/del] you might hurt a bit where they cut you. It’s not like falling asleep at all, it’s more like if you imagine your life is a film reel and they cut out part of the film and joined the ends back together. It’s kind of neat, really. Oh, and they give you a tranquiliser, so even if you’re freaked out now you’ll probably be less so once the time comes.
This describes my experience pretty much exactly, although I _did_ feel pleasantly stoned after waking up.
They say you can’t get addicted to drugs when you take them for a good medical reason, but damnit, I often miss some of the stuff they gave me in the hospital.
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### Author:  [@flex727](https://boards.straightdope.com/u/flex727)
#### Post date: [July 25, 2006, 12:28am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/37 "2006-07-25T00:28:19Z")
My one experience with general anesthesia is a little different than the others in this thread. Some years ago I had my gallbladder removed via laproscopy (may the inventor of laproscopy have a special place in heaven - bless him or her). My memory of going under is a bit muddled because I thought I was asked to count backwards, but I remember discussing the weather. In any event I was out, like a light switch, in a matter of 3-5 seconds. I remember dreaming the most pleasant dream, don’t remember the subject, but do remember that it was extremely pleasant, when someone asked me to wake up. I did, instantly, and also instantly felt the most extreme pain of my life. Someone asked me how I was doing and all I could say was “PAIN!!!”. All this took place while still in the operating room. They probably gave me something, but it was pretty ineffectual. Mrs. Flex said I was very surly for the next several hours. This was day surgery and I had to go home that day. All in all, a successful surgery (pain from the gallstones was immediately and completely gone!). I don’t miss my gallbladder a bit.
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### Author:  [@ASAKMOTSD](https://boards.straightdope.com/u/ASAKMOTSD)
#### Post date: [July 25, 2006, 12:42am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/38 "2006-07-25T00:42:46Z")
> [@Little Plastic Ninja](#):
>
> What’s it feel like when you’re going down?
I am surprised no one mentioned this - for me, I experience a loud buzzing sound - it gets louder & louder very rapidly & then I am waking up after the procedure. Am I the only one to get a literal buzz? 🆒
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### Author:  [@Bill\_Door](https://boards.straightdope.com/u/Bill_Door)
#### Post date: [July 25, 2006, 12:58am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/39 "2006-07-25T00:58:32Z")
I was one of those who woke up during surgery. I remember being in pain, but that the pain didn’t seem to be important. When the doctor asked for a certain instrument I said, “I downloaded an article from “Ocular Surgery News” and they recommended a #11.” The surgeon said, “Well, we’re using a #14”, and then told the anesthesiologist to “take him down a little more”. Next thing I knew, I was in recovery.
I remember it happening, and my wife said the surgeon told her about it when he spoke to her while I was on my way to recovery, plus, I had downloaded an article from “Ocular Surgery News”, which had recommended a #11, so I’m pretty sure it wasn’t a dream.
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### Author:  [@susan](https://boards.straightdope.com/u/susan)
#### Post date: [July 25, 2006, 12:58am UTC](https://boards.straightdope.com/t/why-do-anesthesiologists-say-count-back-from/365744/40 "2006-07-25T00:58:37Z")
> [@](#):
>
> They say you can’t get addicted to drugs when you take them for a good medical reason
Uh, which “they” says this? Iatrogenic addiction is a huge issue. State 'o California requires in its licensing requirements that psychologists be trained on iatrogenic addiction.
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