BehindTheMedspeak: Talkesthesia

The first time I ever saw the word "talkesthesia" was last week when I read an article in Anesthesiology News, a monthly throwaway.

The story was about vibration anesthesia (vibrasthesia?) as an adjunct to reducing the pain of minor dermatologic procedures.

Dr. Kevin C. Smith and colleagues from the department of neurology at Mount Sinai School of Medicine described, in the Dermatology Online Journal, the use of several different commercially available massagers to provide analgesia during a wide range of dermatologic procedures, including:

• Botox injection

• Laser therapy for leg veins

• Laser tattoo ablation

• Collagen injection for facial wrinkles

• Nailfold injections for psoriatic nails

• Incision and drainage of abscesses

• Mild cautery of facial warts

They noted that massager–induced vibration provided useful anesthesia in many patients but noted that their report is anecdotal "because it is clearly difficult to blind or placebo–control patients to the obvious sensation of vibration."

The article has seven video clips demonstating the use of vibration anesthesia.

I won't go into the detailed theory of why vibration anesthesia works: the online paper does that quite nicely and you can read it there if you're interested.

I will note briefly, though, that the general idea is that the conscious brain can only process so much information at one time; therefore, if you overwhelm it with sensation from one source, other sensations won't be nearly as strongly apparent.

The Anesthesiology News report stated, toward the end, "They also recommended so–called talkesthesia (talking during painful procedures)."

Well.

I've been using talkesthesia since I was a resident and find it, along with handholding, among the most useful anesthesia modalities I employ.

You can turn it on and off at any time and there are no side effects that I know of, other than a grateful patient.

I have seen many procedures done under sedation and local anesthesia turn into thrashes because of the use of IV sedatives, hypnotics and narcotics when simply putting a head under the drapes and telling the patient you're there with them, giving them your hand to squeeze and reassuring them that it's almost over — even when that's not so — would have accomplished the same thing without losing the airway and disrupting the surgical field to ventilate the patient.

You see, there is often a conflict between the safest thing to do and what's most comfortable for the patient.

I pride myself on almost never — I say almost because, though I cannot think of an instance I let myself slip in this regard I'm sure it has happened — ever doing what's easier for a patient to tolerate if I think it might increase their risk in any way.

I will make someone very miserable in order to get them through a procedure with the least chance of a complication.

Sorry — but if you're my patient you're doing it my way.

And I don't just talk the talk: when I had four impacted wisdom teeth chiselled out of my mouth back when I was in medical school I refused the oral surgeon's very emphatic recommendation that I allow him to give me a general anesthetic.

He said it would a very unpleasant afternoon if I chose to be awake.

I so chose.

He shot me full of local and proceeded to hammer my teeth out with his big stainless steel mallet and chisel, blood and saliva and bits of teeth flying everywhere.

I saw stars every time he hammered down into my mouth.

And the noise — oh, man, the noise was unbelievable, of teeth breaking and shattering and cracking.

And you know what?

I'd do it the same way tomorrow if I had to undergo the procedure again.

No general anesthesia or IV sedation in the dentist's chair, thank you very much.

My anesthesiology department chairman, Dr. Ronald L. Katz, back in the day when I was a resident, once remarked that when you read a report in the paper about a woman in her thirties who had a heart attack and died at the dentist's you can be sure that the actual events consisted of oversedation, respiratory arrest, inability to ventilate, cardiac arrest and death.

Because, he said, "Women in their thirties don't have heart attacks."

Every few years I read one of those stories in the paper.

Should've had the local.