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November 24, 2007

BehindTheMedspeak: The myth of a 'light general'


From time to time a well-meaning surgeon will ask me to give a patient a "light general" anesthetic.

More often than not the patient is very sick and in bad shape.

Less frequently the individual is healthy, scheduled for a "minor" surgical procedure such as a carpal tunnel release.

In either instance the idea is that I should somehow knock the patient out but in a less intense way than usual.

Hey, if I could figure out how to do that I'd give everyone a "light general."

There are no "light generals."

Unconscious is unconscious.

Now, there is a huge difference between how long it will take someone to wake up depending on the drugs and doses they receive.

But a general is a general.

And similarly, the risk from a "light general" is identical to that with any general anesthetic.

All of the agents we use for anesthesia affect breathing and circulation.

That's no surprise because they act on the brain — more specifically the brainstem, or medulla, where neurons controlling respiration and circulation reside.

Once conscious airway control is lost, the anesthesiologist is the manager of what Dr. Ronald Katz, my chairman at UCLA when I was a resident, called "controlled poisoning."

Because anesthetic drugs are reversible poisons: if given in sufficient amounts, they will kill a person.

Once an individual loses voluntary control of their airway, the difference between uneventful recovery and the alternative becomes management of same by the anesthesiologist.

So while I might respond, "Sure, I'll give a light general," I know and now you do too that there's no such thing.

November 24, 2007 at 04:01 PM | Permalink


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So Joe, a few years back I was facing a 12 to 18 hour operation at your hospital, and the anesthesiologist told me that in his estimation, it takes two months for every hour of being under to purge the anesthetic agents from your body, especially those that bind with fat cells. True, or at least tru-ish?

BTW I forewent the surgery and chose gamma knife instead.

Posted by: iamexluxtroxl | Nov 25, 2007 5:02:43 PM

As a fellow anesthesiologist from the other side of the world, I applaud you for "telling it like is". When ever a surgeon asks me to give a little anesthesia I ask him if he/she/it has ever seen a woman who was a "little" pregnant.
My favorite question during the pre-op visit is: "Doc, am I going to wake up at the end of surgery?"
Now, I admit, in my twisted mind I think, "and if not, what, you're going to know about it?" But as a caring professional, to allay any anxiety, I always promise to wake the patient up. I figure that even in the worst case scenario, the patient won't be able to call me a liar.

Posted by: QuietusLeo | Nov 24, 2007 4:25:36 PM

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