Anesthesia with propofol raises interesting consciousness questions

Because I'm prone to getting non-cancerous polyps, which could turn into cancer if not removed, I've had colonoscopies every five years or so since I was around fifty.

The most recent ones have involved anesthesia with propofol, a frequently-used drug with few side effects but potential for abuse. Because it induces euphoria in many people. One study found about half. 

In 2011 I wrote "Finding enlightenment through a colonoscopy (and propofol)."

After talking about a disturbing conversation I had with a nurse about whether propofol truly prevents a patient from feeling discomfort/pain, or merely takes away the memory of discomfort/pain, I shared how propofol made me feel.

Some pleasantries were exchanged with the doctor and the nurses. Then the nurse anesthesiologist said she was starting to inject the propofol. For about fifteen seconds I felt completely normal. I was mildly concerned that the sedative wasn't working.

Next thing I knew, the nurse was telling me "We're all done."

My instant intuitive reaction was disappointment. I was disturbed to be back in everyday reality. It had been a lot more pleasant wherever I'd been, consciousness wise. I sort of felt like I'd jumped into ice water after basking on a warm beach.

Doing some Googling on propofol before writing this post, I learned this sort of reaction is why the drug is illicitly used non-medically.

There are reports of self-administration of propofol for recreational purposes. Short-term effects include mild euphoria, hallucinations, and disinhibition. Long-term use has been reported to result in addiction.  

I felt completely alert and awake. The only side effect, so far as I could tell, was that feeling of I wish I could have stayed in that pleasant propofol place longer. My first words to the nurse were, "I had some nice dreams. Mostly of having a colonoscopy, but with absolutely no pain, as if it was happening to someone else."

Later, after some reflection, I realized that calling what I experienced a "dream" wasn't entirely accurate.

Yes, it seemed like a dream at the time. But what are the chances that my brain would choose to dream about a colonoscopy, complete with thoughts of the endoscope wending its way here and there through my colon, while I was actually having an colonoscopy?

More likely is that I was minimally aware of what was going on, but the propofol created a feeling that it wasn't really happening to me.

So it's fascinating, but obviously old news, as old as human history probably, that a drug can alter someone's consciousness so completely, while they're under the influence of propofol reality not only seems much more pleasant than in normal life, that reality appears natural rather than artificial.

This raises the familiar question of how it is possible to know what really real reality actually is, if we humans are able to be in various sorts of subjective realities -- all of which seem to be true to the people experiencing them.

I got to thinking about this yesterday when I had eye surgery related to a glaucoma diagnosis that entered my life about eighteen months ago. I wrote a blog post about the surgery last night: "My eye surgery went well, though not a load of fun."

That wasn't the greatest title for the post, since the 30 minutes or so of the actual surgery was the most pleasant part of a long day. (The surgery was in Portland, about 75 minutes from Salem, where I live.) Here's what I said about the anesthesia. The UPDATE was written this morning.

Another stress reducer was my surgery starting on time. My hernia surgery [in 2021] was delayed. I found it tough to be all prepped and ready to go, then be told that because a previous surgery took longer than expected, mine wouldn't start for an extra hour.

But today I was wheeled into the outpatient operating room a few minutes early.

And it was good to be awake through the eye surgery, though I'd told the anesthesiologist that I enjoy propofol when I've had it for colonoscopies. He said that he'd put a small amount in my IV tube. Don't know if that happened, though, since I felt pretty much the same during the surgery.

UPDATE: I need to change my "pretty much the same" claim after idly scratching my chest while watching TV last night and feeling a strange lump. A big lump. Checking it out, I found that it was a square of adhesive with a metal connector thingie on the top. And not just one, there were three of them on the top of my chest where they were hard to see without looking in a mirror. Must have been put there in the surgery room to monitor my heart.

I have no memory of that happening, nor, as I thought more about it, of being wheeled into the recovery room. So now I believe that while I was conscious during most of the eye surgery, I wasn't for all of it, and the "pretty much the same" feeling I had while the eye was being operated on could have been a propofol effect where propofol reality feels more real than actual reality (and more pleasant).

Also, I forgot to credit the anesthesiologist with a clever question. He asked me, "So what did you have for breakfast today?" Quick-witted senior citizen that I am, I replied, "Ha, trick question! I didn't have anything to eat after midnight, as I was told to do by the pre-op instructions." He must feel this gets a more honest answer than "Have you had anything to eat after midnight?"

Again, the interesting thing is that for most of the eye surgery I could hear my doctor, a fellow in ophthalmology who was assisting him, and a nurse talk about some arcane medical subjects unrelated to my surgery that I couldn't understand very well, yet listened to with considerable interest.

As I noted in my blog post, I felt so calm, natural, and relaxed during the surgery, at the time I thought "The anesthesiologist must not have given me propofol, and maybe not even a sedative."

Meaning, the state of consciousness I was in felt like it was the really real reality mentioned above, even though my update to the post explained why almost certainly I was in an artificially-induced reality.

Anyway, I'm prone to find interesting philosophical questions in all kinds of places. Yesterday it was an outpatient surgery room at Good Samaritan Hospital in Portland.

Comments

[Ron E.]

It is practically accepted by neuroscience that our brains create our reality. The way we (and other creatures) function in our respective environments is apparently all down to how our brains, via our senses, interpret the immediate physical world in which we live and have evolved in.

We humans seem to live in a mostly mental world, one created by the forming of concepts. Our senses, like other species, receive the same data while the brain interprets our reality according to our beliefs thoughts and opinions, and generally our cognitive conditioning. Other animals may interpret their surroundings through smell, vision, taste, skin etc. giving them a different reality.

Logically, if we humans alter the brain in some way, perhaps through chemicals or other means, then this must distort (or alter) our customary interpretations of reality. I wouldn’t think this alters conscious awareness, but just presents a different perception of reality to be conscious of – unless of course, through anesthesia, more of the brain is deactivated causing even its capacity of awareness to cease functioning.