How Doctors Keep You Asleep During Surgery

This question originally appeared on Quora. Answer by Richard Muller.

Whenever possible, I ask to be allowed to stay awake during surgery.

The most recent time I did this was after a mild heart attack. The surgeon wanted to install 4 stents, spreaders that keep the arteries of my heart wide open. To do this, they insert a tube into an artery in my arm and then they feed it up into my heart, while watching on ultrasound and then an X-ray machine. The surgeon said that if I wanted to remain awake, that would be OK with him. He would apply only local anesthetic.

Indeed, I watched the whole procedure. The only negative was that the surgeon asked me to stop asking so many questions; I was distracting him.

The evening after the surgery, I felt very good, and asked to go home. The nurse said I could not; not because of the cut in my arm, but because of the long effects of anesthesia; it would be dangerous if I got sick and, for example, vomited when my wound was still not healed.

I told her that I did not have general anesthesia, only local. She seemed surprised, and with some degree of skepticism, checked my charts. “You’re right”, she said. “You can go home now if you wish, but we advise you to stay overnight.” I decided to leave (I hate hospitals). My wife was amazed and delighted.

I had another similar experience with my dentist. For a long root-canal procedure, he asked me if I would be interested in trying nitrous oxide, commonly known as laughing gas, instead of local anesthesia. I was curious and gave it a try.

It was a fascinating experience. I could feel the pain—and yet I didn’t mind the pain. (It reminded me of the famous scene in the movie “Lawrence of Arabia”.) I watched the dentist drill deeper and deeper, and several times motioned for him to move the mirror so I could watch better. During short breaks I asked him what he was going to do next.

At the end he said to me that he has given nitrous oxide many times, but in every previous case the patient just drifted off into dreams. I was the only patient he had ever had who kept on asking questions when under laughing gas. I guess I just find real life far more interesting than dreams.