Going under: The history and mechanisms of general anesthesia

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25:20All right, we're back. We were talking about ether parties, which do sound fun, but I would not engage in an ether party because I'm a wimp. You're so wholesome, Kelly. Yeah, I worked in this lab once where somebody said something to me to the effect of, you're really nice. And it was like, in a condescending, I've never had anyone be like, you're nice and that kind of sucks. But like, anyway, so I have been told that I'm not fun, but that's fine. I'm not fun. You're a lot of fun. You're a lot of fun. But wait, let me ask you a more personal question, which is, what is your drug of choice? Are you an alcohol drinker?

26:00Do you chew on banana peels? How does Kelly unwind? Kelly does not enjoy chewing on banana peels at all. It makes Kelly feel really uncomfortable. Kelly enjoys a glass of red wine and caffeine. Kelly mostly lives a stimulant-free life. You know what? Kelly's favorite stimulant is the anti-anxiety medication she's on. That's how I roll. That's the modern-day ether. What about you? I'm a big believer in caffeine as well, and I enjoy red wine. And for many years, I did also enjoy banana peels. It helped stimulate some creativity in my research, but no longer. Ah. Well, we all have had youthful indiscretions.

26:43All right. So now let's talk about the indiscretions of various men in history who brought us anesthesia. So the first person we're going to chat about is Dr. Crawford Long. And he was at one of these ether frolics and he was really enjoying it. And he noted to himself that when he or others did things that should be painful, they didn't seem to feel the pain. And he was a physician. And this made him think, oh, you know, maybe this could be used in surgery. And so he was the first person to actually test it out. So he had a patient who needed two small cysts removed. And the patient was nervous about getting the surgery done because it was painful.

27:20And he was like, look, this isn't critical. I don't want these things taken out. And the patient had also tried ether recreationally and really enjoyed it. And so Long was like, look, let's try it. I'm going to put you under the ether. You know that you don't feel as much pain under the ether. So let's see how it goes. And actually, it went great. Wow. And Long started using this gas for other operations as well. But the big thing here is that he didn't share this information with the medical profession widely. So he didn't like write a paper or go to a surgery that was watched by a lot of other people.

27:53So at the time, surgeries were done in operating theaters where students of medicine were sort of sitting in the same room. So now, like, you know, if you've watched Grey's Anatomy, you know that there is like an elevated area and you can be behind glass and you can sort of peek in. Like a splash guard there and make sure you don't get sprayed in the face. I'm wondering if maybe they're protecting the patient more than anything. Like when you sneeze, they don't want the germs settling into the patient's abdomen. I wonder if they used to pass around raincoats the way they do with SeaWorld in the first few rows, you know?

28:22Oh, so gross. I know they used to put sawdust under the operating tables to absorb the blood. Oh, wow. Yeah, intense. And I don't think they always cleared the sawdust before the next person. And I read some stories where the guy would like take the saw where he had amputated a leg and he'd kind of like wipe it off on his apron and then get to the next guy, which we don't do anymore. And who would come to these things anyway? Is it just medical students or is this like, you know, an afternoon with the family? What are we going to do? This is before movies. Let's go see some legs get cut off. I don't know if you bring little Susie with you, but like definitely the medical students are there.

28:57And this isn't too far after people used to go to like public executions for funsies. Yeah, that's what I was thinking. Yeah. And so I do think some people did come off the streets just to kind of watch. That's probably not how I'd spend my day. When was Shakespeare around? Like were the options to go to the Globe and see a Shakespearean play or watch someone get their leg amputated? My timeline of history. Not a hard choice. I mean, geez. Shakespeare is a couple hundred years before. He's like early 1600s, late 1500s. Oh, all right. Well, then maybe I would watch the amputation, you know? What else are you going to do in London?

29:33So anyway, Long gets the ball rolling but doesn't share with anyone. So it stops with him. But then in 1844, a dentist called Horace Wells goes to a nitrous oxide demonstration. So there were people who would travel around the country and they would essentially get up on a stage and they'd be like, this nitrous oxide stuff is great. Is there a volunteer from the audience who would like to feel, you know, what nitrous oxide feels like? So they'd have them inhale some nitrous oxide and then they'd be like, I feel great. It would be so fun. And people would watch this. And they're like, let's amputate your leg.

30:05Sure. He he he. He he he. Lol. And so so Wells was watching this demonstration. And one of the people who got sort of exposed to nitrous oxide got a pretty big laceration on their leg, but clearly didn't feel it while it was happening. Wow. And so Wells afterwards goes to the guy doing the demonstration and is like, whoa, hey, I saw that someone got hurt and then they were totally fine. And I'm a dentist. So can you like come with me to my dentist office and we can try like knocking out my patients before doing the procedure? This is a dentist who cares, who doesn't want to cause his patient's pain.

30:41That's right. Amazing. I miss. Oh, you. This is a joke about dentists in general. I didn't get it because I have an amazing dentist. I love him so much. I hope he listens to the pod and hears how much you love him. You're the best, Dr. Caton. Okay, so before he started using it on his patients, he decided he wanted to try it on himself. So this is an example of self-experimentation. So Wells calls over a dentist friend of his. The guy who did the nitrous oxide demonstration knocks Wells out. And the friend dentist who came over pulled out a molar. And Wells doesn't feel a thing. So he just like sacrifices a healthy molar to science.

31:22Yes. Yeah, he does. I like this dentist. Yeah, no, me too. He's willing to like get his hands dirty for the arts. I appreciate that. All right. So far I'm voting for Horace Wells to get credit for this. I like Wells too. So Wells does this on 15 other patients and he decides this is awesome, right? Yeah. So in 1845, he goes to Massachusetts General Hospital and they're doing one of these big public surgeries. and he decides he's going to remove a tooth from a volunteer, but he doesn't give the volunteer enough nitrous oxide. Oh, no. And so now we know that, you know, some people require more nitrous oxide to get knocked out, some require less, and this guy just didn't get the right amount for whatever reason.

32:00And so the patient is clearly feeling pain during this procedure. And it is very embarrassing to Dr. Wells because he's got this whole audience and it's clearly not working. And so this was sort of devastating for him. This is his big moment. Wow. This was his big moment. And we'll see that he doesn't actually emotionally recover from this. Oh, no. I know. I know. He needs some, like, emotional nitrous oxide. He needs some of that antidepressant. He does need some antidepressants, as we'll see. So then the next group that gets in on this at around the same time is Dr. William Morton and his chemistry teacher, Dr.

32:36Charles Jackson. Morton starts experimenting with ether instead of nitrous oxide. And it turns out that ether sort of works a little bit better. And at the time, the professors and the students were playing with ether too. So they were doing these ether parties and you'd get together with your professors and like get high on ether. Times have changed. No, no, no. I do that all the time with my classes. Yeah, absolutely. Oh, yeah. I don't. We're moving on. So if any administrators at UC Irvine are listening, I was a joke, of course. Good. Yes, yes. So I think Morton had been aware of what Wells was doing.

33:09And he starts using ether instead of nitrous oxide. He talks to his chemistry professor. He's like, can you get me some ether? And to try out the ether, Morton wasn't willing to test on himself. He extracted the tooth of one of his assistants. Oh. But the ether he was using wasn't pure enough and it was painful for the assistant. So Morton's like, oh, shoot. So then he starts testing on himself because he can tinker with the doses and the purity. And apparently his wife is like super not excited that he's doing this because he's like, I set a timer and I knocked myself out for eight minutes. And she's like, no, that's not good.

33:44That's not good. What are you doing? You're getting drain bremage. Oh, God. So later he tries it out on a patient who has a toothache and it works great. So he also goes to Massachusetts General Hospital in 1846. And there is a surgeon who is doing a procedure to excise a neck tumor. At the time, Morton was a second-year Harvard medical student, and he gets permission to administer ether while the surgeon is removing the tumor. And the procedure goes so well that when it's done, the surgeon looks out at the audience and says, Gentlemen, this is no humbug. Wait, you have to translate for me. Is that good?

34:23Humbug is bad, so no humbug is good? That's right, yes. Yeah, the double negative threw you a bit. So if you're getting like comments from a reviewer in the 1800s and a reviewer too is like, this paper is no humbug, then that's good. That's good. Yeah. You probably got past reviewer too. Good job. So it worked. But Morton at this point sees a cash cow. And so he doesn't want to tell anybody what it is. And so he names it Letheon, which is after the mythological river Lethe, I think it's pronounced, where the souls of the dead forget their earthly lives. I don't know if I'd want to be taking something that's usually associated with helping the dead forget things.

35:00Like, I'd rather stay alive while I forget the procedure. Would you like to take a trip on the river Styx? Yeah, no, thank you. I'll pass. Can you just take this molar out, please? That's one big humbug for that idea. That's right. Amen. But ether has a super distinct smell. And so surgeons pretty quickly figured out what he was doing. All right. And he tried to get money some other ways. He tried to make this like very particular device for administering the ether, but other people figured out better devices. And so anyway, eventually Morton realizes he's not going to make a ton of money. And everybody now transitions to trying to figure out who can get the most credit for it.

35:36So if you're not going to get rich, at least you can impress the whole world, right? Here comes the dark side of science. That's right. Here we go. So Wells, who was the first to do a public demonstration of it. And if you remember, he's the one where he did the public demonstration. It didn't work. He was super embarrassing. So Wells is interested in this, but he's trying out some other ways to maybe make it work better because it was embarrassing when he did the nitrous oxide thing. So he starts trying chloroform instead. But he gets addicted to the chloroform, and it seems to have eventually, like, sort of messed with his mental health, messed with his mind.

36:09Oh, no. So he goes to jail for throwing sulfuric acid on prostitutes. Oh, boy. Yeah, and while he's in prison, he had apparently managed to smuggle some chloroform in, and he commits suicide using the chloroform and a razor blade in prison. So, and the worst, well, not the worst, the worst thing is he died. That's awful. But his wife, a few days later, gets a letter from the Paris Medical Society, and they have concluded that Wells is the one who should get credit for doing the first painless surgery under anesthesia. Oh, no. So that letter could have saved his life. Probably, yeah. It seemed like he was super concerned about the credit.

36:47Anyway, so next up, we'll talk about Morton. Well, that's a big humbug. That is a huge humbug. Humbug of the year, maybe. So Morton is the guy who was trying to make a bunch of money off of ether. And he had kind of worked with this chemistry professor. And he and his chemistry professor, it turns out, end up in this giant debate about who should get the credit. And Morton, as I mentioned, he had this device that people stopped using. And then he's frustrated because other dentists are using this procedure. So now he's not even making money by having the most patients. In the meantime, a lot of people are now having surgeries and procedures without pain.

37:21So that's good. That should be huge, right? Yeah. But that's not doing it for him. And in 1868, a magazine article comes out saying that Morton's professor, Jackson, is the one who should get the credit. And that seems to drive Morton absolutely crazy. And he drives to New York to confront the editors and dies of a stroke in Central Park. Oh, my gosh. At 48. This whole area is like cursed. I know. It's horrible. Or maybe it's just the product of all this self-experimentation with these crazy drugs. I mean, I do think that the fact that these drugs are a bit mind-altering and had been used maybe way too often and at way too high doses could have had something to do with the mental health problems these people had.

38:01But anyway, Jackson, the chemistry professor, is backed by the Academy of Sciences of the Institute of France. So it looks like the medical communities in France are sort of divided on who they're going to back. Jackson gets told that he's getting the credits, but he becomes an alcoholic and he's found screaming at Morton's gravestone. Like, even after Morton dies, he's still angry enough to, like, go to his gravestone and yell at him. He ends up in an asylum where he stays for 12 years and dies at 75. I hope to never be found yelling at a gravestone. Yeah. Like, wow. No, that seems, that's pretty high end.

38:35Like, at the point where your enemy has passed on, I feel like you should move on. But I guess it's not always that easy. On the other hand, gravestones are kind of there for you to, like, visit someone who's passed and talk to them and connect with them. And so if yelling's what you got to do, I guess that is the place for it. Yeah, I guess. Sure. Sure. But maybe I'd want to like smoke some banana peels to chill me out before I get there. Yeah. But I'm also intrigued by this facet of history where like societies are deciding who gets credit for something. Yeah. You know, that's not the way we do things these days, at least not in physics.

39:10Like if you make a discovery, you argue about the paper or you argue about who gets prizes. But it's never like the American Physical Society decides Daniel gets credit for this idea or Sally gets credit for that idea. I mean, I feel like the Nobel Prize has just like that is the ultimate arbiter of who gets credit for the idea. And maybe nobody else minds, I guess. I don't know. Nobody else feels like it's worth weighing in. I don't know. Yeah. Yeah. I guess this is all pre Nobel Prize stuff. So maybe that plays a role. Fascinating. All right. So, so far, three folks have tried to take credit for it and either died or gone mad.

39:45Who's up next? I saved the best for last. So remember the first. No, this is actually the best. So the first person who we talked about who didn't share his results publicly and was just like, oh, this is great. I'm going to make sure that all of my patients are well taken care of from here on out. He continues his medical practice, owns a pharmacy in Georgia and has a happy life. Oh, my gosh. I was waiting for the disaster there, but I'm glad he lives happily ever after. Well, he dies at 62. He dies while prepping to give ether to a woman in labor. So that wasn't great for her. I'm sure she was like, no, at first, give me the ether.

40:22That's not a good sign if your doctor drops dead during labor. No, no. But actually, before we go to a commercial, I want to real quick tell you this story about chloroform in the UK. So the UK was more interested in chloroform. We were more interested in nitrous oxide and ether. And a very important time when you can use ether is during childbirth. So there was the Scottish obstetrician, James Simpson. We talked about this guy in the intro. he ran out of the operating theater and thought about becoming a lawyer because it was so upsetting to watch surgeries without ether. But anyway, around 1847, he's experimenting with different gases, decides chloroform is best.

41:00But there was this idea at the time that women needed to actually go through the process of labor and that the pain was sort of part of it and taking the pain away was unethical or like wasn't okay on religious grounds. And so he wasn't able to start administering it widely until John Snow and any epidemiology nerds out there are like, John Snow with the cholera pump and the Broad Street pump. But anyway, so he helped figure out the cause of cholera. I think the pandemic was wrapping up by the time he figured it out. He, in 1853, administers chloroform to Queen Victoria while she's giving birth to her eighth child.

41:34That's high stakes. That's super high stakes. But it goes great. Queen Victoria is like, awesome. Everyone should have access to this. And now it becomes super widespread. It has since been sort of superseded by other methods because it is kind of nasty stuff. And if you use it for too long, it damages like the liver, kidney, hearts, and eventually chloroform falls out of favor. But Queen Victoria and obstetrician James Simpson helped bring some pain relief to women in childbirth. Hurrah. Hurrah, James and Queen Victoria. It's amazing how these things are cultural, right? How like one person in one country can turn a whole society in one direction or another to use chloroform and nitrous oxide.

42:14It's incredible how random history really is. Oh, my gosh. Yeah, it absolutely is. Agreed. All right. Well, let's take a break. And when we come back, we'll learn what we do and don't know about how anesthesia actually works.

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45:17But when it pays, it pays. Why? Because I'm consistent. Each week, I break down the law, politics, media, leadership, and business into practical lessons you can apply immediately. My mission is to help you prepare with knowledge, position yourself for your next opportunity, and learn how to push until something happens. Listen to the Tesla and Figaro podcast from the Black Effect Podcast Network on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, my love. Starting your day can be tough. You wake up, maybe hit snooze, and then scroll on your phone for a while, checking your emails, all before even giving yourself the chance to really open your eyes and breathe.

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47:01All right. So let's chat about what we know about how anesthesia works. And let's just clarify, there's different kinds of anesthesia. In this episode, we've been talking about general anesthesia, where you breathe it in and it totally knocks you out. You feel no pain. We're going to go into a bit more detail about that. Well, you don't remember feeling pain, right? Isn't there still some debate about like, are you actually feeling pain, but then the experiences are wiped from your memory? And so it's like you didn't feel pain. If you're taking a local anesthetic, you are awake. And so like when I got an epidural, when I was giving birth to my second kiddo, I was awake, you know, but I didn't feel any pain.

47:35I felt very itchy, but I didn't feel any pain. And he was a 10 pounder. And so I don't think that my memory was wiped because if so, I would have be feeling pain in the moment. Right, but general anesthesia you're not conscious of, right? So it's possible that you are aware of the pain, you just don't remember it, right? Because in general anesthesia, you don't remember the procedure. Yeah, I think there is a subset of people who will wake up sometimes, and they can't move. Yeah. But I don't think they feel pain. They're just like, this is a very disconcerting experience. Well, let's hope not.

48:10But it strikes me that if I went through a very painful experience, and then somebody came and deleted those memories, I wonder how that would be different from the experience of general anesthesia, right? Yeah, I don't know. Anyway, maybe that's more a philosophy question. But tell us what we know about how this actually works medically and neurologically. Not a lot. So the Proceedings of the National Academy of Sciences is a big, prestigious group of scientists in the United States. And a 2020 paper started by saying, anesthetics are used every day in thousands of hospitals to induce loss of consciousness.

48:42Yet scientists and the doctors who administer these compounds lack a molecular understanding for their action. This is 2020. 2020. So we're not talking about ancient history anymore. This is basically today. That's right. That's where we are. But another thing that was sort of interesting is that they mentioned in 1846, William Morton demonstrated general anesthesia with inhaled anesthetic diethyl ether. So apparently they picked Team Morton. Like, I don't know if they, you know. They're wading into this controversy. That's right. That's right. But anyway, they're giving credit to him. Well, I hope that the descendants of these four gentlemen are not like still battling it out.

49:18I hope they get together and toast these guys and all their achievements and all get along. I think it would be much nicer to just appreciate the memory of people who took pain away for so many of us as opposed to like turning it into a nasty fight for credit. But anyway, OK, so I ended up reaching out to two different anesthesiologists because it was really complicated. working through the literature. And I couldn't tell if I was reading sort of fringe ideas or the main idea. And so I ended up talking to Dr. Shannon Stem and Dr. Ajoa Botang-Evans. So the main mechanism that we think is important here is a neurotransmitter called GABA aminobutyric acid, or just GABA.

50:01Your neurons have receptors. And these receptors are responsible for tinkering with the electrical charge inside of the neuron. So let's talk about why that's important. So our neurons are connected to each other. There's like this open area in between neurons called the synapse. And when chemicals are released into that synapse, one cell has talked to another and a message passes between the neurons. The way you get that message into the synapse is that your cell needs to pass a certain electrical charge to initiate what's called an action potential. So usually your neuron has a little bit of a negative charge.

50:36And when it starts to accumulate a positive charge, at some point it'll pass a threshold. An electrical charge will pass through the neuron. The chemicals will get released into the synapse and the conversation between neurons will happen. This is fascinating to hear about because I think about neurons all the time, but from the point of view of artificial neural networks. I do a lot of machine learning and AI, and we use neural nets all the time, but we never think about them as neurons anymore. But we use the same language. You know, our mathematical model is that a neuron is like a little blob and it has inputs.

51:07And if the inputs are high enough that they add up to a certain amount, then the neuron is activated and it sends a pulse to its output, which is linked to other neurons, of course. And my understanding of the brain basically is that it's this big network of neurons that are all firing and stimulating each other. And so you're talking about the bit between the neurons, the synaps, the connection, and whether that thing is allowed to fire or is inhibited from communicating with other neurons. Is that right? Yeah, pretty much. I mean, we're focusing on the neurons too. So what GABA does is it inhibits the action potential.

51:39So what essentially happens is that your neuron has all of these receptors on it, and it has three different kinds of GABA receptors. For two of them, when this chemical GABA binds, they open up and they let chloride ions in. And so these ions have a negative charge. And so the negative charge in the neuron gets more negative, which makes the cell less likely to hit that action potential point and talk to the next neuron. I see. There is another kind of receptor that when GABA binds to it, it opens up and it lets potassium ions out. And these are positive charge. So the positive charge is fleeing.

52:15And so here again, the cell is getting more negative, but just through a slightly different mechanism. So in all of these cases, GABA is making the cell more quiet, less likely to communicate with the next cell down the line. And it's just like a hypothesis or something we can observe by taking like a single neuron and putting it in an experiment and, you know, connecting it to electrodes. So I can't say that I am an expert in how we know this. One of the women that I talked to did mention that there was some experiments done in mice where they genetically tinkered with the mouse so that their GABA receptors were kind of messed up.

52:53And when you do that, anesthesia doesn't work the same way in these mice. So that's pretty good evidence that GABA is somehow involved in anesthesia. But in terms of what we know about what these neurons are doing in our brains in response to GABA, like I don't know that we've been able to observe that happening in real time. Yeah, although the system is so complicated, it's hard to draw conclusions, right? There's the famous example of the scientist who trains frogs to jump when he says jump and then he cuts their legs off and he says jump and they don't jump. And it's like, oh, see, they can't hear me.

53:26So therefore, they must hear with their legs. Yeah. Right. Like you can obviously draw the wrong conclusion when you're dealing with a complex system. Was that a ridiculous example? Yeah. What famous experiment is that? I've never... It was not a real experiment. It's a famous anecdote illustrating how you can draw the wrong conclusion from your data, even if it sounds reasonable, right? So in this case, you're saying like it interferes with the GABA and the anesthetics don't work the same way. And that is suggestive, but I don't know how conclusive it is. Yes, absolutely. I agree. And further highlighting the fact that we don't really know what's going on, we've looked at the structure of the chemicals that are used as general anesthetics.

54:03And based on the chemical structures, we've tried to predict other kinds of chemicals that should also act as anesthetics because we think we understand what's going on. In some cases, that works. In other cases, it doesn't. So there's something we don't understand. Also, Dr. Shannon Stem was telling me that xenon kind of has similar characteristics when you give it to people, like it acts as an anesthetic and xenon is a noble gas. So it's not supposed to be reacting with anything. So what the heck is happening there? We don't know. Maybe it just interferes, right? Xenon can also like kill you because you can breathe it in and it can interfere with you breathing oxygen, right?

54:41So maybe it just gets in the way. Yeah. Yep. Maybe it does just get in the way. And then it also seems like the function of some of the different kinds of anesthetics that we try is making cells more excitatory, so more likely to talk to each other. And so I saw what appeared to be a hypothesis where the idea was just that it messes up communication. So instead of having like a clear signal traveling from neuron to neuron, there's just all kinds of things communicating with each other at weird times. And it's more about like the pattern of communication getting thrown off. But anyway, I want to make clear that anything that I have gotten incorrect is my fault and not the fault of the anesthesiologist who very patiently tried to explain this all to me.

55:19And how terrified do you think they are by not really knowing how this works? Doesn't that make it something of an art for every patient? You have to really monitor them. Maybe they're reacting differently because you can't always predict, right, how much anesthetic somebody is going to need. Yeah, so they both highlighted to me during our conversations how amazing the monitoring equipment is now. So, yes, you do need to be careful. Some people need more. Some people need less. Some people have strong reactions. But they're monitored very carefully. And as long as the people know what they're doing, you know, and I'm sure hopefully all certified anesthesiologists do know what they're doing.

55:53You know, they felt like it would be good if we knew the mechanism. Maybe that would help us become even better at this stuff. But they felt like not knowing the mechanism didn't keep us from doing a good and safe job. And I feel like there's got to be all kinds of physics stuff that you apply that even though you don't understand it at a, like, atomic level or whatever, you can still form predictions and, you know, do amazing new experiments. Oh, for sure. There's so many cases where we don't understand the microphysics or it's too complicated for us to model, but we know generally how things behave.

56:26And so absolutely you don't need to know all the details. I'm just super curious. Oh, yeah. And, you know, somebody's life is at stake here. And so it seems pretty important. Did you get a sense from them, like, what is the cutting edge? Are we going to, in 10 years, develop new, amazing anesthetics that are better or safer or transcendently wonderful or something? What are people working on? I didn't get a clear answer on that. They did mention in passing, again, how great we are getting at monitoring and how we're getting a better understanding of how people from different backgrounds respond differently to anesthesia so that we can try to make things even safer for everyone.

57:00My conversations with Shannon highlighted that they are trying to predict different compounds that would make good anesthetics and they're trying those out. So maybe we'll even have better tools in the future. But if they were here, they might give a much better answer. No surprise. So the final question we got from the listener is, is going under anesthesia different than sleeping or is it the same? And it's definitely different than sleeping. So the anesthesiologist I talked to said that it's more like a drug-induced reversible coma. Yeah. So the main criteria are that you want the person to be unconscious, not feeling pain, not moving, and making no memories.

57:40So when you are sleeping, one, you move. People sleepwalk sometimes. Right. Two, if somebody were to poke you, you would feel pain. Three, as I understand it, the main function of sleep is that it helps us consolidate memories. And sometimes you even remember the dreams that you had. Whereas when you are knocked out under general anesthesia, you don't make any memories. Additionally, when you are sleeping, when you do an EEG, you're looking at the activity in your brain. And you'll see that we alternate between two different kinds of brain waves. So when we're in rapid eye movement sleep, our brains are doing one thing.

58:18And when we get out of rapid eye movement sleep, our brains are doing something different. And we're going to probably go into a lot more detail about this in a future episode because we're getting Dr. Gina Poe on the show to tell us all about sleep and why we sleep. So more on that later. But the point is that when we're sleeping, our brains are sort of alternating between two modes. And when you go under anesthesia, you are staying in the same mode the whole time. And I believe it also just like creates different sort of electrical patterns altogether. So there's really no way in which it's sleep.

58:47And this is we can sort of end on a moderately interesting story, which is Michael Jackson used to take this drug called propofol and it's an anesthetic. It helped knock him out and it made him feel good. And so he was given it by his doctor at night to help him sleep. Because he had sleep problems, right? OK. Yeah. But it's not actually sleep. So all of the important things that your body does while you're sleeping are not getting done, or at least they're not getting done as well when you're knocked out by something like propofol. And so part of why it's thought that he ended up dying was because he was laying down, but he was actually over time being deprived of sleep.

59:26Oh, my God. So it is different than sleep in a way that is very meaningful and important. It's amazing how vital and how crucial all these brain functions are, how little we understand them, and yet how much we rely on all these medical advances to manipulate them. Yeah, it's incredible. And, you know, despite the fact that we don't really understand this at a mechanistic level, I am still on team anesthesia. I would not want to live in any time that didn't have it. And, you know, in addition to not needing to be like literally pinned down and restrained while someone cuts into you for surgeries, anesthesia opened up much longer, much more complicated surgeries.

1:00:05And it has, I'd say, really changed our lives in a lot of great ways. Yeah. And it's so recent, right? Until just a couple hundred years ago, surgery was horrible suffering. Makes me wonder what medical advances in a few years or a few hundred years people will be unable to live without or imagine what it was like before we had them. Yeah. No, it's incredible. I mean, I had to have my wisdom teeth out. I can't imagine someone just yanking those out with pliers without being knocked out. And clearly that is one of the easier surgeries to do. I've never had someone have to cut into my abdomen, for example.

1:00:37Right. So hurrah for living today. All right. Well, we hope that journey into the history of anesthesia didn't put you all to sleep or numb your brain. It couldn't have. It was fascinating. Some folks like to listen to the podcast to fall asleep. So we hope that they're now asleep pleasantly. Have a great night, everyone. Sleep tight. And let's end by hearing what Eric thought about our hour-long episode on anesthesia. Eric? That definitely answered my questions. I went to college in Atlanta, so I think I'm definitely going to have to be on Team Crawford Long in the great anesthesia wars. And I admit to a little disappointment that I was born too late for ether parties and too early to live in a city on Mars.

1:01:22But I do live in the golden age of podcasts. So thank you so much and have a great day.

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