Hello doctor, I am a 55-year-old female. Before asking my question, I need to provide some background and context. I have had many surgeries and am a well-educated (Ph.D.) person. I am not a typical patient, given my knowledge, background, etc., including the fact that I get a copy of my complete chart for each surgery or medical procedure using any form of sedation or anesthesia. I am knowledgeable about most drugs used during anesthesia and how they work. I have been told by a surgeon (included in his surgical report) and two dentists that I require a lot of anesthesia. I have had multiple bad experiences with anesthesia, primarily conscious sedation. In my last surgery, I became alert, aware and had full memory of the second, third and fourth stitch. I have experienced pain and awareness or memory during other oral surgeries and other procedures. I abhor the idea of conscious sedation, and the drug versed, specifically, except when used for induction. I have had my specific verbal and written expectations violated. This has all lead to both fear of some simple procedures (like oral surgery and even regular dentistry) and a distrust that I will be cared for in a manner that I do not find acceptable. Two days ago, I had oral surgery and had some memory of pain and other things and, because of my experience, I am also a person that brings a high-quality recorder into the procedure room or OR (when the opportunity presents itself). So, for the oral surgery two days ago, I recall experiencing pain and asking for more medication. I recall being told to calm down (the audio recording supports these recollections, plus the oral surgeon and anesthesiologist, who I paid extra out-of-pocket to have available so I could be in deep sedation and not experience pain. Note to all anesthesiologists and surgeons; patients can sometimes hear and remember everything you say. Be respectful, at least in the presence of the patient. I had recalled something like this but was not certain exactly what was said until I listened to the recording. Okay, my question is this is a short and long-term question. I have a procedure with the anesthesiologist at 8 AM. He also does some pain management procedures, and I will be getting the nerve block test for lumbar RFA tomorrow. I will have a CRNA who will be doing the anesthesia or sedation. But, I want to be able to discuss what happened to me during oral surgery with the anesthesiologist. I am a bit upset about that. I have a fear of dental and other painful procedures. I know that the local anesthetics do not work as well on me as they do on others which is presumably why I was feeling pain and this is an issue not just for the procure in the morning. It is an ongoing issue that just grows more intense with every procedure that my trust is violated, and I experience pain and, I need the RFA. I have multiple herniated discs and arthritis, facet joint damage. I do not know how to articulate my needs in such a way that the anesthesiologist or CRNA (later this morning or in the future) takes my concerns seriously. I do not just need something to calm me, and in fact, the very thing that an anesthesiologist would use to calm me is one of the most fearful things to me. I do not want to experience pain. I do not need amnesia, and I do not need to be calm (well, I would be calm if these things did not repeatedly happen to me). I just need no pain and if that takes a heavier dose of Propofol (in a hospital setting). So be it. If that takes more local anesthetic. So be it. I need to be unconscious, or I need enough pain management and deep sedation or no sedation. What do I need to say to get that without offending or getting interpreted as just another person who is afraid of the OR (which I am not) and, I am pretty sure that they would be freaked out if I told them that I bring a recorder in with me (for additional curiosity, if that is not something that I want to share. Is it possible that I would share that after being given versed? What if I just tell them no versed? Low dose Propofol would do the same thing. Right?). Please help me.
Hello. I have read your past experiences of conscious sedation, and I understand how difficult it would have been for you. One thing I want to clear you first is that conscious sedation does not mean general anesthesia. Conscious sedation works on this principle only that you or the patient is conscious. It may decrease the pain and increase the cooperation for the procedure, but it does not mean that you will not hear or feel anything. For small oral surgeries and small procedures, everywhere conscious sedation is used. It just means that it will decrease to some extent your feeling of pain and you might be sedated for most of the procedure time but not the whole time of the procedure. It means one can recall so many things from surgery in conscious sedation. If you want to be completely knocked down and not feel or listen anything then what you need is general anesthesia which is usually not given for small procedures. Now coming to your problem. First, you need to discuss with your anesthesiologist better a day or few days before the surgery explaining him everything what happened in past surgeries and what you expect from him. If you will discuss this with your anesthetist a few days earlier or at least a day before, he will not think that you are just afraid of OR (operating room). You have to make your mind and explain it to him that whether you want conscious sedation or general anesthesia. If you do not want to feel anything and not want to be awake in between the procedure, explain to him that you want general anesthesia and no sedation. Explain it to him clearly what are your experiences from past and what you expect from him this time in procedure. Regarding the recording thing, let me ask you a question. Do you never talk to your colleague whenever you were doing your thesis or research work? I guess everybody does. It is routine work for them, so it is not possible that everybody is keeping silence during work. Have you never met a little difficult person to handle? The next thing I want to tell you is that keeping a recorder during the procedure is like interfering into someone else's privacy. It may have legal implications for you. Next, it is affecting your mental peace too. You are doing something which is increasing your sufferings more. Just answer one question, if you get a scary dream, is it good to have any horror dream repeated in your mind again and again or is it better to forget one. The choice is yours. Telling some patient to calm down during a procedure is a type of psychotherapy, and it has been proven effective. It is not that the person wants to give you less drug, the problem with conscious sedation is that you have to limit the dosage of the drug or else the patient will stop breathing, and that is not what you or the doctor wants. So, better ask for general anesthesia. Last but not the least, consult a psychotherapist or psychiatrist regarding your past awareness of anesthesia. The sessions will help you remove or at least decrease the mental trauma from past episodes. For more information consult an anesthesiologist online -->