In the end, he says, it makes sense that people who do want to have full anesthesia pay a bit more for the service.

How shall we wrap up this article .... Nicely done,

I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

kidsizedcoffin: 404 page not found: kidsizedcoffin: Link (new window)

I think this is a much better article on the issue.

Anesthesiologists are people too, my friend.

I'm not arguing against getting sedation. I had to have scopes at both ends about a year ago, and I have to say I was saying ouch a lot through about half of the procedure, and they kept giving me more drugs until they ran out, and that was with the MAC. About 5 minutes after they ran out of drugs, I stopped remembering anything, so they may have started a bit early on the procedure after giving me the drugs.

/High tolerance for pain meds
//Not a drug user

I get you, bro. I liked your article better.

Besides, pain is subjective. Some people might tolerate a flex sig with little more than a handshake. I assisted in a flex sig where the patient couldn't tolerate even 4 cm of the scope and she had some Diazepam onboard. Some people need it, some people don't. But like a lot of things in life, it's better to have it and not need it than to need it and not have it. Especially when someone is "dithering" a camera up your ass. Doubly so when that camera has nearly the girth of a garden hose and is 60+ cm long, depending on which section of the colon needs to be examined.

404 page not found: Mabman: When I had a colonoscopy in the fall of 2010 (in a hospital), they gave me a shot of fentanyl. All I heard the doctor say was "Great prep!" as they inserted the scope, and then I woke up afterward in the recovery area.

So, I'd say, yes, anesthesia makes it all so much easier. Given that I'll probably have to have one regularly (family history), I wouldn't want to go through it repeatedly awake.

Most likely you were given were given Fentanyl for pain and Midazolam for sedation (i.e., calms you down before the insertion of the Optimus camera). Midazolam also offers the benefit of a bit of anterograde amnesia, so that you won't remember all of it. Additionally, Naloxone (opiod-antagonist) and Flumazenil (benzodiazepine-antagonist) were on-hand in case you had a bad reaction to the Fentanyl and Midazolam and went into respiratory distress or arrest.

alfentanyl for the win. wears off faster after the procedure. and of course, a propofol drip. no versed, pt wakes up feeling good as new almost immediately.

r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

RogermcAllen: Fast forward to the actual procedure. They are halfway in and I hear "There's blood everywhere". Apparently when the tell you not to eat solid food for 24 hours, Jello counts as a solid. There were little bits of red Jello all up in me.

I was told to avoid red and purple jello and similarly colored drinks during the prep, for precisely this reason.

Lime Jello and Lemonade mixed with miralax.

Barfmaker: [www.hubbywishlist.com image 533x336]

rga184: 404 page not found: Mabman: When I had a colonoscopy in the fall of 2010 (in a hospital), they gave me a shot of fentanyl. All I heard the doctor say was "Great prep!" as they inserted the scope, and then I woke up afterward in the recovery area.

So, I'd say, yes, anesthesia makes it all so much easier. Given that I'll probably have to have one regularly (family history), I wouldn't want to go through it repeatedly awake.

Most likely you were given were given Fentanyl for pain and Midazolam for sedation (i.e., calms you down before the insertion of the Optimus camera). Midazolam also offers the benefit of a bit of anterograde amnesia, so that you won't remember all of it. Additionally, Naloxone (opiod-antagonist) and Flumazenil (benzodiazepine-antagonist) were on-hand in case you had a bad reaction to the Fentanyl and Midazolam and went into respiratory distress or arrest.

alfentanyl for the win. wears off faster after the procedure. and of course, a propofol drip. no versed, pt wakes up feeling good as new almost immediately.

An opiod that wears off faster FTW? I'm sorry, good farker, I do not follow. I would think that a patient would want the benzo to wear off quicker and the opiod to last longer. It's why Marcaine is often preferred over Lidocaine.

Munden: People in the Northeast are much more likely to get anesthesia services. That happened 59 percent of the time, compared to 13 percent in Western states...

NPR just called your sexual orientation into question Western states, whatchu gunna do bout it?

We're kind of busy. Idaho and Utah are trying to count their wives, Nevada is banging some hookers, Arizona is wanking to some gun-fetish porn, and California, Washington, and Oregon are having a stoned three-way.

Dennis Wolfberg has the funniest take on this subject you will ever see...

Mai Balsicz: Anesthesiologists aren't paid the big bucks to put you to sleep - they earn their paycheck by making sure you wake up.

Ta-da!

I used to give the sedation in the GI Lab. Back then we gave 5mg of Versed with a Demerol chaser (today, you will probably get a Fentanyl chaser). Most of the time, 20 mins later the patient was asking me, "Seriously, it's over? I don't remember nuttin'". If it weren't for the greasy butt and massive farts, you would never know it happened. Afterward, you have to monitor for a while to make sure the patient wakes up enough to be able to crawl from the car to the house after someone drives them home. It works like a charm.

Propafol, on the other hand, is a BEAUTIFUL bit of pharmacological engineering. With the right dose and proper monitoring, Propafol (AKA "Milk Of Amnesia") puts you out quick, keeps you asleep, and you wake up quickly and are clear-headed a short while later. Of course, with the wrong dose and improper monitoring, you can kill a pop star with it. This is where the pros come in, the anesthesiologists and the nurse anesthetists.

Given a choice, I'd take Propafol any day, but it really is overkill for low risk patients. I'm surprised that any insurance companies cover it. I mean, you would feel more discomfort getting stitches with no lidocaine than you would getting a colonoscopy with no sedation at all. Hell, getting a cavity filled even after novacaine hurts more.

It's not about sedation vs no sedation.

It's about sedation with versed+fentanyl or similar pushed by an RN under order (and liability) of a gastroenterologist; versus sedation with propofol which must be pushed and monitored by a trained anesthesia provider (CRNA or MDA) who can bill for their services separately.

The insurers prefer one thing and patients/best practice prefers the other.

/ICU RN. I do conscious sedation, but no, mister doctor electrophysiologist, sir, I will not push your etomidate or propofol for your elective bedside cardioversion. I prefer keeping my license and my patient prefers keeping his airway patent.

My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

hypocaffeinemia: It's not about sedation vs no sedation.

It's about sedation with versed+fentanyl or similar pushed by an RN under order (and liability) of a gastroenterologist; versus sedation with propofol which must be pushed and monitored by a trained anesthesia provider (CRNA or MDA) who can bill for their services separately.

The insurers prefer one thing and patients/best practice prefers the other.

/ICU RN. I do conscious sedation, but no, mister doctor electrophysiologist, sir, I will not push your etomidate or propofol for your elective bedside cardioversion. I prefer keeping my license and my patient prefers keeping his airway patent.

Throw a tube in that farker! And crack some farkin' teeth while you're at it!

Tatterdemalian: My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

HMO?

404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

Why bother having it done? Sounds like a money grab from the doctors. Remember when you needed a yearly chest xray?

r1niceboy: 404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

That's what she said.

ZuZu: As someone getting an endoscopy soon, I can say the only reason I am not freaking out is knowing they will be sedating me. I just got out of the hospital a few days ago and know I need to have this done so they can figure out what is wrong with me....but damn, the idea of having a camera rammed down my throat is terrifying.

I've had one, and dont worry about it. Believe me when I say you wont remember a damn thing about it, not even flashes of memory. just a blank slate for the duration of the procedure and about an hour after it. The sedation they give you is strong!

404 page not found: Tatterdemalian: My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

HMO?

Nope, it's supposed to be the real deal. Not sure if it's some kind of weird exception, or if the doctor lied to me because he was some freak that used his patients to indulge his BDSM fantasies, but I never went back to that doctor again, and even try to avoid the hospital if I can. I still drip blood in the toilet sometimes, and wonder if it's from some fissure the colonoscopy left, but my new doctor said that, aside from an odd scar, I don't seem to have any permanent damage.

/might be PTSD, but I'd rather just forget the whole thing happened
//just NEVER buy the whole "nerve endings" BS, nociceptors are distributed throughout the body almost homogeneously

r1niceboy: 404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

The one the used on me was white...the black one he linked is probably bigger.

quasimike: Dennis Wolfberg has the funniest take on this subject you will ever see...

I'll see your Wolfberg and raise you a Schimmel (new window).

One Bad Apple: [i.ytimg.com image 450x360]

Anesthesia for a colonoscopy ? LUXURY !

When I was a child we had a splintery telephone pole wrapped in rusty barbed wire and topped with a hornets nest AND a Polaroid camera with a magnesium flash cube at the end.

You were lucky! My first colonoscopy involved a sketch artist climbing up my bum with a giant drawing pad in one hand, a collection of sharply pointed pencils in the other, a lit coal miner's lamp attached to his head, and a large rope tied around his waist to make sure he could be removed in a timely manner.

Tatterdemalian: 404 page not found: Tatterdemalian: My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

HMO?

Nope, it's supposed to be the real deal. Not sure if it's some kind of weird exception, or if the doctor lied to me because he was some freak that used his patients to indulge his BDSM fantasies, but I never went back to that doctor again, and even try to avoid the hospital if I can. I still drip blood in the toilet sometimes, and wonder if it's from some fissure the colonoscopy left, but my new doctor said that, aside from an odd scar, I don't seem to have any permanent damage.

/might be PTSD, but I'd rather just forget the whole thing happened
//just NEVER buy the whole "nerve endings" BS, nociceptors are distributed throughout the body almost homogeneously

Man, if you "drip" blood into the toilet that is serious business. Usually it's "occult" and has to be detected with the use of reagents. Gross, visible blood from your anus is usually a sign that something ain't right in Denmark.

404 page not found: r1niceboy: 404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

That's what she said.

No, she never said that to me. Oh, you're in already? She said that. Once.

404 page not found: Tatterdemalian: 404 page not found: Tatterdemalian: My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

HMO?

Nope, it's supposed to be the real deal. Not sure if it's some kind of weird exception, or if the doctor lied to me because he was some freak that used his patients to indulge his BDSM fantasies, but I never went back to that doctor again, and even try to avoid the hospital if I can. I still drip blood in the toilet sometimes, and wonder if it's from some fissure the colonoscopy left, but my new doctor said that, aside from an odd scar, I don't seem to have any permanent damage.

/might be PTSD, but I'd rather just forget the whole thing happened
//just NEVER buy the whole "nerve endings" BS, nociceptors are distributed throughout the body almost homogeneously

Man, if you "drip" blood into the toilet that is serious business. Usually it's "occult" and has to be detected with the use of reagents. Gross, visible blood from your anus is usually a sign that something ain't right in Denmark.

Even if it's not your blood?

/I have no idea why I felt compelled to post this

When I had my colonoscopy a few years ago, I had twilight sedation. It was probably necessary, since even still I could feel what they were doing.

This headline is funny.

What the doctors are really inserting when you're sedated:

Pvt Joker: What the doctors are really inserting when you're sedated:

Just be careful when you plug that into a European outlet. They use different voltages.

r1niceboy: 404 page not found: r1niceboy: 404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

That's what she said.

No, she never said that to me. Oh, you're in already? She said that. Once.

"Deeper! Give it to me deeper!"

Semi-related. A little more than a year ago I had an open lung biopsy. 4 inch incision, chest tube, bunch of days in the ICU afterwards, 8 weeks to recover fully, even though other than the lung snot autoimmune thing I was healthy as an ox at the time. My insurance provider is still denying the anesthesia for the biopsy, saying it was a luxury.

So when an insurance company says anesthesia is a luxury, I'm gonna side with "they are full of shiat." FOR ANYTHING.

Nuclear Monk: 404 page not found: Tatterdemalian: 404 page not found: Tatterdemalian: My doctor gave me the "there are no nerve endings in the colon, so it won't hurt" line.

It hurt so bad that it took every ounce of willpower I could muster to stay completely still on the table, but my reflexive intestinal contractions were still so fierce I shot the tube out my ass three times, spraying the doctor with blood the last time. He called a halt to the whole thing after that.

/sedation probably would have helped
//the doc said BCBS wouldn't pay him a single penny if he did it, though, so I never got the colonoscopy

HMO?

Nope, it's supposed to be the real deal. Not sure if it's some kind of weird exception, or if the doctor lied to me because he was some freak that used his patients to indulge his BDSM fantasies, but I never went back to that doctor again, and even try to avoid the hospital if I can. I still drip blood in the toilet sometimes, and wonder if it's from some fissure the colonoscopy left, but my new doctor said that, aside from an odd scar, I don't seem to have any permanent damage.

/might be PTSD, but I'd rather just forget the whole thing happened
//just NEVER buy the whole "nerve endings" BS, nociceptors are distributed throughout the body almost homogeneously

Man, if you "drip" blood into the toilet that is serious business. Usually it's "occult" and has to be detected with the use of reagents. Gross, visible blood from your anus is usually a sign that something ain't right in Denmark.

Even if it's not your blood?

/I have no idea why I felt compelled to post this

And I have no idea why I just favorited you, but there you go.

libranoelrose: This headline is funny.

SHOP IT!

Haven't ever had it without the anaesthetic (had the colonoscopy that I should have had when I was 25 last year--first time both my employment + SO's employment + insurance + what insurance the farking hospitals and clinics AREN'T in a pissing war with at the moment was STABLE enough to plan....have I mentioned I REALLY want Canadian-style single-payer here?).

Fortunately the combo I had (propofol + alfentanil--which is rather like fentanyl except it's shorter acting and knocks you on your arse even FASTER) is probably the gentlest they can give you, and pretty much as soon as the stuff went in...I remember COLD, then nothing until about an hour and fifteen minutes later. (Apparently the actual process went uneventfully and I was raving afterwards to the entire hospital staff that alfentanil was "my favourite antibiotic", unable to remember the proper "A word" for "opiate that knocks your arse out". :D)

No grogginess, and if you can talk the docs into the alfentanil + propofol combo I recommend it. (The main thing I worried about being under was getting Versed rather than propofol--I've heard a lot of folks tend to react poorly to Versed.)

/glad I got it done, too--they did catch something precancerous, but it got snipped out like a mole about to go off
//yes, family history of Lynch syndrome (one of the hereditary colon cancer syndromes) means I get to get checked early and often, heheh
///srsly, get your arses checked out, folks

If you gaze into the abyss the also abyss gazes into you

Ok, here's the thing.

If you have to have one, you have to go through that grueling 18hrs of raw hell they call a 'cleansing' first. If you're healthy, it's misery, if you've chain-cast upper and lower gastritis for 6 times over the preceding two months, you want the anesthetic before you even get there.

The answer is yes.
If I've just cleaned out my colon so well I'm pretty sure that at least 6hrs of my life have been used standblasting the porcelain in my toilet clean, then yes, you are going to KNOCK ME THE FARK OUT FIRST.

Don't care how. Just do it.

Thanks.

404 page not found: r1niceboy: 404 page not found: r1niceboy: 404 page not found: r1niceboy: I've had a scope take a peek at my prostate. Any further and I'd be asking for some serious sleepytime.

Prostate?!? HA! You barely got the anoscope!

[www.hnmmedical.com image 500x453]

That looks like it. It felt bigger though.

That's what she said.

No, she never said that to me. Oh, you're in already? She said that. Once.

"Deeper! Give it to me deeper!"

No ma'am, that's my elbow.

ZuZu: As someone getting an endoscopy soon, I can say the only reason I am not freaking out is knowing they will be sedating me. I just got out of the hospital a few days ago and know I need to have this done so they can figure out what is wrong with me....but damn, the idea of having a camera rammed down my throat is terrifying.

I had one done a few years ago. No sedation. Just some throat spray to numb my throat and stop any gag reflex. It was bad, but not as bad as spending every day in excruciating pain.

mbowness: ZuZu: As someone getting an endoscopy soon, I can say the only reason I am not freaking out is knowing they will be sedating me. I just got out of the hospital a few days ago and know I need to have this done so they can figure out what is wrong with me....but damn, the idea of having a camera rammed down my throat is terrifying.

I had one done a few years ago. No sedation. Just some throat spray to numb my throat and stop any gag reflex. It was bad, but not as bad as spending every day in excruciating pain.

Wrong hole, fool.

Anesthesia is always a luxury. Appendectomies can be, and have been, performed without anesthetic.

To remove the appendix from an awake patient, tape him to the operating table. You'll need a lot of tape, enough for a continuous, solid coil from his shoulders to ankles, leaving a small gap at the lower abdomen. No hearing protection for the operating team, BTW, as they need to communicate clearly between the screams, but a thoughtful nurse will stuff a towel under the door to spare the folks outside.

Emergency cardiac surgery is sometimes performed without anesthetic. While you are recovering from coronary bypass surgery you may notice a bag of surgical instruments taped up near your bed. These are for opening your chest in the event that your graft dissects. This will be done on the spot, anesthesia or no, the instant the surgeon arrives; and in the latter case you may be treated to the sight of your beating heart.

Talk to the women in your family if you want to hear about the many ways pregnant women get their ladybits carved -- often without anesthetic, because of its potential effect on the fetus. Imagine having your scrote opened with a razor, the wound getting stretched wide, and the surgeon rummaging through the contents therein. All. Without. Anesthetic.

Hose to the butt? You can tough it out.

ShannonKW: Anesthesia is always a luxury. Appendectomies can be, and have been, performed without anesthetic.

To remove the appendix from an awake patient, tape him to the operating table. You'll need a lot of tape, enough for a continuous, solid coil from his shoulders to ankles, leaving a small gap at the lower abdomen. No hearing protection for the operating team, BTW, as they need to communicate clearly between the screams, but a thoughtful nurse will stuff a towel under the door to spare the folks outside.

Emergency cardiac surgery is sometimes performed without anesthetic. While you are recovering from coronary bypass surgery you may notice a bag of surgical instruments taped up near your bed. These are for opening your chest in the event that your graft dissects. This will be done on the spot, anesthesia or no, the instant the surgeon arrives; and in the latter case you may be treated to the sight of your beating heart.

Talk to the women in your family if you want to hear about the many ways pregnant women get their ladybits carved -- often without anesthetic, because of its potential effect on the fetus. Imagine having your scrote opened with a razor, the wound getting stretched wide, and the surgeon rummaging through the contents therein. All. Without. Anesthetic.

Hose to the butt? You can tough it out.

Or instead of using all that tape, just use a nice paralytic like Succinylcholine.

Women who are in labor and are in need of an episiotomy are typically anesthetized by a spinal epidural block. This is usually performed in the lumbosacral region of the spinal cord and everything below that is without sensation. An epidural isn't always done, but more often than not, it is.

404 page not found: rga184: 404 page not found: Mabman: When I had a colonoscopy in the fall of 2010 (in a hospital), they gave me a shot of fentanyl. All I heard the doctor say was "Great prep!" as they inserted the scope, and then I woke up afterward in the recovery area.

So, I'd say, yes, anesthesia makes it all so much easier. Given that I'll probably have to have one regularly (family history), I wouldn't want to go through it repeatedly awake.

Most likely you were given were given Fentanyl for pain and Midazolam for sedation (i.e., calms you down before the insertion of the Optimus camera). Midazolam also offers the benefit of a bit of anterograde amnesia, so that you won't remember all of it. Additionally, Naloxone (opiod-antagonist) and Flumazenil (benzodiazepine-antagonist) were on-hand in case you had a bad reaction to the Fentanyl and Midazolam and went into respiratory distress or arrest.

alfentanyl for the win. wears off faster after the procedure. and of course, a propofol drip. no versed, pt wakes up feeling good as new almost immediately.

An opiod that wears off faster FTW? I'm sorry, good farker, I do not follow. I would think that a patient would want the benzo to wear off quicker and the opiod to last longer. It's why Marcaine is often preferred over Lidocaine.

there's no pain after the procedure is done, so no need for something long acting. if there were an incision, then yes, something long acting would give the pt pain relief after the surgery from the pain.

the colonoscopy is uncomfortable while it's happening, but you don't need anything after it's done. the sooner the stuff is out of your system, the sooner you're up and about!

ShawnDoc: As someone who has been through a colonoscopy, let me just tell you the answer to that question. No it farking isn't a luxury, its damn well required. At least the way my doc kept ramming the end of that thing into my intestines.

When I had mine done, I was completely under. The only thing I remember is the doctor applying a large portion of lube to my chocolate starfish. By far, the worst part of a colonoscopy is the prep.

404 page not found:

Women who are in labor and are in need of an episiotomy are typically anesthetized by a spinal epidural block. This is usually performed in the lumbosacral region of the spinal cord and everything below that is without sensation. An epidural isn't always done, but more often than not, it is.

Yeah, lots of women claim they did "natural" childbirth but it only started out that way. I was there for all 3 of my little Bad Apples births (and the conceptions too) and Mrs Bad Apple was higher than a giraffe's ass as soon as the first REAL contraction hit. Unless she gave birth someplace besides a hospital she was given pain meds, early and and generously.



/I liked the way the epiziotomy stitches tickle too

404 page not found: libranoelrose: This headline is funny.

SHOP IT!

ZuZu: As someone getting an endoscopy soon, I can say the only reason I am not freaking out is knowing they will be sedating me.

I've had several done over the years ranging from full sedation to almost none. My first one was done while in the Army and all they gave you was a little injection of some sedative. I was gagging so hard that I ended up breaking blood vessels in my face. In the civilian world, they were better about the sedation but you were still awake enough to know what was going on. For my most recent few, I've been completely knocked out. The part I don't like is the stuff they make you gargle to numb your throat. It gives me the sensation that my throat is closing up and that I can't breathe. Luckily it only lasts for a few seconds because they hit you with the knockout juice just afterwards.

ShannonKW: Hose to the butt? You can tough it out.

Not without someone at least buying me dinner first...

404 page not found: Or instead of using all that tape, just use a nice paralytic like Succinylcholine.

Women who are in labor and are in need of an episiotomy are typically anesthetized by a spinal epidural block. This is usually performed in the lumbosacral region of the spinal cord and everything below that is without sensation. An epidural isn't always done, but more often than not, it is.

When those fine things are available, yes. When they aren't, it's not like you can always wait for them.

The awake appendectomy is described by Richard Selzer, who apparently performed them during the Korean War. For obvious reasons, one supposes a nice paralytic like Succinylcholine wasn't always on hand.

Many places lack the facilities to do a spinal block, but the show goes on without it. I have a lingering, unsavory memory of a mud-daubed Punjabi delivery room that lacked the technological innovation of window panes.

The point is, the need to get a good outcome generally trumps comfort. Of course, we prefer to have both when we can, but that doesn't change the fact that comfort is optional; good outcomes, much less so.